Physicians and nonphysicians: What are the differences?

Nonphysician providers such as nurse practitioners and physician assistants are an essential part of the physician-led care team and can help health care organizations and physician practices deliver high-quality care.

But it is easier than ever for patients and the public to get confused about who does what in health care, and mixed up about what distinguishes the training and skill of physicians from those of other health professionals.

That is especially the case given the relentless efforts to expand the scope of practice for nonphysician providers, which has been dubbed scope creep. Such legislative or regulatory changes would inappropriately permit nonphysician providers to deliver care without doctor supervision, prescribe medications to patients, or even perform surgery—all without attending medical school and despite data that shows such scope expansions can increase patient safety risks and health care costs. 

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Physicians are trained to lead, and the AMA stands in strong support of physician-led health care teams. More than 90% of patients say that a physician’s years of education and training are vital to optimal patient care, especially in the event of a complication or medical emergency. Patients also deserve to know who is providing their health care and the education and training of their health care professional. 

The AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety. To help set the record straight, the AMA is publishing a series of news articles outlining the key differences between various types of physician specialists and nonphysician providers.

1. Physicians and nurses practitioners

   1. Nurse-practitioner (NP) programs generally last two to four years, however, some nurse practitioners can get their degree in as little as 18 months after becoming an RN. Online-only programs are allowed. Physicians, by contrast, must complete four years of medical school to earn a degree as an MD (a doctor of medicine) or a DO (doctor of osteopathic medicine). There are no online medical schools.
   2. Meanwhile, nurse practitioners have no residency training requirement, whereas physicians must complete three to seven years of residency and fellowship training depending on which specialty they pursue. Nurse practitioners will tally just 500–750 patient-care hours in training. By comparison, physicians get between 12,000 and 16,000 hours of patient-care experience.

2. Physician assistants and physicians

   1. Physician assistant (PA) programs usually run about two years long, or perhaps two and a half. In addition, physician assistants have no residency-training requirement. Compare that with physicians’ training, which includes four years at a medical school—none of which are online-only—along with three to seven years of residency and fellowship training, depending on the physician specialty they pursue.

3. Optometrists and ophthalmologists

   1. All optometrists have completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (OD) degree. Some also complete an optional residency in a specific area of practice, but there is no mandatory postgraduate training in optometry.
   2. By contrast, ophthalmologists are physicians—either medical doctors, MDs, or doctors of osteopathic medicine, DOs—whose education and training consists of pre-professional undergraduate education in a college or university, four years of medical school, four years of residency training, and about 40% of ophthalmology residents go on to do an additional one- or two-year fellowship in a subspecialty.
   3. In addition, whereas optometrists receive about one-year in clinical rotations, ophthalmologists get more than 12,000–16,000 hours during their training.

4. Psychiatrists and psychologists

   1. Doctors of psychology and doctors of philosophy in psychology—who earn PsyD degrees and PhDs, respectively—get four to six years of graduate-level education plus a one-year internship. Moreover, psychologists complete a one-year internship while psychiatrists (MDs, DOs) get between 12,000 and 16,000 hours of patient care during their four- to six-year residency program. That only comes after completing four years of medical school.
   2. More important even than years of training, however, is the nature of the education these two types of health professionals get. The core issue is that, while psychologists may be well-equipped behavioral experts, their educational requirements include zero training in medicine. While psychologists provide care for emotional and behavioral issues, they are not equipped to provide the medical care psychiatrists provide.

5. Physicians and pharmacists

   1. Pharmacists get four years of postgraduate education, which includes 1,740 hours of clinical training. They have no residency requirement. By contrast, physicians get four years of post-graduate education in medical school, plus three to seven years of residency training. Included in this is some 12,000–16,000 hours of clinical training—which is, about seven times as much as what pharmacists get.
   2. In addition, physician education includes performing differential diagnoses, treating patients for a broad range of illnesses and diseases, and caring for patients during each phase of the lifecycle. Pharmacist training does not include making a diagnosis, being exposed to patients with any specific medical conditions or even conducting a comprehensive physical examination.

6. Anesthesiologists and certified registered nurse anesthetists (CRNAs)

   1. Nurse anesthetist programs run two to three years and typically require completion of one-year as a critical care nurse prior to admission. Nurse anesthetists complete around 2,500 hours of clinical training but are not required to complete a residency.
   2. By contrast, anesthesiologists are physicians who complete four years of medical school followed by four years of residency and often another one to two years of fellowship to study and become certified in a subspecialty, such as pain management, cardiac anesthesia, pediatric anesthesia, neuroanesthesia, obstetric anesthesia or critical care medicine. This adds up to between eight and 10 years of post-graduate education. In addition,  an anesthesiologist will get 12,000–16,000 patient-care hours—about five to seven times more than a nurse anesthetist.

7. Physicians and naturopaths

   1. Naturopaths are educated on the basic sciences and complementary and alternative treatment modalities, focusing on “body, mind and spirit,” according to the Association of Accredited Naturopathic Medical Colleges. Naturopaths also focus on “the body’s natural ability to heal itself,” the association’s website says.
   2. Postgraduate training is neither common nor required of graduates of naturopathic schools, except in Utah, which requires one year. Some naturopathic students may choose to shadow or practice with an experienced naturopath before setting up their own practice, while others may choose residencies. Medical literature indicates that less than 10% of naturopaths participate in an approved residency, and such residencies last only a year and lack a high degree of standardization.
   3. Unlike the standards for family medicine residencies, the Council on Naturopathic Medical Education standards for naturopathic residencies do not require that naturopathic residents treat patients across the lifespan, with any particular health condition, or in different health care settings—including hospitalized patients.
   4. Compare this with physicians—either doctors of medicine (MDs) or doctors of osteopathic medicine (DOs)—who complete four years of medical school where they get a comprehensive education rooted in evidence-based medicine. This is followed by a minimum of three and as many as seven years of residency. In addition, whereas naturopaths are required to get at least 1,200 hours of direct patient contact, physicians get 12,000–16,000 hours of clinical training—at least 10 times more than that minimum.

Patients deserve care led by physicians—the most highly educated, trained and skilled health professionals. The AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety.