Doctors and Nurses and Physician Assistants and Nurse Practitioners, oh My....

There is no doubt that the medical field has changed in the United States. Doctors have more paper work than ever, more demands are put on them to do more with less, and they are so overworked, that I can not even comprehend that their burn out rate is not higher than it is. I have seen that 51% of doctors surveyed lack the initial enthusiasm they had when they entered the field. Then, medscape.com had a great report dated January 13, 2016, where anywhere between 40-55% of doctors surveyed said they suffered from burnout -- that lack of enthusiasm for a job. Actually, with the burnout, the career becomes simply a job. Lots of difference there, folks.

The first time I encountered medical burnout was when I was tutoring at a university, and I had a student who was a pediatric oncology nurse. She said she could not do it any longer, it was too hard to watch one child after the other die, and she had to quit. Not because she was not good at her career, not because she was not knowledgeable about the medicine; simply, it got the best of her. Somewhere out there is a nurse turned teacher, and I am sure she has had a fulfilling second career.

So, how can we help? We, the public, continue to get sick, to develop symptoms of chronic or fatal diseases, and we need the medical team's knowledge to guide us on that journey.

There are two ways that are relieving some of the burden doctors face today. These people are called Physician Assistants and Nurse Practitioners. So, what's the difference?

Physician Assistants are what I would call the doctor's right hand man (or woman). PAs have a lot of education, but fall short of the mandatory residencies the doctors must fulfill to become board certified. PAs have an undergraduate degree, enter a PA program that lasts about 2-3 years, and then have a one year clinical rotation, gaining experience in clinics, physicians' offices, and long-term care facilities.

They are an employee, which means they do not take calls after hours, do not make hospital calls (although that is changing), and do not have the hours of paperwork the doctor is responsible for. In other words, the doctor is the supervisor, and once the day is done, the PA can go home and have a regular life.

They basically do what a doctor does except perform surgery. They may be able to assist in surgery (I know my orthopedic doctor employed a PA who assisted in my surgery), but they can NOT perform the surgery.

They are nationally certified and must continue their education forever, which means they must take so many hours of continuing education hours every so many years. Whatever their state says.

Doctors make around 200-300,000 a year, and for that they get to work 24/7. Lucky them! A PA's starting salary is around 80,000 a year, and the average is 90-113,000 a year, and they get to go home at the end of the day. Good job!

A Nurse Practitioner is different from a PA in many ways. The first and foremost way is they do not have to have a doctor as a supervisor, they can practice independently. When I first learned about this, I thought of the 60 Minute program showing the nurses who went around in a really, really used RV in the Appalachians helping those without any sort of medical care.

NPs first start off with an RN degree, then they have to have 1-2 years experience before getting a NP Masters Degree, and then have between 750-1400 clinical hours. If you would calculate that in a 40-hour work week, it would be up to 35 weeks in clinical practice.

The other big difference between the PA and the NP is the PA is a generalists -- once he gets licensed, he can go anywhere and work in any of the medical fields he wants; once the NP gets into the program, he must specialize in a certain medical field, such as family practice, psychiatry, or gynecology (I had a NP who worked in my gynecologist's office, and she was good, very, very good).

They, too, are nationally certified, but they also need to be re-certified every five years. They also make a good wage -- on average 82-96,000 a year. And they get to go home, too, at the end of the day.

I am all for doctors. I will help them in any way I can, so when there is a minor adjustment to my body, I definitely will see a PA. I really don't see too many NPs, but I would imagine they are in more clinics or in rural areas without the benefits of a doctor at hand. And I am also an advocate of my doctor taking time off. I figure if you have to work 24/7, then you should be able to take more vacation time. I want my doctor to not burn out, and to be relaxed, so go, enjoy, and let the PA or NP take over for a week every so often.

If you want more information about these two career choices you can visit AAPA.org for the Physician Assistant, and AANP.org for the Nurse Practitioner.

Until Wednesday...have a great day...