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Who Should Lead Your Healthcare Journey? Picking Your PCP

Writer's picture: Cindy DavisCindy Davis

Image of possible PCPs - Doctors, NPs, and PAs

Each year during the open enrollment period for your health insurance plan, it is recommended you consider whether your current Primary Care Provider (PCP) aligns with your health needs, particularly as you age. This period is an ideal opportunity to assess your options, ensuring your PCP can manage your physical and cognitive health along with any chronic conditions. Your decisions may also be influenced by the availability of medical practitioners, as access in rural and low socioeconomic areas often differs from that in well-resourced urban communities. But always remember, you don't have to wait until open enrollment to switch PCPs, changes can be made anytime during the year.

Understanding Primary Care Provider (PCP) Options

Your Primary Care Provider is your first point of contact for all your healthcare needs. There are three main types of doctors that can serve as your PCP – a Family Medicine Physician (Family Doctor), a General Internal Medicine Physician (Internist), or a Geriatrician. In some states, a Nurse Practitioner (NP) or Physician Assistant (PA) in your doctor’s office may also be designated as your PCP.  To help you make your decision, let’s first explore the differences between the doctors.

Graphic showing the range of PCPs by Age
Primary Care Provider Options by Patient Age

Family Medicine Physicians

Picture of Family Medicine Physician with multigeneraltional family

Family Medicine Physicians are equipped to treat patients of all ages and genders, from infants to the elderly, making them a versatile choice. For example, a Family Medicine Physician in a rural clinic may treat a child with an ear infection, a teenager with acne, and an elderly patient with arthritis all in the same day. Here are some of the common services offered by your Family Doctor:

 

  1. Preventive Care including routine check-ups, health screenings, and vaccinations to prevent illnesses and detect health issues early. Family doctors emphasize preventive care to help maintain the overall health of family members across all ages.

  2. Chronic Disease Management of ailments such as asthma, diabetes, hypertension, and high cholesterol, providing ongoing care and monitoring to optimize health outcomes.

  3. Acute Care treatment of sudden medical issues like respiratory infections, injuries, and other urgent health concerns, seeing patients for everyday ailments that need immediate attention.

  4. Pediatric Care including well-child visits, immunizations, growth and development monitoring, and treatment of common childhood illnesses.

  5. Women’s Health by performing gynecological exams, family planning, and prenatal care. Although not specialists in obstetrics, many family doctors manage uncomplicated pregnancies and provide postpartum care.

  6. Men’s Health in addressing specific health issues related to men, including prostate health and screening for conditions more prevalent in males.

  7. Geriatric Care for health concerns common in older adults, such as arthritis, osteoporosis, and mobility issues, with a focus on maintaining independence and quality of life.

  8. Mental Health Services giving support for issues such as depression and anxiety, often managing these conditions through medication and therapy referrals.

 

If you have children and elderly parents, a Family Doctor can treat all of you, offering developmental advice for your children and handling chronic conditions for you and your parents. Family Medicine Physicians are particularly valuable in rural settings and underserved areas where they often form long-term relationships with entire families and populations with limited resources, understanding and treating health issues within the family's broader context.

 

Family Medicine Physicians complete medical school followed by a three-year residency in family medicine, covering a broad spectrum of care, including pediatrics, internal medicine, obstetrics, and geriatrics. Their training allows them to handle a diverse range of health issues, from delivering babies to managing the challenges associated with aging.


General Internal Medicine Physicians (Internists)

Picture of an Internist with older adult couple

Internists specialize in managing multi-system disease processes affecting internal organs that arise in adulthood (18+ years of age). Their approach is more specialized, focusing on the internal systems of the body such as the heart, lungs, and digestive tract. Here are the common services provided by your Internist:

 

  1. Comprehensive Adult Physicals to assess and monitor vital signs, organ function, and overall health status.

  2. Chronic Disease Management of long-term conditions such as hypertension, heart disease, obesity, and arthritis, including medication management and lifestyle advice.

  3. Diagnostic Testing through utilization of blood tests, imaging studies, and other diagnostic tools to understand the cause of symptoms and how conditions are progressing.

  4. Preventive Care guidance on disease prevention and health maintenance strategies, such as vaccinations, cancer screenings, and counseling on diet, exercise, and smoking cessation.

  5. Specialized Care for Complex Health Issues that require a deep understanding of how different conditions affect each other, such as managing a patient with diabetes who also has heart disease.

 

If you have multiple challenges like chronic obstructive pulmonary disease (COPD), dementia, and inflammatory bowel diseases, an Internist will coordinate your care, ensuring each condition is managed effectively and considering how disorders interact with each other. When advanced treatment is necessary, an Internist will provide a referral to other specialists such as oncologists, neurologists, orthopedists, and rheumatologists.

 

Your General Internal Medicine Physician will have completed medical school followed by a three-year residency in internal medicine. Their expertise includes managing complex diseases like heart failure, chronic kidney disease, and advanced liver disease, making them well-suited for patients with multiple health issues.


Geriatricians

Image of Geriatrician with Elderly woman

Geriatricians are specialized in treating older adults, providing comprehensive care tailored to the unique needs of the frail and elderly, often scheduling longer appointments to address complex issues. For example, if you are 65 or older and taking multiple medications, a Geriatrician can help adjust your prescriptions to suit how aging bodies process ingredients and mitigate side effects. Here are some of the common services provided by Geriatricians:

 

  1. Comprehensive Geriatric Assessment including a detailed evaluation of your physical, psychological, and functional performance. Geriatricians gauge cognitive function, mobility, nutritional status, and social support systems to create a personalized care plan.

