The healthcare system is ever evolving, and in it, providers of every type are specializing and becoming reliant on one another. Advanced Practice Providers as well as physicians have shared the core practice of patient care, but the two are differentiated from one another based on education, practice, and work. 

APPs like Nurse Practitioners (NPs), Physician Assistants (PAs), and Clinical Nurse Specialists (CNSs) have become increasingly important as healthcare organizations seek to expand access to care and address provider shortages. Physicians and APPs are complementary, but together they can offer improved patient outcomes, productivity, and satisfaction. This article will analyze the fundamental differences between APPs and physicians and how the combination of partnership would be best for existing medical practice.

Key Differences

1. Education and Training Differences

One of the biggest differences between physicians and APPs is in the educational background and training lengths. Physicians undergo intensive education and training, starting with a four-year undergraduate degree followed by four years of medical school. After the receipt of a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO), they proceed with residency training, typically three to seven years, based on the specialty. They may also proceed with fellowship training in a move to sub-specialize, taking their overall training to more than ten years.

Otherwise, APPs have a separate educational track. Nurse Practitioners (NPs) first complete a Bachelor of Science in Nursing (BSN), get licensed as Registered Nurses (RNs), and next earn a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) degree within two to four more years. Physician Assistants (PAs) will first have a health science bachelor’s degree and subsequently a two- to three-year PA program with a Master’s degree. Their training is shorter than physicians’ but is still challenging with clinical training, and they have to undergo national certification examinations in order to practice.

2. Scope of Practice and Autonomy

Scope of practice is extremely wide for physicians relative to APPs, and it is highly variable by state law, institutional policy, and specialty. Physicians have unrestricted practice unlicensed privilege in every state and may diagnose disease, establish treatment, prescribe, and perform surgery independently without supervision. They are responsible for final patient care and medical decision-making.

However, APPs differ in their scope of practice depending on their credentials and state law. Autonomous practice authority does exist in some states for NPs to independently diagnose and treat patients without physician supervision. For the majority of states, PAs and NPs practice with collaboration or supervisory relationship to physicians. Though APPs are trained to handle all types of medical illness, they do refer complex cases to physicians, especially those that require special talent or surgery.

3. Clinical Responsibilities and Patient Care

Both APPs and physicians actively engage with patient care but in varying capacities in complication and supervision. Physicians have more responsibility to visit very acute patients, order very high-end diagnostic tests, and craft very complex treatment regimens. Physicians also specialize in some areas, including cardiology, neurology, and surgery, which require extensive training for very subspecialized treatment and procedure.

APPs are a vital component of primary care, urgent care, hospital medicine, and specialty practice. They perform patient evaluation, order and report tests, prescribe, and manage a range of conditions. APPs perform patient education and chronic disease management better, spend more time with patients than physicians in most situations, and can offer close patient-provider relationships and more effective treatment plan follow-through.

4. Workforce and Healthcare Accessibility

The growth of the need for healthcare services in rural and under-served areas has resulted in an increased reliance on APPs. With a shortage of physicians impending on a national basis in the near future, APPs have an important role to play in filling gaps in care and reaching out to provide access to care. APPs are being leveraged by states and healthcare systems increasingly in models of care that are team-based as a response to workforce shortages and to realize patient need fully.

Physicians, as so formally trained, exist in concentration of specialty practice and urban hospital care. APPs, however, are more dispersed in primary care offices, community health clinics, and rural hospitals, where they plug the medical access gap. Studies have shown that APPs deliver quality care with equal patient satisfaction and outcome as physicians for the majority of primary and preventive care practice.

Collaborative Benefits of Physicians and APPs

Although there are appreciable differences between APPs and physicians, their collaboration has been proven to be extremely efficient in the improvement of the delivery of care. Physician-APP team-based models of care ensure improved patient management, improved workload allocation, and improved access to care.

The most significant benefit of team practice is more patient-centered care. Practitioners would enjoy the luxury of treating acute cases and specialist procedures because APPs would take follow-ups for patients with chronic conditions, preventive care, and follow-ups for routine visits for patients. This sort of distribution allows timely care for patients.

Collaboration enhances health outcomes too. Studies have proven that when APPs and physicians work together, patients spend less time waiting, have better chronic disease management, and receive better compliance with treatment guidelines. Team practice even cuts the cost of healthcare by eliminating duplicate hospitalization and emergency room visits.

Another significant advantage of physician-APP cooperation is professional mentorship and support. APPs are able to reap physician advice and oversight, particularly regarding challenging cases. 

Challenges in Physician-APP Collaboration

Even in a desire for collaboration, however, there are a few problems with incorporating APPs into care teams. The biggest problem is one of regulatory heterogeneity among states. In certain regions, scope-of-practice statutes restrict APPs from practicing autonomously, and care models become disjointed.

The second issue is the likelihood of role change resistance and role ambiguity in health care organizations. Health care managers and physicians oppose maximum utilization of APPs because they fear discrepancies in training and quality of care. These need to be managed through education, role definition, and teamwork culture.

Reimbursement variances are a concern as well. APPs in most cases are reimbursed less for services physicians do equally and paid much higher. Having fair reimbursement plans in place can help make sure healthcare organizations can maximize benefits without causing integration of APPs to come apart at the seams.

Future Physician and APP Collaboration Trends

Medicine’s future is more and more in the way of interprofessional practice, with APPs as a logical response to shortages in staffing and increased patient access. With growing numbers of states licensing practice to APPs, more collaboration-based models of care will emerge.

Technology, and telemedicine in particular, is also changing the working relationship between physicians and APPs. Telehealth systems enable APPs to telephone consult with physicians so that physician shortage areas can still get quality care. This has already been working well for rural care and will be ever more important.

In addition, changing healthcare policy and education curriculum are promoting greater collaboration among physicians and APPs. Increasingly, residency programs today place strong emphasis on team-based care, so physicians to come will be trained to practice together in every aspect of healthcare.

Conclusion

Physicians and Advanced Practice Providers bring special strength to the healthcare system through scope of practice, education, and clinical responsibility. Physicians have higher education and are exposed to complex cases, whereas APPs play an important role in expanding access in healthcare, managing primary care, and managing chronic disease. Together, the two providers create a strengthened, patient-centered healthcare system that maximizes outcomes and saves cost.

Further focus on partnership care models puts the spotlight on the integration of APPs into healthcare teams. With greater development in healthcare, embracing physician-APP collaborations will be critical in addressing workforce shortages, better patient care, and guiding the healthcare industry towards sustainability.