Selected Podcast
MD vs. NP vs. PA: What’s the Difference
Many times, our “doctor’s visit” are with a Nurse Practitioner or Physician Assistant. What is the difference between an NP, a PA and an MD? When can I see a nurse practitioner instead of a physician? In this podcast, two nurse practitioners from University of Maryland Shore Medical Group explain the benefits of seeing an “advanced practice provider,” what their education and experience is like compared to a medical doctor, where they see patients and much more.
Featured Speakers:
Katelyn (Chapman) Mullaney, CRNP, is a Nurse Practitioner at University of Maryland Shore Medical Group – Primary Care. She earned a Bachelor of Science degree from James Madison University and then a Bachelor of Nursing degree from George Washington University in 2014. She worked for over 3 years as a labor and delivery nurse before earning a Master of Nursing degree from George Washington University School of Nursing in 2018. She is certified by the American Academy of Nurse Practitioners. A native of Northern Virginia, Katelyn now resides with her husband and two dogs in Easton. In her free time she enjoys hunting, fishing, camping and spending time with her family and 12 nieces and nephews.
Brittany Krautheim, CRNP | Katelyn Chapman Mullaney, CRNP
Brittany Krautheim, CRNP, is a Nurse Practitioner at Shore Regional Health Clark Comprehensive Breast Center in Easton, Maryland and specializes in surgical oncology. She earned her RN at Beebe School of Nursing in Lewes, Delaware in 2004, her Masters of Nursing from Wilmington University in 2009, and her nurse practitioner degree and midwifery degree from Georgetown University in 2013. Brittany is a native to the Southern Delaware beach area, and now resides in Queenstown, Maryland, with her partner, Andrew, and her four-year-old son, Gage. They enjoy boating and travel.Katelyn (Chapman) Mullaney, CRNP, is a Nurse Practitioner at University of Maryland Shore Medical Group – Primary Care. She earned a Bachelor of Science degree from James Madison University and then a Bachelor of Nursing degree from George Washington University in 2014. She worked for over 3 years as a labor and delivery nurse before earning a Master of Nursing degree from George Washington University School of Nursing in 2018. She is certified by the American Academy of Nurse Practitioners. A native of Northern Virginia, Katelyn now resides with her husband and two dogs in Easton. In her free time she enjoys hunting, fishing, camping and spending time with her family and 12 nieces and nephews.
Transcription:
MD vs. NP vs. PA: What’s the Difference
Caitlin Whyte (Host): Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This episode is sponsored by UM Shore Regional Health and UM Shore Medical Group with locations and Caroline, Dorchester, Kent, Queen Annes and Talbot counties. UM Shore Regional Health is dedicated to bringing world class care to the communities of our 2000 plus square mile region. UM Shore Regional Health where the health of the eastern shore comes first. Today we are talking acronyms. What is the difference between an MD an NP and a PA?
Well, here to tell us is Katelyn Mullaney, a Nurse Practitioner at UM Shore Medical Group, Primary Care in Easton, Maryland, and Brittany Krautheim, a Nurse Practitioner at Clark Comprehensive Breast Center in Easton, Maryland. Now Katelyn, we'll start with you. What training and licensing does an Advanced Practice Provider have compared to a doctor?
Katelyn Chapman Mullaney, CRNP (Guest): So as a nurse practitioner, we have to be nurses first. So that is a four year degree as to get your bachelor's in nursing, followed by full-time a two year program as a nurse practitioner. Doctors end up having to do typically a four year post-grad program instead of our two year. And then they end up having to do a residency as well.
Host: Brittany, a lot of times patients will see APPs in primary care offices. What are some other specialties in which APPs work?
Brittany Krautheim, CRNP (Guest): Well, it's pretty diverse. Quite frankly, you can find us anywhere from a gynecology office, oncology, gastroenterology, cardiology, wound care, pain management, palliative care, neurology. We're pretty much all over the spectrum. The only areas where you might not find quite as many nurse practitioners specifically, but more so physicians assistants, which are also under the spectrum of advanced practice providers; would be in the orthopedics arena just because that's more of a surgical based line of service.
Host: Now, what if my illness is complex Katelyn, when should I see a physician instead of an advanced practice provider?
Katelyn: So I work in primary care and for the most part there isn't a I guess, hierarchy. So my patients would see me no matter what their complexity is. The benefit is I do have physicians in my office that if I needed to, I could go and speak with them along with the other nurse practitioners. But there isn't, in my office, a protocol where if you have a certain severity of an illness that you would see the physician over myself. I do know that varies by practice and by state. So, for nurse practitioners, the wall behind what they can and cannot do differs sometimes drastically based on where they live.
