By Katie E. Golden, MD

Any patient who comes to the ER is going to meet a steady stream of new people throughout the course of their stay.

Before a patient even gets into a room, they are greeted and evaluated by triage nurses and registration staff, and it only gets more confusing from there. Our team-oriented approach means that each patient will be cared for by medical technicians, licensed paramedics, multiple nurses, and ultimately evaluated by a clinician that could be a doctor, physician assistant, or nurse practitioner. It can be hard to keep all the faces and credentials straight, and can even be confusing as each member of the staff has their own unique expertise and approach to patient assessment.


Patients often wonder what the difference is between these different levels of training, so today we are going to briefly explain what those two letters mean behind your clinician’s name.


Advanced Practice Providers (PAs and NPs)


Physician Assistants (PAs) and Nurse Practitioners (NPs) are healthcare professionals that are sometimes referred to as ‘Advanced Practice Providers’ (or APPs). While they are two different schools and degrees, they are often categorized together given both professions require a higher level of medical training. Both training programs typically take 2 to 4 years, which includes classroom instruction and clinical rotations. After graduation, PAs and NPs typically focus on a specific specialty or patient population as they continue their career, and will sometimes complete additional fellowship programs to advance their practice.


While all APPs formally require the supervision of a doctor, they are trained to evaluate patients, order and interpret medical tests, diagnose disease, prescribe medication and treatment, and perform procedures. As APPs gain cumulative experience and training, very little supervision is often necessary and they can practice largely independently.


Doctors (MDs and DOs)


Patients are more familiar with the training to become a doctor. After four years of medical school, where doctors earn their Medical Degree (MD) or Doctor of Osteopathy (DO), they must then complete a residency program to become licensed in a particular specialty. Primary care doctors, for example, complete a three year residency in Internal Medicine or Family Medicine. ER doctors complete a four year residency specifically in Emergency Medicine, where they spend clinical rotations in both ERs as well as multiple different types of hospital care units (ICUs, labor and delivery, cardiac floors, trauma and general surgery, pediatrics, etc.). This ensures a broad scope of knowledge that allows them to treat any emergency that may come through the door. After completion of residency, doctors must pass board exams to become specifically licensed in their field.


While some people are curious about the difference between an MD and a DO, the level of training is the same. People with either degree attend the same residency programs, and need to pass the same board exams for specialty certification and independent practice. The main difference between these two degrees is the approach and philosophy of their medical schools. Doctors of Osteopathy (DOs) learn a curriculum that emphasizes the musculoskeletal system and its contribution to health and disease. They learn, for example, how to perform adjustments on the body to relieve conditions that lead to chronic pain.


Does it make a difference if a patient sees an APP instead of a doctor?


All ER patients will eventually be seen by either an APP (a PA or NP) or a doctor at some point in their evaluation. At MEMA, we have a highly trained and experienced group of APPs that work alongside our doctors to provide exceptional care to our patients. It is important to our group that the level of care and expertise delivered by all of our clinicians meets a high standard, regardless of the clinician’s degree. Our doctors and APPs work closely together with every shift, and our APPs typically require very little supervision thanks to their advanced emergency medicine training. It is important to us that every patient knows who is treating them, and can be confident in the care they receive in our ERs.