Choosing Between Doctors, Nurse Practitioners, and Physician Assistants

How to Choose the Right Medical Provider for You

doctor nurse practitioner physician assistant
Who makes up your health care team?. Thomas Barwick/Stone/Getty Images

Do not let the scrubs fool you. The health care provider ordering your tests and medication could be a doctor, a physician assistant or a nurse practitioner. Does it make a difference? It does for Medicare.

The government does not allow just any provider to participate in the Medicare program. Providers must meet certain qualifications in addition to signing a contract with the government, agreeing to certain rules and regulations.

What You Need to Know About Doctors 

A physician can be trained in either an American or a foreign medical school. Medical schools may be allopathic or osteopathic in their focus. In the former case, the physician graduated as a medical doctor, an MD; in the latter, a doctor of osteopathy, a DO. 

In order to practice in the United States, medical school graduates must complete a U.S. residency training program in their primary care field of choice (family medicine, internal medicine or obstetrics/gynecology) or a medical specialty. Altogether, the average physician trains for a minimum of eleven years (four years in an undergraduate college, four years in a medical school, three or more years in a residency training program) to earn the privilege to care for you.

Completion of training alone is not enough to be recognized in Medicare's eyes. A physician must also apply and meet criteria for a license in each state he wishes to practice and must also be board-certified in his field.

What You Need to Know About Nurse Practitioners

A nurse practitioner also undergoes extensive training and often has a similar scope of practice to a doctor. They spend six to eight years in training beyond high school. Similar to physicians, they are required to be certified in their field and must be licensed in the states they practice.

Many states require that a nurse practitioner be supervised by a physician. The 17 states that allow these providers to practice autonomously and without supervision are AK, AZ, CO, HI, IA, ID, ME, MT, NV, ND, NH, NM, OR, RI, VT, WA and WY.

Beyond providing medical care, some states also limit a nurse practitioner's ability to prescribe medications, especially when it come to controlled substances. U.S. states that pose limitations are AL, AR, FL, GA, LA, MO, OK, SC, TX and WV. U.S. territories include Puerto Rico and the Virgin Islands.

Nurse practitioners remain an excellent resource for care but if you are in hospice, your terminal illness must first be diagnosed by a physician. If you choose to be cared for by a nurse practitioner while you are in hospice, that practitioner will need to work side by side with a doctor for Medicare to pay.

What You Need to Know About Physician Assistants

Physician assistants can also be primary care providers and specialty clinicians. They average training over five to six years after high school and also require licensing and certification.

Unlike nurse practitioners, physician assistant always requires supervision by a physician. More states restrict prescription management by physician assistants than nurse practitioners. U.S. states and territories that pose limitations on prescription management are AL, AR, AZ, FL, GA, HI, KY, LA, ME, MO, MT, OK, Puerto Rico, SC, TX, the U.S. Virgin Islands and WV.

Medicare has rules in place that prohibit physician assistants from acting as primary care providers for hospice patients.  

How Payment Works

Nurse practitioners and physician assistants are paid less by Medicare even though you are billed exactly the same. A nurse practitioner will be paid 80 percent of what a doctor would be paid if they are unsupervised by a physician or 85 percent if they are supervised. Physician assistants are paid 85 percent since they always require supervision.

Physicians can charge you what Medicare recommends if they accept assignment or they can charge you more up to a certain amount known. Finding a doctor who accepts assignment can help you to get free preventive screening tests.

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