Today we see many different types of doctors.   A doctor may, for example, be a physician, psychologist, biomedical scientist, dentist, or veterinarian.  Some doctors are specialists who treat very specific areas of the body (i.e. oncologists, neurologists, and podiatrists) and other doctors treat the entire person (doctors of osteopathy), and primary care doctors.  The healthcare providers you see in your family practice often have different designations too.  We are going to discuss four medical designations – Medical Doctors (MD), Doctor of Osteopathy (DO), Physician Assistants (PA) and Nurse Practitioners (NP).

Differences between MDs and DOs

A Medical Doctor or Doctor of Medicine (MD) is a person who has 4 years of undergraduate study at a college or university and has also completed 4 years of medical school (some cases 3 years) and a residency which last from 2 to 6 years. 

A Doctor of Osteopathy (DO) is very similar to a MD and has the same educational requirements plus the extra training in musculoskeletal system.  Osteopathy is a system of therapy (founded in the 19th century) based on the concept that the body can formulate its own remedies against diseases when it is in a normal structural relationship, has a normal environment and enjoys good nutrition.    

• Applicants to both DO and MD colleges typically have a four-year undergraduate degree with an emphasis on science courses.
• Both DOs and MDs complete four years of basic medical education.
• After medical school, both DOs and MDs can choose to practice in a specialty area of medicine—such as psychiatry, surgery, obstetrics, or sports medicine—after completing a residency program (typically two to six years of additional training).
• Both DOs and MDs must pass comparable state licensing examinations.
• DOs and MDs both practice in fully accredited and licensed hospitals and medical centers.
• Both are medical doctors; MD is specifically Doctor of Medicine and DO is Doctor of Osteopathic Medicine.

Differences:

• DOs can perform surgery, child delivery, treat patients, and prescribe medications in hospitals and clinic settings.
• DOs look at the "total person." Osteopathic physicians focus on preventive care. Instead of just treating specific symptoms or illnesses, they look at the whole body.
• DOs receive extra training in the musculoskeletal system, which is comprised of the nerves, muscles, and bones. This training gives DOs a better understanding of how an injury or illness in one part of the body can affect another part of the body; therefore, DOs have a therapeutic and diagnostic advantage.
• DOs use what is called osteopathic manipulative treatment (OMT). OMT is a technique in which the DOs use their hands to diagnose injury and illness, giving special attention to the joints, bones, muscles, and nerves. Manipulations improve circulation, which in turn, creates a normal nerve and blood supply, enabling the body to heal itself.
  

Differences between PAs and NPs

Physician Assistants and Nurse Practitioners are also considered “healthcare providers” working under the supervision of a doctor.  Many times, PAs and NPs are the primary care provider who interfaces with parents.

A Physician Assistant or PA is a mid-level medical practitioner who works under the supervision of a MD or DO.  A Physician Assistant must have at least an undergraduate degree before attending PA school and the current trend has been to obtain a master’s degree.   

The Physician Assistant came about in the 1960’s as a response to the need for more clinicians due to the shortage of family physicians, especially in rural and medically underserved communities that were often economically deprived as well.  During the last 10 years, however, the duties of a PA have expanded to include the care of hospitalized patients.  PA training programs are accredited by the National Commission on Certification of Physician Assistants. Each state in the U.S. has its own specific licensing and practicing restrictions for PAs.  Most states require PAs to pass the certification examination of the National Commission on Certification of Physician Assistants.  By law, PAs may perform medical services, but only when supervised by a physician and only when such acts and duties are within the scope of practice of the supervising physician.

A Nurse Practitioner or NP is a registered nurse (RN) who has completed advanced education (a minimum of a master's degree) and training in the diagnosis and management of common medical conditions, including chronic illnesses.  Nurse practitioners provide a broad range of health care services.  They provide some of the same care provided by physicians and maintain close working relationships with physicians.  An NP can serve as a patient's regular health care provider.

Nurse practitioners see patients of all ages.  The core philosophy of the field is individualized care.  Nurse practitioners focus on patients' conditions as well as the effects of illness on the lives of the patients and their families.  NPs make prevention, wellness, and patient education priorities.  This can mean fewer prescriptions and less expensive treatments. Informing patients about their health care and encouraging them to participate in decisions are central to the care provided by NPs.  In addition to health care services, NPs conduct research and are often active in patient advocacy activities.

Here are some relevant duties in which a PA and a NP focus their energy on.  As you can see some of their duties are very similar.

• Medical histories and physical examinations: a PA usually can perform histories and physical examinations that do not go beyond a particular level.
• Laboratory tests: a PA can order any test which he or she is competent to interpret and provide the appropriate treatment. While an NP can order, perform, and interpret diagnostic studies (e.g., lab tests, x-rays, EKGs)
• Collaborating with physicians and other health professionals as needed, including providing referrals
• Counseling and educating patients on health behaviors, self-care skills, and treatment options
• Diagnosing and treating acute illnesses, infections, and injuries
• Diagnosing, treating, and monitoring chronic diseases (e.g., diabetes, high blood pressure)
• Prescribing medications (in most states)
• Prescribing physical therapy and other rehabilitation treatments
• Providing prenatal care and family planning services
• Providing well-child care, including screening and immunizations
• Providing health maintenance care for adults, including annual physicals
  
  

Nurse Practitioners and Physician Assistants practice under supervision of a Medical Doctor or a Doctor of Osteopathy.  Each of the four physicians discussed have their place in our medical community.   All provide quality total body care.