If you were to take a picture of some–body in a pair of scrubs and a white coat and a stethoscope, you don’t know if it’s a doctor or a nurse practitioner or a physician assistant,” says Julie Waitkoss Raaum, a nurse practitioner at Froedtert Hospital.
As medical fields have specialized, collaboration between medical professionals has become essential. Plus, it isn’t practical to only see a doctor. That would be more expensive, have longer wait times and could lead to insufficient treatment, says Gina Dennik-Champion, CEO of the Wisconsin Nurses Association. “Every patient deserves a team. No one practices in a silo anymore.”
But what differences are there between the three primary medical pros: nurse practitioners, physician assistants and MDs?
Starting with similarities: they’re all well-educated. Every physician assistant (PA) and nurse practitioner (NP) must have a master’s degree or higher, and they both must pass their respective national certification exams. Doctors, predictably, have the most freedom to treat maladies thanks to their 12-or-so years of postsecondary education.
A physician assistant’s responsibilities are confined by two things: their own training and their supervising doctor’s discretion.
“Any medical act can be delegated” from an MD to a PA, Raaum says, so long as the PA is trained in that act. For typical clinic visits, a PA’s responsibilities are usually tasks like physical exams, injections, office-based procedures and interpreting diagnostic tests.
The rules surrounding nurse practitioners are grayer – and, in Wisconsin, a little more restrictive than federal law.
Some states – although not Wisconsin – allow NPs to be primary care providers. In Wisconsin, besides being able to do everything PAs can, NPs can order drug prescriptions more freely than PAs. They can also open up private practices, so long as they have a written agreement with a physician. PAs can’t do that.
Right now, doctors can have no more than four PAs under their supervision at any one time, a sometimes rather restrictive ratio.
But that could be changing. A piece of legislation in Madison aims to address medical professional shortages by getting rid of that 4:1 ratio and allowing PAs in Wisconsin to operate more independently. The proposed change is inspired by several other states – including Michigan – granting more freedom to PAs.
If enacted, PAs would be allowed to work “in collaboration” with doctors, rather than only under a doctor’s “supervision,” Raaum explains, giving them autonomy closer to that of NPs.
Supporters say PAs occasionally aren’t allowed to do something they’re skilled at simply because it isn’t within their supervising doctor’s purview. For example, some doctors have never been trained to inject joints. And even if one of their PAs has experience doing just that, they won’t be able to because of their supervisor’s limitations. Opponents of the bill, like the New York-based Physicians for Patient Protection, say it’s irresponsible because PAs “have 15 percent of the training of a primary care doctor.”
The bill reached committees in February before being tabled.