Today, office visits and hospital stays can be overwhelming.  The list of providers you can encounter during your care is astounding. Medical Assistants.  Hospitalists. Nurse Practitioners. Physician Assistants. Specialists. CNAs. PCTs. Interns.  Students. Different colored scrubs. Lab coats. And not a familiar face in any uniform. Who do you reach out to? Where do you start?  Who is in charge of your care? 

Back in the day, going to the doctor’s office used to be simple.  Sign in at the reception desk, sit in the waiting room, head back with the nurse and then meet with your doctor.  Same with a hospital stay – if you found yourself admitted as a patient – your primary doctor would see you every day and manage your care.  This isn’t the way it works anymore, and the list of providers you can encounter has grown.

Let’s start with the many people who can be involved in your care.

Primary Care Providers (PCPs)

First, what does “primary care provider” actually mean?  Originally, the term “PCP” referred to ‘primary care physician’, ie. your primary doctor or family physician.  With our changing healthcare team, this has evolved to the term ‘primary care provider’. They are the ones who will perform your yearly physical, manage medications, as well as discuss preventative health care options, and usually the one you visit in times of illness or injury.  

There are three groups of providers who can provide this care.  Physicians, Nurse Practitioners and Physician Assistants. In the whole realm of healthcare, your primary care provider should be the one who is most involved with your care. 

Physician

Most everyone in healthcare is familiar with the role of the physician.  They can be referred to as physician, doctor, osteopath, general practitioner, internist and pediatrician.  All of these providers treat adults in an office, or outpatient setting. Pediatricians are for those ages 0-18, and some pediatricians continue into college years as patient transition to a primary adult practice. 

Nurse Practitioner (NP) 

While many believe Nurse Practitioners are a new specialty, nurse practitioners as a profession has been going strong for 54 years.  Founded in 1965 by Dr. Loretta Ford, EdD, PNP, FAAN, and Henry Silver, MD, at the University of Colorado, the nurse practitioner evolved to help respond to the declining physician presence in urban and rural communities.  Nurse practitioners (NP) have additional educational training beyond their initial RN (registered nurse) education program. NP program preparation is either a Masters (MSN) or Doctoral (DNP) degree, that includes both classroom and clinical rotations.  Following completion of the MSN or DNP degree, nurse practitioners must be credentialed by either the American Association of Nurse Practitioners (AANP) and the American Nurses Credentialing Center (ANCC).

Nurse Practitioners can assess, diagnose and treat diseases, educate and promote prevention management, and provide patient centered care.  Over the past 54+ years, the cost effective care provided by nurse practitioners has demonstrated improved clinical outcomes and helped promote quality health care in all settings.  

Physician Assistant (PA)

Physician Assistants also have been around since 1965.  Dr. Eugene Stead Jr at Duke University Medical Center formed the first class of physician assistants, also in response to the anticipated shortage & maldistribution of physicians.  Physician Assistant (PA) is also a Masters degree program, that includes both classroom and clinical training. The clinical rotation is slightly different then NP programs including medical and surgical discipline rotations such as family medicine, internal medicine, general surgery, pediatrics, obstetrics and gynecology, emergency medicine and psychiatry. 

Both Nurse Practitioners and Physician Assistants provide quality patient care and offer to many individuals improved healthcare access they might not otherwise have.

Ancillary Staff

There are many other medical staff members within the office or hospital setting that could be involved with your care.  

Registered Nurse (RN):  This can be an associate degree or bachelor degree prepared registered nurse, with the scope of practice including assessment, diagnosis, planning, implementation, and evaluation of nursing care. RNs can be employed almost anywhere and are vital in the hospital (acute care) setting, and often found in the office (primary care) setting assisting working with patients and providers.  

Licensed Practical Nurse (LPN):  Traditionally a one-year program degree that focuses on patient care, observation, medication administration and reporting concerns to appropriate providers (including Registered Nurse, MD, NP, PA).  While LPNs can be found in the office setting, few hospitals employ LPNs because of the level of care that is needed with acute care patients. They usually work in long term care and assisted living facilities.

Medical Assistant (MA): These roles are usually found in the office setting.  They are often mistaken as the nurse in the office setting.  During an office visit they can take vitals (blood pressure, temperature, weight, pulse), draw blood, administer vaccines, review medications and call back patients with test results, etc. per provider instructions.  

Certified Nursing Assistant (CNA):  Some organizations use different terms for this position such as care tech, PCT, nursing assistant.  They are frontline staff who help the patients with basic patient care needs and report changes in patient condition to the nursing staff.  They usually assist with ADLs (Activities of Daily Living) including dressing, grooming, bathing, eating and toileting needs.  

Receptionist/Unit Secretary: Either in the office or hospital setting, these are people who keep the office or nursing unit on task.  They answer the phones, triage the calls, relay messages to staff and help schedule appointments. While they are the first person you speak with, they usually have no medical training.  This is important to keep in mind as you need to give them information to help them direct who best to help you; but don’t be surprised if they stop you from telling your story in depth as they will not be the one to ultimately help solve your problem. 

Answering Service/Call Center: This team involves those you would only interact with over the phone when you call the office after it is closed, or during lunch hours.  There is a good chance they have no direct connection between your provider or office staff – they just deliver the message that you called. They are important especially after hours, when you need to reach your provider when you have a concern about your health. 

So, who is in charge?

So, now that we know everyone we might encounter, who is actually in charge of your care? 

In our busy society, when we need to see our provider, we want to see our provider.  Waiting 2-3 weeks for a “sick” visit isn’t desirable, especially when you are ‘actually sick’.  Even follow-up visits after a long illness, injury or emergency room visit can be difficult to schedule.  To maximize a provider’s availability during office hours, they need to be there more which means rounding at the hospital when you are sick isn’t the best use of time.  That’s why, when you are in the hospital, the hospitalists are so important.  

What is a hospitalist?  

Hospitalist teams are a group of physicians, nurse practitioners and physician assistants that oversee patient care as the attending provider while in the hospital.  This hospitalist team will round on you daily, help direct care and any consulting providers needed, and ultimately coordinate your discharge. While in the hospital, they are usually the one “in charge” of your hospital stay.  

This is the first difference many patients realize when they are admitted to the hospital.  Their primary care provider isn’t going to visit or oversee their care. While this might be disappointing, keep in mind this allows for your provider to be in the office to focus on your recovery once you are back home.

Outpatient Setting

Once you are discharged back home, you are considered in the outpatient (or primary care) setting and your primary care provider takes charge once again.  They are critical to helping you transition from the hospital back home. A visit to the provider office should be at the top of your to-do list once your home.  This will ensure your provider is up to date on your health status, manage your medications and ensure you are on the right path to recovery. When you do call the provider office – be sure to tell the receptionist that you were just discharged from the hospital so they know the proper steps to take in order to get you the appointments you need.

While this can be overwhelming, the best decision you can make is to establish a relationship with a primary care provider.  Find the provider that is right to fit your needs and that you feel comfortable with talking about your own health concerns. They will help navigate preventative healthcare, wellness visits, immunizations and yearly vaccines.  They manage your medications, chronic diseases and when the unexpected happens, help guide you to the resources you need. Remember, your primary care provider’s focus is to be the one in charge to steer you on the best path towards your optimal health.  

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