SAUSALITO, CA (ASRN.ORG) -- Ever since he was a hospital volunteer in high school, Adam Kelly was interested in a medical career. What he wasn’t interested in was the lifestyle attached to the M.D. degree. “I wanted to treat patients, but I wanted free time for myself, too,” he said. “I didn’t want to be 30 or 35 before I got on my feet — and then still have a lot of loans to pay back.”

When Mr. Kelly was in college, his older brother, then a medical student, mentioned the role of physician assistant — a “midlevel” health care provider with two to three years of medical training, who is licensed to examine and treat patients, make diagnoses and write prescriptions, under a doctor’s supervision. Mr. Kelly, 26, now works as a physician assistant in the neonatal unit of St. Francis Hospital and Medical Center in Hartford.

In an aging population, a shortage of doctors has created new demand for care providers like physician assistants and nurse practitioners — nurses with advanced training who can also examine and treat patients, make diagnoses and write prescriptions.

From 2001 to this year, the number of nurse practitioners in the United States has grown to 125,000 from 82,000, according to the American Academy of Nurse Practitioners, and the number of P.A.’s to 68,000 from 43,000, says the American Academy of Physician Assistants.

To patients, the two roles can seem very similar. Salaries can be similar, too. The average total income for physician assistants in full-time clinical practice is about $86,000, according to the P.A. academy. The average total income for nurse practitioners is $92,000.

But there are important differences. Physician assistants must practice under a physician’s supervision. Nurse practitioners are licensed as independent health care providers, without mandated physician supervision, although some states require them to have a supervising or collaborating physician to whom they can turn for advice. Some nurse practitioners have private practices.

Another important difference is that P.A.’s are generalists, while nurse practitioners train in a specialty like family medicine or women’s health. As a result, P.A.’s can switch fields more easily.

Linda Gale, 51, of Fairfield, Conn., worked as a physician assistant in orthopedics for 18 months after graduating from the physician associate program at Yale in 2005. In 2007, she switched to a urology office, where she sees patients and assists doctors in the operating room, suturing incisions and operating the tiny camera used in laparoscopic surgery.

P.A.’s are licensed by state boards of medicine. Like doctors, they initially take classroom lecture classes emphasizing science and diseases, then continue with clinical rotations. Ninety percent of P.A. schools offer master’s programs. After finishing a program, candidates must pass a national certifying exam. The programs have an average total cost of $46,000, the P.A. association says.

Nurse practitioners are licensed by state boards of nursing, and typically are registered nurses with bachelor’s degrees as they begin their advanced training. To become licensed, they must hold a registered nurse’s license, earn a master’s in nursing science or a doctorate of nursing practice, and pass a certification exam in a specialty area. Both master’s and doctoral programs are offered by nursing schools, which integrate classroom instruction and clinical teaching throughout two or more years of advanced training.

To date, most nurse practitioners hold master’s degrees, which can cost $20,000 to $45,000 to complete. But that standard is changing. In late 2004, the American Association of Colleges of Nursing recommended that new nurse practitioners earn a doctorate of nursing practice by 2015, and nursing schools are responding rapidly.

Since the first such doctorate was awarded in 2005 by the Columbia School of Nursing in New York, 74 nursing programs have added the degree, and 63 other programs are in the works, the association says. Doctoral programs take an additional 18 months to three years and may cost $20,000 to $40,000.

Rachel Lyons, 33, of New York, was a nurse practitioner for five years at an emergency room in Rhode Island before joining the Columbia doctoral program. After finishing it in 2005, she took a new job at NewYork-Presbyterian Hospital, running two clinics in pediatric orthopedics. Next year, she will start seeing private patients.

She also introduces herself as “Dr. Lyons”; doctors of nursing practice can use the title, though they must also introduce themselves as nurse practitioners. “I’ve worked hard to obtain this degree and I make no false pretenses about who I am,” she said. “I’ve earned it.”

Some physicians voice concern at use of the doctor title. “It may cause patient confusion and misunderstandings,” said Jim King, president of the American Academy of Family Physicians.

But nurse practitioners say they are clear about describing their role — as are physician assistants, who don’t use the title “doctor” but are often mistaken for physicians.

“Because I’m wearing a white coat or scrubs, patients call me ‘doctor’ and I have to correct them,” Mr. Kelly said. “It’s a great opportunity to educate them about my role.”

 

 

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