What’s the Difference Between MD/DOs, NPs, and PAs?


When you get sick or need a checkup, you probably make an appointment to go see a doctor. But sometimes, the “doctor” you see isn’t really a doctor at all. 

If you go to your neighborhood clinic or an urgent care clinic, for example, you may be seeing a Nurse Practitioner (NP) or a Physician’s Assistant (PA) instead of a fully licensed doctor.

That isn’t to say NPs or PAs are not skilled or capable. In general, they serve a vital function within the healthcare industry and can help patients receive safe and timely care. However, an NP or PA is not going to be a good fit for all patients and all situations. And it’s not always easy for patients to navigate a sea of acronyms–or fully understand the qualifications of the healthcare professional you are seeing.

Questions You Might Ask

It’s not always important for patients to fully understand the difference between a PA and an MD/DO, for example. But that’s not the case for everybody. And there are some times when it’s in a patient’s interest to understand whether you are seeking treatment from a licensed physician or not. If you make an appointment to see a doctor but an NP or PA shows up instead, here are some questions you can ask to make sure you feel you’re getting the care you need.

What’s the Difference in Education and Training Between a PA, NP, and MD/DO?

Healthcare is a high-stakes profession. It’s also very complicated. As a result, there is a strong emphasis on training. Here is how training breaks down between an NP, PA, and MD/DO.

  • Nurse Practitioner (6-8 year post-high school education): 500 hours in the classroom, 500-700 hours in the clinic, 1-2 year optional residency.
  • Physician Assistant (6-7 year post-high school education): 1000 hours in the classroom, 2000 in the clinic, and a 1-2 year optional residency.
  • Medical Doctor: (11 years post-high school education minimum): 4 years college, 4 years medical school, 3 years residency minimum. 

As you can see, medical doctors tend to receive significantly more education and hands-on learning time–at least within a structured learning environment. A doctor of nurse practitioners (as you may sometimes encounter) is not equivalent to a medical doctor. It would be more accurate to equate a doctor of nurse practitioners to a PhD than an MD/DO. Their area of expertise is nursing (which is not necessarily the same type of expertise as you would find in an MD/DO).

What’s more, the topics that are in each degree program are sometimes the same (ex: anatomy and physiology) and sometimes different (ex: chemistry and pharmacology). Generally speaking, a medical doctor’s training is deeper in most topics, meaning they’re equipped to have a deeper understanding of the ins and outs of patients’ problems.

NPs and PAs Are Supposed To Be Supervised. Is Yours?

In theory, one of the reasons that Nurse Practitioners and Physician Assistants do not need as much formalized education and training is because they will be supervised by physicians on site. This way, if there are any questions or concerns (or something a PA or NP can’t handle), the PA or NP would be able to go ask the doctor for an opinion.

Regulations for supervision vary by state–and, unfortunately, some states are more lax than others. In Illinois, one physician can supervise only up to two Physician Assistants. And every Nurse Practitioner must be supervised by a licensed physician as well. But the reality is that many NPs and PAs diagnose patients and make treatment decisions every day that physicians review only much later.

There are also some limitations on what a PA or NP can do for patients. For example, an NP can only prescribe 30-day supplies of many medications.

Is the Doctor in the Room with an NP or PA?

The short answer is no. In most states, the licensed doctor must only be available for consultation. Which means, in many cases, doctors may not even be on site during your appointment. 

What We Think About NPs and PAs

We know that NPs and PAs are here to stay. That’s because NPs and PAs offer practices a way to keep up with the number of patients that the doctors on staff can’t get to. It’s also true that those practices can bill insurance at the same rate whether you’re seen by an MD/DO, NP, or PA (In this way, they also represent some of the ways in which the health insurance model has warped the delivery of medical care.) We’ll let you come to your own conclusion about this.

But we also think it’s important that patients are able to make informed decisions. When you make an appointment to see an MD/DO but a PA or NP shows up instead, we think you should know the difference so you can be in the driver’s seat of your own care.

At Progressive Health Primary Care, we believe in having as little separation as possible between your doctor and your care. (This is why we also work hard to keep insurance out of your care decisions.) As a result, we do not use PAs or NPs. A doctor who is treating your routine wellness needs or primary care will simply have more expertise, more experience, and more options when it comes to delivering the care you need.

See a Primary Care Doctor Today

It’s important to have a doctor you like, who you can communicate with, and who will offer you sound medical expertise. If you want to make an appointment to take care of your primary care needs–without insurance getting in the way–contact Progressive Health today!