Physicians and nonphysicians: What are the differences?

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hat is especially the case given the relentless efforts to expand the scope of practice for nonphysician providers—dubbed scope creep. Such legislative or regulatory changes would inappropriately permit nonphysician providers to deliver care without doctor supervision, which can increase patient safety risks and health care costs.

Fighting scope creep is a critical component of the AMA Recovery Plan for America’s Physicians.

Patients deserve care led by physicians—the most highly educated, trained and skilled health professionals. The AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety.

Physicians are trained to lead, and the AMA stands in strong support of physician-led health care teams. More than 90% of patients say that a physician’s years of education and training are vital to optimal patient care, especially in the event of a complication or medical emergency. Patients also deserve to know who is providing their health care and the education and training of their health care professional. 

To help set the record straight, the AMA is publishing a series of news articles outlining the key differences between various types of physician specialists and nonphysician providers.

1. Physicians and nurses practitioners.
2. Nurse-practitioner (NP) programs generally last two to four years, however, some nurse practitioners can get their degree in as little as 18 months after becoming an RN. Online-only programs are allowed. Physicians, by contrast, must complete four years of medical school to earn a degree as an MD (a doctor of medicine) or a DO (doctor of osteopathic medicine). There are no online medical schools.
3. Meanwhile, nurse practitioners have no residency training requirement, whereas physicians must complete three to seven years of residency and fellowship training depending on which specialty they pursue. Nurse practitioners will tally just 500–750 patient-care hours in training. By comparison, physicians get between 12,000 and 16,000 hours of patient-care experience.
4.  Physician assistants and physicians.
5. Physician assistant (PA) programs usually run about two years long, or perhaps two and a half. In addition, physician assistants have no residency-training requirement. Compare that with physicians’ training, which includes four years at a medical school—none of which are online-only—along with three to seven years of residency and fellowship training, depending on the physician specialty they pursue.
6.  Optometrists and ophthalmologists.
7. All optometrists have completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (OD) degree. Some also complete an optional residency in a specific area of practice, but there is no mandatory postgraduate training in optometry.
8. By contrast, ophthalmologists are physicians—either medical doctors, MDs, or doctors of osteopathic medicine, DOs—whose education and training consists of pre-professional undergraduate education in a college or university, four years of medical school, four years of residency training, and about 40% of ophthalmology residents go on to do an additional one- or two-year fellowship in a subspecialty.
9. In addition, whereas optometrists receive about one-year in clinical rotations, ophthalmologists get more than 12,000–16,000 hours during their training.
10.  Psychiatrists and psychologists.
11. Doctors of psychology and doctors of philosophy in psychology—who earn PsyD degrees and PhDs, respectively—get four to six years of graduate-level education plus a one-year internship. Moreover, psychologists complete a one-year internship while psychiatrists get between 12,000 and 16,000 hours of patient care during their four- to six-year residency program.
12. More important even than years of training, however, is the nature of the education these two types of health professionals get. The core issue is that, while psychologists may be well-equipped behavioral experts, their educational requirements include zero training in medicine. While psychologists provide care for emotional and behavioral issues, they are not equipped to provide the medical care psychiatrists provide.

Find out in detail why education matters to medical scope of practice, with information on:

• Nurse practitioners compared with physicians.
• Physician assistants compared with physicians.
• Nurse anesthetists (CRNAs) compared with anesthesiologists.
• Psychologists compared with psychiatrists.
• Naturopaths compared with physicians.

Visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.

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