And that would change as well. There's some states that a nurse practitioner has to pretty much be signed off by their physician. Whereas in Maryland, nurse practitioners can own their own practice and practice completely without a physician.
Host: We of course have to talk about insurance. Brittany will my insurance cover a visit with an APP and will Medicare also cover that visit?
Brittany: Yes. And to kind of piggyback off of what Katelyn said, sometimes this can vary by the state and the type of advanced practice provider you're seeing. But by most part, all nurse practitioner visits are covered by all the major insurance networks. I know when I practiced as a midwife, which is another subset of advanced practice providers. There were some insurances who had some issues with midwives providing the initial consult, but as a nurse practitioner, I have not encountered that issue in my particular practice.
Host: Now, Brittany, what benefits do patients have when seeing an APP?
Brittany: Well, I think for one, and again, this varies by practice, but by and large, you have longer visit times with an APP, than with a physician, usually physician visits are 10 to 15 minutes and on average nurse practitioner or PA visits can range from about 20 to 30 minutes, depending on the practice type. So, you get more face-to-face time. And I also think, you know, if you're comparing a physician model to a nursing model, you know, Nurse Practitioners are, I guess you could say raised in the realm that people are healthy until proven unhealthy; whereas in a physician model, it's a little bit to the contrary where people are believed to have illness until proven otherwise.
So, I think we give patients a large opportunity to be well and to promote wellness and to do more screening, to offset illness later versus just disease management, which I think is a little bit more towards the medical model. Not that there's anything wrong with that, but I think it's just a difference in the type of care and the type of visit that the patient might have.
Host: What do these different letters stand for? We have APP, NP, PA, MD. What is the difference?
Brittany: Sure. So MD is a medical doctor and that's the traditional role that people think of when they say I'm going to go see my doctor and a nurse practitioner is NP and a PA is a physician's assistant, both NPs and PAs are categorized under an umbrella term of APP, which is an advanced practice provider.
So APP is just kind of a generalized term that encompasses both NPs and PAs in terms of the class of, or the level of care that is provided. So we're not practicing as physicians, but we are practicing as advanced practice providers.
Host: And Katelyn can APPs prescribe medication and testing. And if so, what kinds?
Katelyn: So this goes back to the difference between what a nurse practitioner, even a PA can do based on what state that they live in. For Maryland, nurse practitioners have full practice authority, meaning we can prescribe or order tests pretty much the exact same that a physician could, and some states they have rules against say like narcotics or controlled substances. And then the same would vary based on what tests they were ordering. Some vary based on the insurance as well. So I know Medicare has some tests that they have at least in the past, preferred for a physician to order. But I think a lot of those have been changing recently as well.
Host: Now, as we wrap up here, Brittany, in what kinds of locations do APPs work? You know, talking about hospitals, outpatient facilities, private offices, things like that.
Brittany: Yeah. So we are in all of those locations actually. And some of that ties back to what we talked about in terms of the education of a nurse practitioner. So I think we differ in our education from physicians where their education is very generalized for a longer period of time. And then they specialize right at the end. Whereas nurse practitioners, we specialize very early in our education to the point where, as, for example, Katelyn graduated as a Family Nurse Practitioner. So, her focus is in the outpatient arena, taking care of a wide range of age groups, men and women. My specialization is Women's Health.
So I specialize more from the female perspective from menarche to post-menopausal time. And likewise, there are acute care nurse practitioners and their education and focus is on the inpatient setting, whether that be interoperative, post-operative care, working with hospitalists, for making rounds on patients on the floor. But we are all in the outpatient setting, inpatient setting, we're in the community really all over there really isn't a area of healthcare where we aren't practicing with our colleagues.
Host: I'll stick with you, Brittany, is there anything else we should know when navigating all of these different types of providers?
Brittany: Yeah. You know, I think the biggest misconception I encounter usually comes from the older clientele patient who grew up with the physician and that was the be all, end all in terms of who you see, in an office or a hospital. And I think there's a little bit of fear that, that is shifting. And what are these new providers and what are their credentials and can they take care of me?
So I think, you know, just educating the public that we are highly trained providers and I think patients would be intrigued or maybe surprised to know that patient care is a collaborative effort. It is not that any one of us knows everything, whether it be a nurse practitioner, a physician, a PA, none of us know everything.
And so to think that we do, would be misguided and we all collaborate on every single patient. I think that's where patients get the best care. So, with Katelyn's practice with primary care and with mine, with surgical oncology, I'm always collaborating with my physician and they're always collaborating with me because, you know, none of us have all the answers and we all have our own arenas where we have areas of expertise.
