Alphabet Soup

What the Letters Behind Your Provider’s Name Stand For

“Someone will be in to see you in a moment,” the nurse says as she walks you to the exam room at your primary care office. But who will that someone be?

Currently, there’s an evolution in care providers that include more people than just your traditional M.D. There are nurse practitioners, who have a master’s degree in addition to being a registered nurse, there are physician assistants, who partner with a physician to provide care, and you might see a doctor who is not an M.D., but a D.O., or doctor of osteopathy. Here’s what each of those mean:

NP: Nurse practitioners have grown in popularity as health care providers, with nearly 200,000 in the United States in 2011, including more than 6,000 in Virginia. They are also known as “advance practice nurses” due to their additional education.

The American Association of Nurse Practitioners notes that NPs are already the health care providers of choice for millions of patients. People can choose to see a nurse practitioner as their primary provider. They assess patients, order and interpret diagnostic tests, make diagnoses, and initiate and manage treatment plans—including prescribing medications.

PA: A physician assistant is not the executive assistant of the doctor, nor a doctor in training. “People always ask ‘How long until you become a doctor?’” says Rochelle Hamilton, a PA with Hampton Family Practice in Hampton, Va. Although a PA is similar in function to a nurse practitioner, the educational path is different. Hamilton has a bachelor’s in health science and master’s in physician assistant studies, including a year of clinical rotations.

The PA model started in the military and is more common in rural areas. A PA sees patients for physicals, preventive care, chronic conditions and acute illnesses. They can prescribe medicine, make referrals, order tests and send people to the emergency room, if needed. But an important thing to note is that they are part of a team that includes a doctor and other medical staff. With Hamilton and her supervising physician, she knows that she can consult with him on any cases or even request that he come see them as well. “I go to him for things I deem necessary and he trusts that I know my limitations,” she says.

Nurse practitioners and physician assistants can do many of the tasks of a physician, but the physician is the leader of the practice, and often the administrative head. NPs and PAs do not perform surgery or any specialized medicine. The roles of both types of “mid-level practitioners” continue to evolve, though, due to less doctor availability.

DO: There are two types of fully-qualified physicians in the U.S.—D.O.’s and M.D.’s—both of whom are licensed to prescribe medication and perform surgery. In many ways, they are similar, completing the same number of years of education, residencies and specialty training and licensing. A D.O. may have attended an osteopathic medical school or a traditional medical college with other M.D.’s.

“Many people don’t even know that they are seeing a D.O. because we fill the same roles in primary care. They may not notice the different letters at the end of our names. But many people who are familiar with D.O.’s seek them out to benefit from their additional training,” says Phillip Snider, a D.O. with Bon Secours Amelia Medical Associates in Norfolk, Va.

Snider says that his desire to become a D.O. came from his background in personal training and dietetics. The difference is that osteopathic medicine, a parallel branch of American medicine, has a distinct philosophy and approach to patient care. They focus on integrated medicine and receive extra training in the musculoskeletal system in order to use osteopathic manipulative treatment, a hands-on technique. According to the American Osteopathic Association, approximately 60 percent of practicing osteopathic physicians practice in the primary care specialties.

Many health care professionals feel that the expected primary care doctor shortage could be helped by expanding the role of nurse practitioners and physician assistant roles. But the licensing requirements in each state, the physician professional groups and the general public’s preferences may all play a role in who opens the door to see you at your next visit.

About the author

Natalie Miller Moore

Natalie runs Moore than Words, a health communications consulting firm in Williamsburg. She loves to learn and write about health, particularly relating to patient experience and research.