But You're Not a Doctor? - Introduction

If you've ever been to a family medicine clinic, hospital, or specialist's office (which, let's face it, we all have), then you've probably uttered the phrase "I went to the doctor." But what does that really mean? Did you actually speak to a doctor? A nurse? A medical assistant? Today's healthcare system has so many varying occupations, from phlebotomists to ultrasound technicians to physicians, that it can be hard to keep up with what everyone's role is, even for me, someone with a career in healthcare.

An unfortunate side effect of continuing advancements in medical knowledge is that there's simply too much to know. When before we had family medicine physicians who would admit and treat their own patients requiring a hospital stay, we now have hospitalists for that job. We have a myriad of specialties and subspecialties to treat increasingly complex and rare conditions that didn't previously exist. Surgeons who stick to a few surgeries they can do really well, instead of general surgeons responsible for every condition requiring a cut.

To the unfamiliar, this may sound like a step back, an increase in healthcare complexity that negatively affects patient outcomes, but in reality, it's a necessary evil to keep up with the current standard of care. A family medicine physician does not have the experience or knowledge base needed to properly treat multiple myeloma or pituitary stalk interruption syndrome. Interventional cardiologists don't have time to see someone suffering from diabetes. The specialization of medicine, while often annoying and expensive for patients, increases patient safety and outcomes.

Out of this specialization has emerged the role of the mid-level healthcare practitioner. We're here to fill the gaps between all these specialists and all the different types of healthcare facilities. We have many names. Advanced practice provider, advanced practice clinician, non-physician practitioners, among probably several others, and new ones are being tossed around every day. Likely because no one knows exactly how to define us. Which, in a way, is impossible, as the role we fill in healthcare varies from person to person, from facility to facility, and is constantly evolving with our changing healthcare world.

I'll talk about this career field as "mid-levels," as this is a colloquial term I'm familiar with using, not because I believe it accurately describes our jobs. Mid-levels are primarily physician assistants (PAs), nurse practitioners (NPs), certified registered nurse anesthesists (CRNAs), and nurse midwives. I'd be surprised if you haven't been seen by a mid-level at some point, although you may not have realized it at the time. In many instances, our job is exactly the same as a physician's. Evaluate, test, diagnose, and treat patients. But this can be understandably confusing, as nurse practitioners and physician assistants are not doctors. So what gives?

I'll share with you a conversation I have with patients multiple times a day.

"Hello, I'm Hannah, I'm a PA and I'll be taking care of you today."

"Okay, but I'll still see the doctor?"

"Well, I'm a healthcare provider, and it's my job to evaluate and treat you today."

"But you're not a doctor?"

I can understand the confusion. My own nephews see-saw between calling me a nurse and calling me a doctor, they simply can't understand the difference between what I tell them I do and what a doctor does, so sometimes they fall back on calling me a nurse. And I don't mind. But I think it's important to understand the difference, as mid-levels are only going to become increasingly prevalent in the future, and hopefully my ramblings about my own experiences can help clear things up. And maybe we'll get some entertaining stories out of it along the way.