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Getting an appointment with a primary care physician (PCP) can take weeks. That's because we're facing a shortage of PCPs, due in part to medical students flocking to higher-paying specialist fields. (A University of Missouri study suggests the country could have up to 44,000 fewer PCPs by 2025.) Fortunately, there are alternatives: Physician assistants, nurse practitioners, and hospitalists who can fill in for PCPs. Here's a guide.
Physician Assistant (PA)
What it is: A licensed clinician who has completed at least a two-year accredited program—think of a truncated MD education—and practices under the supervision of a physician. PAs are not required to complete internships or residencies; many focus their studies on primary care medicine.
The reason: The PA role began in the mid-1960s in response to a shortage of PCPs in underserved and rural areas. One doctor's office can employ several physician assistants to act as principal care providers, per the guidance of the supervising physician.
The benefit: Physician assistants are often available for appointments when physicians aren't, and you won't be sacrificing quality of care, suggests a recent Duke University study. This care can include conducting physical exams, diagnosing and treating illnesses, ordering and interpreting tests, counseling on preventive care, writing prescriptions, and assisting in surgery.
Where to find one: At a doctor's office: About 35 percent of PAs work in primary care, the rest in medical and surgical specialties, according to the American Academy of Physicians Assistants. There are almost 74,000 PAs today, compared with 240 in 1970. The U.S. Bureau of Labor Statistics estimates that the number of PA jobs will increase by 27 percent between 2006 and 2016.
Nurse Practitioner (NP)
What it is: A registered nurse who has also completed graduate-level medical education. For most, this has meant getting a master's degree, but more and more NPs are advancing to a Doctor of Nursing Practice, which can take two to four more years of study.
The reason: Like PAs, nurse practitioners helped fill the PCP shortage in the mid-'60s. NPs can function as primary care providers, no supervision required, says Mary Jo Goolsby, EdD, director of research and education at the American Academy of Nurse Practitioners.
The benefit: Studies have found that NPs can provide care that matches and at times improves on that of doctors while still being cost-effective: NPs emphasize prevention and spend an average of 21 minutes with a patient, longer than a typical doctor visit, says Goolsby. "We're not using a shotgun approach and ordering unnecessary tests. We focus on the patient and help her learn to take care of herself, so she may avoid future complications."
Where to find one: Check your local directory or visit NPFinder.com, a service provided by the American Academy of Nurse Practitioners. About 67 percent of NPs are in primary care, and they may work independently or in collaboration with a physician, depending on state regulations. The field is rapidly growing: There are more than 125,000 NPs today, 44 years after the first NP program was developed in 1965.
What it is: A physician who manages a patient's care in the hospital until she has been discharged. Most hospitalists have a Doctor of Medicine or a Doctor of Osteopathic Medicine degree; the majority are trained in internal medicine or pediatrics.
The reason: A hospitalist makes it unnecessary for a PCP to visit hospitalized patients, says Patrick Cawley, MD, president of the Society of Hospital Medicine. It also means a hospital patient will have an in-house point person to oversee the care she receives from nurses, surgeons, and specialists.
The benefit: Hospitalists are available around the clock, and are intimately familiar with the hospital environment. This can translate to a reduction in length of stay—and expense—by an average of 15 percent. And research shows that hospitalists provide a standard of care that matches or surpasses that provided by PCPs. In fact, a few studies indicate lower mortality and readmission rates in hospitalist programs.
Where to find one: Once you've checked in to a hospital, they'll come to you. (You can call local facilities to see if they employ these doctors.) Hospitalists monitor and coordinate all aspects of your care—about the only thing they don't do is perform surgery. According to a recent study, this is the fastest-growing medical specialty in U.S. history; more than 22,000 are practicing today.
From the March 2009 issue of O, The Oprah Magazine
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