So I think from the patient perspective, just getting the knowledge out there, that it's always a collaborative effort, even though you quote unquote, just see this person, behind the scenes, you're being discussed with other providers in the office if there is a situation that necessitates it.
Host: Oh, absolutely. And Katelyn, same question to you.
Katelyn: No, I think Brittany hit most of the high points. I get a lot of my patients who think that, I guess the, the nurse practitioner is the stepping stone to becoming a physician. I've heard that one a handful of times, but it's a completely different career choice. And we can go on to get like a doctorate, so like a DNP, but it is completely different than becoming like an MD.
So that's another misconception I've heard a lot about, but for the most part, especially in advanced full practice authority states, I mean, a nurse practitioner can pretty much do what a physician can do in the mini realm. So I, I want patients to feel very comfortable if they are seeing a nurse practitioner or a physician's assistant, in any of their settings, whether it's just a temporary provider that they're seeing, because theirs is not available, or if they're meeting a new provider.
And just like Brittany said, I mean, we have full backing from our physicians that we work with. So I want them to feel safe and well cared for.
Host: Well, thank you so much for clearing this up. I know we discussed a lot of letters and certifications today, but it really is great to have a solid understanding of each one and how they all work together. To find more shows just like this one, head to umms.org/podcast.
Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.
MD vs. NP vs. PA: What’s the Difference
Caitlin Whyte (Host): Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This episode is sponsored by UM Shore Regional Health and UM Shore Medical Group with locations and Caroline, Dorchester, Kent, Queen Annes and Talbot counties. UM Shore Regional Health is dedicated to bringing world class care to the communities of our 2000 plus square mile region. UM Shore Regional Health where the health of the eastern shore comes first. Today we are talking acronyms. What is the difference between an MD an NP and a PA?
Well, here to tell us is Katelyn Mullaney, a Nurse Practitioner at UM Shore Medical Group, Primary Care in Easton, Maryland, and Brittany Krautheim, a Nurse Practitioner at Clark Comprehensive Breast Center in Easton, Maryland. Now Katelyn, we'll start with you. What training and licensing does an Advanced Practice Provider have compared to a doctor?
Katelyn Chapman Mullaney, CRNP (Guest): So as a nurse practitioner, we have to be nurses first. So that is a four year degree as to get your bachelor's in nursing, followed by full-time a two year program as a nurse practitioner. Doctors end up having to do typically a four year post-grad program instead of our two year. And then they end up having to do a residency as well.
Host: Brittany, a lot of times patients will see APPs in primary care offices. What are some other specialties in which APPs work?
Brittany Krautheim, CRNP (Guest): Well, it's pretty diverse. Quite frankly, you can find us anywhere from a gynecology office, oncology, gastroenterology, cardiology, wound care, pain management, palliative care, neurology. We're pretty much all over the spectrum. The only areas where you might not find quite as many nurse practitioners specifically, but more so physicians assistants, which are also under the spectrum of advanced practice providers; would be in the orthopedics arena just because that's more of a surgical based line of service.
Host: Now, what if my illness is complex Katelyn, when should I see a physician instead of an advanced practice provider?
Katelyn: So I work in primary care and for the most part there isn't a I guess, hierarchy. So my patients would see me no matter what their complexity is. The benefit is I do have physicians in my office that if I needed to, I could go and speak with them along with the other nurse practitioners. But there isn't, in my office, a protocol where if you have a certain severity of an illness that you would see the physician over myself. I do know that varies by practice and by state. So, for nurse practitioners, the wall behind what they can and cannot do differs sometimes drastically based on where they live.
And that would change as well. There's some states that a nurse practitioner has to pretty much be signed off by their physician. Whereas in Maryland, nurse practitioners can own their own practice and practice completely without a physician.
Host: We of course have to talk about insurance. Brittany will my insurance cover a visit with an APP and will Medicare also cover that visit?
Brittany: Yes. And to kind of piggyback off of what Katelyn said, sometimes this can vary by the state and the type of advanced practice provider you're seeing. But by most part, all nurse practitioner visits are covered by all the major insurance networks. I know when I practiced as a midwife, which is another subset of advanced practice providers. There were some insurances who had some issues with midwives providing the initial consult, but as a nurse practitioner, I have not encountered that issue in my particular practice.
Host: Now, Brittany, what benefits do patients have when seeing an APP?
Brittany: Well, I think for one, and again, this varies by practice, but by and large, you have longer visit times with an APP, than with a physician, usually physician visits are 10 to 15 minutes and on average nurse practitioner or PA visits can range from about 20 to 30 minutes, depending on the practice type. So, you get more face-to-face time. And I also think, you know, if you're comparing a physician model to a nursing model, you know, Nurse Practitioners are, I guess you could say raised in the realm that people are healthy until proven unhealthy; whereas in a physician model, it's a little bit to the contrary where people are believed to have illness until proven otherwise.
