What's the difference between a PA and an NP? How do chiropractors and naturopaths fit into the healthcare team?
There are different professional pathways to healthcare, and it is helpful to understand the differences in these careers when deciding which to pursue. Even as a patient, you may not understand enough about each role to choose which practitioner to make an appointment with.
I am new to the world of healthcare, but I can honestly say that it has been enormously rewarding already. I have already had experience working with allied health professionals and have many family members and friends who work as non-physician healthcare professionals, such as physician assistants, nurses and nurse practitioners, and therapists.
Here are some fast facts about three types of healthcare providers that you are most likely to encounter in the hospital or at an outpatient office:
Medical doctors (or physicians) hold a DO or MD degree (osteopathic medicine and allopathic medicine, respectively). Medical doctors complete a bachelor's degree (4 years), medical school degree (4 years), and residency training (3+ years, depending on specialty) for a total of at least 11 years of training. Physicians are usually required to take the MCAT before admission to medical school. To become a licensed medical doctor, they take the USMLE and the COMLEX exams, which involve three parts: two during medical school and one during residency. Physicians then take additional board exams to become specialty board-certified. Medical doctors include pediatricians, psychiatrists, cardiologists, surgeons, pulmonologists, dermatologists, neurologists, etc.
Nurse practitioners start as registered nurses (RNs) with a Bachelor of Science in Nursing (BSN), which usually takes four years to complete. They then complete a master's (2 years) or doctoral (4 years) advanced nursing program, at least six years of training. They must also pass a national board certification exam, which allows certification in a specific patient population (e.g., family NP, pediatric NP, adult-gerontology NP, psychiatric NP, neonatal NP, or women's health NP). NPs are licensed healthcare providers who can work with physicians. In most states, NPs cannot practice independently.
Physician assistants complete a bachelor's degree (4 years) and then a Master of Science (MS) in Physician Assistant Studies degree (2 to 3 years) for a total of at least six years of training. The education they receive follows a medical model (similar to medical school) instead of the advanced nursing model that NPs follow in their advanced nursing programs. PAs take a licensing exam for general practice instead of for a specific specialty (like medical doctors) or a patient population (like NPs). PAs are licensed healthcare providers who can work with physicians. The title of PAs depends on the department they work in (e.g., cardiology PA, dermatology PA, family medicine PA).
Twenty-five states allow licensure for naturopathic doctors (NDs) or naturopaths. The federal government does not recognize NDs as physicians. There are seven naturopathic schools in the United States. At their broadest scope of care in Arizona, they can only prescribe vitamins and minerals, vaccines, antibiotics, and oral contraceptives. It is unlikely that insurance would cover naturopathic care. The American Academy of Family Physicians stated: "Naturopathic theory and practice is not based upon knowledge widely accepted by the scientific community." After consulting official naturopathic websites, I could not find any support that naturopathic practice follows evidence-based medicine, which is the basis on which physicians practice medicine. Evidence-based medicine means that medical doctors ensure that treatment is proven to be the most beneficial option for patients. I agree with elements of the naturopathic approach (e.g., holistic care, prevention, and the importance of a healthy diet). However, their scope of care is far too limited and obsolete to be taken seriously in the medical community. We should be cautious before embracing healthcare that is not evidence-based.
If you like the holistic approach, I encourage you to seek care from an osteopathic medicine physician (DO). Learn more about osteopathic medicine in my blog post here.
A small subgroup of techniques that DOs use, called high-velocity low-amplitude techniques (HVLA), inspired the approaches used by chiropractors. Unfortunately, chiropractors changed these techniques so much over time that they are far from osteopathic manipulative treatment (OMT). Like naturopathic care, chiropractic treatment has limited evidence. Whereas chiropractors focus almost exclusively on the joints, OMT treats with the guiding principle that the body is composed of interconnected systems. Chiropractors are not medical doctors. They lack a degree in medicine and have limited healthcare knowledge outside of the techniques they learn in chiropractic school.
Learn more about this topic in the related episode of First Line here.