Many of us say we’re “going to the doctor” whenever we have a medical appointment. But are you actually seeing a doctor each time you step foot in an exam room or log on for a video visit? And if not — does it matter?

In a primary care setting, you might meet with a physician (an MD or a DO), or you could see a nurse practitioner (NP) or physician assistant (PA). Each type of provider can specialize in primary care, diagnose and treat illnesses and write prescriptions, but there are differences in their training and the ways they practice.

We talked with experts to help break down each specialty and understand the different roles providers play in primary care.

The doctor will see you now: MDs and DOs

There are two types of medical degrees for doctors: An MD (doctor of medicine) and DO (doctor of osteopathic medicine). The term “physician” can apply to either one. 

Many of us are familiar with the MD designation, which means a doctor is trained in traditional Western medicine, also known as “allopathic” medicine. To earn an MD, a physician must complete a four-year medical school program that focuses primarily on disease diagnosis and treatment, says Dr. Douglas L. Ambler, an internal medicine physician at Northwestern Medicine Regional Medical Group in Wheaton, Illinois.

DOs also spend four years in med school, but their programs emphasize a holistic approach to medicine that includes evaluating a patient’s lifestyle and environment in addition to their symptoms. DOs are also trained in hands-on manipulative treatment to diagnose and treat various conditions (this is sometimes compared to chiropractic treatment, but DOs and chiropractors are  not the same).

“During medical school, doctors of osteopathy receive focused training in the musculoskeletal system,” which prepares them to perform manipulative treatment, says Dr. Ada Stewart (an MD), American Academy of Family Physicians.

Only about one-quarter of medical students in the US train to become DOs, according to the American Medical Association, but the American Osteopathic Association reports that the number of osteopathic physicians is on the rise and even reaching record numbers. DOs are also more likely to practice in primary care than MDs: Fifty-seven percent of DOs are primary care providers, compared to less than 30 percent of MDs.

After medical school, the paths for MDs and DOs converge. Both have to meet the same residency requirements, which entail between three and seven years of clinical experience and vary by specialty.

So from a patient’s perspective, does it matter whether a PCP has an “MD” or “DO” after their name?

“I don’t think in this day and age it makes a whole lot of difference,” Ambler says, “The residency training programs are essentially going to be exactly the same.”

Non-physician providers: NPS and PAs

Physician assistants (PAs) and nurse practitioners (NPs) also commonly work in primary care.

There are “likely more similarities than differences between PAs and NPs” in practice, according to the American Academy of PAs, but one difference is their training. PAs study general medicine; NPs select a population focus, such as women’s health or pediatric care, and that population focus drives their training. Nearly 90 percent of NPs are certified in an area of primary care, according to the American Association of Nurse Practitioners.

“The nurse practitioner training … looks at the patient as a whole,” says Mariea Snell, assistant director of the Online Doctor of Nursing Practice program at Maryville University in St. Louis. “We are trained under a nursing model of care, which is a more holistic approach. PAs are trained under a medical model which focuses on disease and disease processes.”

The average PA student receives about three academic years of medical training, including more than 2,000 hours of clinical rotations, according to the AAPA. No matter what, PAs must be supervised by a physician in order to practice.

Nurse practitioners are Registered Nurses that go on to earn either a master’s or doctoral degree in nursing. Specific licensure requirements vary by state for NPs (and for PAs). In some states, NPs have full practice authority, which means they can practice independently. In other states, they must practice under a written agreement with a physician, similar to PAs.

You’ll sometimes see PAs and NPs referred to as “midlevel providers.” But that term is “very offensive,” Snell says.

“We are all providers of care. It’s not ‘one is better than the other,’ ” she says. Snell recommends using the term “provider” to describe all primary care providers, including MDs, DOs, PAs and NPs.

A team approach

In many primary care practices, teams of providers including MDs, DOs, NPs and PAs work together. 

In Ambler’s office, for example, he works closely with PAs to care for his patients..

“[PAs] are almost like an extension of the physician they’re working under in that practice,” he says. “While seeing a patient of mine, they may grab me and say, ‘Hey, I’m seeing Mrs. Smith right now, what do you think I should do?’ ”

NPs also work in primary care offices alongside physicians or run their own independent practices in states with full practice authority.

Patients can also specifically request a non-physician provider for primary care.

“Some patients will select a PA as their PCP just because they might have seen this physician assistant a number of times, develop a relationship, and rather than seeing an MD they might have more access and ability to see the PA,” Ambler says.

However, you may not be able to officially designate a PA or NP as your PCP on your paperwork, Ambler says — it depends on your clinic’s practices, your insurance provider’s requirements and state regulations.

But as far as patients are concerned, “it becomes kind of a moot point,” Ambler says. “Basically, the PA will function as the PCP,” even if you have a physician listed as your official PCP.”

The debate over independence for PAs and NPs

There have been calls from PAs and NPs to loosen restrictions on both groups so they can practice independently, especially with the US facing a critical shortage of primary care physicians and fewer medical students specializing in primary care.

Proponents of full practice authority for NPs, for example, argue that allowing NPs to practice independently helps extend care into rural and underserved areas.

“In areas where you can have independent practice, you have all of these NPs that can come in,” Snell says. “It is a great way to bridge that gap in access to care.”

On the other hand, states with licensure laws requiring physician oversight for NPs “limit NPs’ ability to provide the care they are educated and nationally certified to provide,” says Sophia L. Thomas, president of the American Association of Nurse Practitioners.

Thomas says there are no studies that show requiring NPs to maintain written agreements with physicians improves outcomes for patients, but critics of increased independence for PAs and NPs argue that patients prefer to be treated by physicians, and that non-physician providers practice mostly in densely populated areas — not underserved communities. 

Some physicians also point out that the education and residency requirements for MDs and DOs are more rigorous than requirements for NPs and PAs.

“Patients oftentimes don’t come into doctor offices with straightforward, simple textbook presentations of a disease process,” Ambler says. “That’s where the extra training of a physician of an MD/DO really comes in handy to be able to decipher some of the nuances.” 

How should you choose?

When you’re selecting a provider, the letters after their name can provide helpful information about their training, but that doesn’t mean one type of provider is more qualified than another. You should also consider the provider’s area of expertise.

Snell, for example, has a background in infectious diseases and HIV. In one practice where she worked as an NP, “all of the physicians with an HIV-positive patient would send them to me,” she says. “Even though they had more advanced medical training in theory than I did …  the practice trusted me with those patients.”

Some patients remain skeptical of providers that lack “MD” after their name, Snell says, but in primary care, NPs and DOs are just as qualified to care for patients.

“There are always going to be people who feel that way because they just don’t understand the training and what the NP or PA can provide,” Snell says. But “I think it’s shifting quite a bit … I’ve seen a lot of people starting to say they would prefer to see the NP because of the holistic care they provide. Most of my patients that I have in primary care refuse to see anybody else.”

It’s also important to choose a primary care provider you connect with on a personal level.

“Are you able to develop an easy line of communication and trust with this person?” Ambler says. “You could have the smartest physician in the world, but if you have no connection, you might not have as good of a working relationship.”

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