“Are you a doctor or a mid-level?”
Many people may not be aware of the differences in what the credentials mean following a health care provider’s name. Some may be confused when they see a PA, CHP, or NHP stating their credentials or expertise. Here’s an explanation to make you aware of what some of these differences are so you can better understand the education and expertise levels some of our providers come with, the next time you see them in clinic.
A commonly used term is the “mid-level provider,” or a clinician that is under a physician (doctor) but can still see and treat patients for a wide variety of health concerns.
There are three main types of mid-levels: nurse practitioner (NP), nurse midwife (CNM), and physician assistant (PA.) They function in similar ways, which may seem indistinguishable to a patient at first glance, but there are differences in regards to their training and what they can legally practice or perform on a patient.
Let’s begin with a nurse practitioner (NP)
First, they have to graduate from a registered nursing (RN) program with a bachelor’s degree. Many NPs will have practiced as a nurse, (see Jean Brinich’s experience) before going back to school. Equivalent to receiving a Master’s in Nursing degree, many NPs have trained in the nursing model with emphasis on patient care and learning diagnosis and treatment algorithms to treat patients. Often, NPs can practice independently but can consult with other physicians if they wish. NPs are often trained in a specific field such as pediatrics, OB/GYN, family medicine (generalist), or internal medicine.
CNM or WHNP
A nurse midwife (CNM) or women’s health nurse practitioner (WHNP) is similar in that they are RNs first, but then do advanced training which may focus on OB/GYN or Women’s Health. They are often an option for low-risk pregnancies or deliveries but may work under a medical doctor or physician (MD) in the event of complications.
Physician Assistant (PA)
A physician assistant (PA) is trained in a regimented medical model like a regular physician (MD) but under a shorter time frame. The average PA school is two years, equivalent to obtaining a Master’s Degree. A PA is required to work under the supervision of a physician but it doesn’t mean an MD has to see every patient the PA sees. An MD may have to review a certain number of the PA’s charts and be available for consult if any concerns come about from the patient or the provider.
PAs are trained in primary care (often called generalists), not specializing at first. Many PAs prefer the routine aspect of patient care as a generalist, so as not to have to be “on-call” for emergencies or deliveries like many MDs or specialists—often allowing PAs more time with their families and routine work weeks.
CHPs and CHAs
In the YKHC model of care, we also have our Community Health Practitioners, which practice routinely at the same experience or credentials as a certified Emergency Trauma Technician (ETT) or Emergency Medical Technician (EMT.) Did you know that in Alaska alone, our Community Health Aides (CHA) have close to 300,000 patient encounters during each fiscal year alone? Our mid-level providers—which include nurse practitioners, physician assistants—and MDs also provide additional oversight to our CHAs, managing and providing consult to our first line of care on a daily basis.
Mid-levels work very hard in our outpatient/family medicine clinics and subregional clinics to help alleviate the nationwide shortage of physicians. They are the primary go-to persons for our Community Health Aides practicing routine care in our village clinics.
Health care delivery in our geographically challenged system is very complex, but we hope this will allow you to understand what’s really in a name the next time you visit your local provider.
Did you know that YKHC is the only remote health care organization to require board certification for all of the physicians and mid-levels we hire? We are proud to say that all of our mid-levels and physicians are board certified by the State of Alaska. Thank your provider today!