Health Report: Making sense of the alphabet soup of medical titles – Learn who’s who in your primary care team

As more people have gained access to health care in recent years, the trend in primary care medicine has been shifting to “clinical care teams.” This is a departure from the traditional model where patients are seen by nurses for preliminaries such as height, weight and blood pressure before they are seen by their primary care physicians.

Clinical care teams are more dynamic, made up of clinicians with various medical titles and skills. They are in essence small groups of health care professionals who work together to help care for patients.

“This team-based model of care provides better quality of care for patients as it allows health care providers to perform at the highest levels of their qualifications. It improves efficiency and helps patients access their health providers more effectively,” said Russell Zane, M.D., family medicine physician at Scripps Coastal Medical Center and a leader in primary care redesign at Scripps Health.

Research has shown that this team-based approach can help improve patient access to care and ensure that a full range of medical and nursing care can be received.

The team consists of a primary care physician, support staff and advanced health care practitioners, including nurse practitioners and physician assistants. 

M.D.s and D.O.s

Most primary care teams are led by a primary care physician who is either a medical doctor (M.D.) or a doctor of osteopathic medicine (D.O.).

Both types of physicians must complete four years of medical school in addition to an internship, a residency and possible fellowship as well pass state licensing exams in order to practice medicine. M.D.s account for the majority of actively licensed physicians in the United States. D.O.s tend to focus on the neuro-musculoskeletal system and are trained to have a more holistic approach.

The care team also may include licensed medical professionals such as physician assistants and nurse practitioners who work under the supervision of a primary care physician. They are also known as advanced practice clinicians. “They are well trained and allow us to provide the most comprehensive care for patients in the most efficient manner,” Dr. Zane said.

Working alongside the physicians, physician assistants and nurse practitioners examine and treat patients in the clinic, respond to patients messaging throughout the day, and review laboratory and other diagnostic data.

What is an N.P.?

A nurse practitioner (N.P.), also known as an advanced practice nurse, has advanced clinical training and must complete an advanced graduate degree, in addition to professional registered nurse preparation. N.P.s undergo a rigorous national certification and state licensing process, and participate in professional development to maintain their clinical expertise. In addition, nurse practitioners can conduct research that they bring to their team and apply to their practice.

N.P.s provide a full range of health care services, including:

  • Ordering, performing and interpreting diagnostic tests, such as lab work and X-rays
  • Diagnosing and treating a wide scope of acute and chronic conditions, such as diabetes, high blood pressure and injuries
  • Prescribing medications and other treatments
  • Counseling
  • Educating patients about disease prevention, and positive health and lifestyle choices

What is a P.A.?

A physician assistant (P.A.) is a nationally certified medical professional who is trained to work as part of a team with physicians and is a graduate of an accredited P.A. educational program. A typical student graduates with a master’s degree and approximately six years of health care experience.  In order to retain their certification, P.A.s must participate in continuing medical education throughout their career.

P.A.s provide a full range of health care services, including:

  • Taking health histories
  • Conducting physical examinations
  • Ordering X-rays and laboratory tests
  • Performing routine diagnostic tests
  • Prescribing medications
  • Treating and managing patient health issues
  • Administering immunizations and injections
  • Counseling
  • Providing preventive health care services

P.A.s and N.P.s are often able to see patients for routine exams and illnesses sooner than the primary care physician could, which allows patients to access care without waiting several weeks to get an appointment. However, the primary care physician is always kept informed. The P.A. or N.P. will review patients’ care with the physician, including the treatment plan and any concerns that may require follow-up. Often, because the physician is also in the office seeing other patients, the P.A. or N.P. can consult with the physician immediately if there is a question, or even bring the physician in to see the patient.

Medical assistants and L.V.N.s

Finally, medical assistants and licensed vocational nurses (L.V.N.s) assist the team by bringing patients to exam rooms and answering patients’ phone or email messages. They also perform procedures such as immunizations, electrocardiograms (EKGs), pulmonary function testing and audiograms. Although certification is not always required, many medical assistants have completed accredited programs and are certified by the American Association of Medical Assistants. L.V.N.s must graduate from an accredited vocational nursing school and pass a licensure exam through the state of California.

How does the patient benefit?

  • Expanded ability to increase scope of care for patients and provide more detailed patient visits
  • Better access for patients including same-day appointments
  • Enhanced chronic disease management
  • Patient- and family-centered care
  • Stronger relationships between clinicians and patients
  • More than one expert and perspective in evaluating patient care

For more information about Scripps Health, visit or call 858-240-5075.

Categories: Health