So, I think we give patients a large opportunity to be well and to promote wellness and to do more screening, to offset illness later versus just disease management, which I think is a little bit more towards the medical model. Not that there's anything wrong with that, but I think it's just a difference in the type of care and the type of visit that the patient might have.
Host: What do these different letters stand for? We have APP, NP, PA, MD. What is the difference?
Brittany: Sure. So MD is a medical doctor and that's the traditional role that people think of when they say I'm going to go see my doctor and a nurse practitioner is NP and a PA is a physician's assistant, both NPs and PAs are categorized under an umbrella term of APP, which is an advanced practice provider.
So APP is just kind of a generalized term that encompasses both NPs and PAs in terms of the class of, or the level of care that is provided. So we're not practicing as physicians, but we are practicing as advanced practice providers.
Host: And Katelyn can APPs prescribe medication and testing. And if so, what kinds?
Katelyn: So this goes back to the difference between what a nurse practitioner, even a PA can do based on what state that they live in. For Maryland, nurse practitioners have full practice authority, meaning we can prescribe or order tests pretty much the exact same that a physician could, and some states they have rules against say like narcotics or controlled substances. And then the same would vary based on what tests they were ordering. Some vary based on the insurance as well. So I know Medicare has some tests that they have at least in the past, preferred for a physician to order. But I think a lot of those have been changing recently as well.
Host: Now, as we wrap up here, Brittany, in what kinds of locations do APPs work? You know, talking about hospitals, outpatient facilities, private offices, things like that.
Brittany: Yeah. So we are in all of those locations actually. And some of that ties back to what we talked about in terms of the education of a nurse practitioner. So I think we differ in our education from physicians where their education is very generalized for a longer period of time. And then they specialize right at the end. Whereas nurse practitioners, we specialize very early in our education to the point where, as, for example, Katelyn graduated as a Family Nurse Practitioner. So, her focus is in the outpatient arena, taking care of a wide range of age groups, men and women. My specialization is Women's Health.
So I specialize more from the female perspective from menarche to post-menopausal time. And likewise, there are acute care nurse practitioners and their education and focus is on the inpatient setting, whether that be interoperative, post-operative care, working with hospitalists, for making rounds on patients on the floor. But we are all in the outpatient setting, inpatient setting, we're in the community really all over there really isn't a area of healthcare where we aren't practicing with our colleagues.
Host: I'll stick with you, Brittany, is there anything else we should know when navigating all of these different types of providers?
Brittany: Yeah. You know, I think the biggest misconception I encounter usually comes from the older clientele patient who grew up with the physician and that was the be all, end all in terms of who you see, in an office or a hospital. And I think there's a little bit of fear that, that is shifting. And what are these new providers and what are their credentials and can they take care of me?
So I think, you know, just educating the public that we are highly trained providers and I think patients would be intrigued or maybe surprised to know that patient care is a collaborative effort. It is not that any one of us knows everything, whether it be a nurse practitioner, a physician, a PA, none of us know everything.
And so to think that we do, would be misguided and we all collaborate on every single patient. I think that's where patients get the best care. So, with Katelyn's practice with primary care and with mine, with surgical oncology, I'm always collaborating with my physician and they're always collaborating with me because, you know, none of us have all the answers and we all have our own arenas where we have areas of expertise.
So I think from the patient perspective, just getting the knowledge out there, that it's always a collaborative effort, even though you quote unquote, just see this person, behind the scenes, you're being discussed with other providers in the office if there is a situation that necessitates it.
Host: Oh, absolutely. And Katelyn, same question to you.
Katelyn: No, I think Brittany hit most of the high points. I get a lot of my patients who think that, I guess the, the nurse practitioner is the stepping stone to becoming a physician. I've heard that one a handful of times, but it's a completely different career choice. And we can go on to get like a doctorate, so like a DNP, but it is completely different than becoming like an MD.
So that's another misconception I've heard a lot about, but for the most part, especially in advanced full practice authority states, I mean, a nurse practitioner can pretty much do what a physician can do in the mini realm. So I, I want patients to feel very comfortable if they are seeing a nurse practitioner or a physician's assistant, in any of their settings, whether it's just a temporary provider that they're seeing, because theirs is not available, or if they're meeting a new provider.
And just like Brittany said, I mean, we have full backing from our physicians that we work with. So I want them to feel safe and well cared for.
Host: Well, thank you so much for clearing this up. I know we discussed a lot of letters and certifications today, but it really is great to have a solid understanding of each one and how they all work together. To find more shows just like this one, head to umms.org/podcast.
Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.