  2. Management of Chronic Diseases such as heart disease, diabetes, arthritis, and dementia considering how these conditions manifest differently in an aging body versus that of a younger adult.

  3. Medication Management for older adults often taking multiple medications from different specialists, which can lead to complex drug interactions and side effects. Geriatricians review medication mix and make changes to reduce risks and ensure the treatment regimens are safe and effective for someone of your age and health status.

  4. Fall Risk Prevention assessments and interventions that may include physical therapy, home safety evaluations, and modifications to reduce hazards.

  5. Functional Independence Appraisal focusing on maintaining and improving your ability to perform daily activities such as bathing, dressing, and eating. This may involve working with occupational, physical, and speech therapists or other specialists.

  6. Cognitive and Emotional Health Evaluation addressing issues like depression, anxiety, and dementia to provide or coordinate appropriate therapies, support services, and counseling for patients and their families.

  7. End-of-Life Care for patients and families to understand the progression of age-related diseases and assist in making informed decisions about end-of-life care, including palliative care options, advance directives, and naming a healthcare agent.

  8. Support for Caregivers by providing resources for family members and caregivers who play a crucial role in ensuring elderly quality of life preferences. This includes education about the patient's health and guidance on caregiving techniques.

 

By focusing on these areas, geriatricians aim to improve the quality of life for the elderly, helping them maintain their independence and dignity as they age. In addition to medical school and residency in internal or family medicine, Geriatricians complete additional fellowship training in geriatrics. This specialized training equips them to handle the complexities of aging-related health issues. Their training allows them to focus on conditions like osteoporosis, dementia, and frailty, providing targeted care that addresses the specific challenges faced by older adults.

Nurse Practitioners vs. Physician Assistants

When it comes to primary care, Nurse Practitioners (NPs) and Physician Assistants (PAs) can perform many of the same tasks as doctors. They diagnose and treat medical conditions, order and interpret lab work and diagnostic tests, prescribe medication, and provide patient education.

 

Both NPs and PAs are highly trained professionals who can provide a range of healthcare services and play vital roles in hospitals, clinics, physician offices, and other medical facilities, but they differ in approach, scope of practice, and training backgrounds.

Understanding the differences between these two roles can help you make informed decisions about whether you are open to using a NP or PA in place of a traditional doctor. Let’s review the differences.


NP and PA - Approach to Care

Nurse Practitioners
Physician Assistants

NPs are trained in the nursing model, which emphasizes a holistic approach to care. This model prioritizes the health and well-being of the whole person by considering physical symptoms in the context of emotional, social, and environmental factors. NPs tend to spend more time in patient consultation, focusing on education, preventive care, and wellness, along with treating chronic conditions.

 

An NP managing a patient with heart disease might discuss medication management, diet, exercise, stress reduction, and family support as integral parts of the treatment plan.

PAs are educated in the medical model, which is the same model that trains physicians. The medical model focuses more on the biological and pathological aspects of health, emphasizing diagnosis and treatment of acute and chronic illnesses. PAs are likely to delve deeply into the science of the patient’s condition and the specifics of treatments.

 

A PA managing a patient with heart disease will focus on diagnosing the extent of the disease, prescribing and managing medications, and monitoring physiological responses to treatment.

NP and PA - Scope of Practice

Nurse Practitioners
Physician Assistants

In many states, NPs have the authority to practice independently without physician oversight. They can open their own clinics and make independent decisions about patient care, including diagnosing conditions, ordering tests, and prescribing medications. This autonomy allows NPs to serve as primary care providers, particularly in underserved areas.

Generally, PAs must work under the supervision of a physician, although the level of supervision can vary from direct to collaborative depending on state laws. PAs are versatile in their ability to work across various specialties, including emergency medicine, surgery, and primary care, adapting to different roles as needed within a healthcare team.

NP and PA - Training and Education

Nurse Practitioners
Physician Assistants

NPs must first be registered nurses before pursuing further education, typically a Master's or Doctoral degree in Nursing. Their training includes specific focus areas like family practice, pediatrics, or geriatrics, with a strong emphasis on patient-centered care and community health.

PAs typically hold a master’s degree from an accredited educational program that involves training across the medical spectrum. Unlike NPs, who specialize during their advanced studies, PAs receive a broad medical education akin to medical school, which enables them to enter various specialties without additional schooling.

Both NPs and PAs are integral to the healthcare system, offering high-quality care. Your choice might depend on your personal health philosophy, the type of healthcare relationship you prefer, and the specific services you need. NPs might be the right choice if you value a holistic approach and perhaps need consistent care for chronic conditions in a community-based setting. PAs might be better suited if you have complex medical needs that require frequent collaboration with various specialists. Understanding these differences can help guide your decision in choosing the provider that best fits your health care philosophy and needs.


Making Your PCP Choice

As you navigate the complexities of choosing a Primary Care Provider (PCP) during open enrollment or at any time you feel a change is needed, it's essential to understand the different types of providers available to you. Whether you opt for a Family Medicine Physician, an Internist, or a Geriatrician, each brings unique skills and focuses that cater to specific health needs. Additionally, in many states, you can also choose a Nurse Practitioner (NP) or Physician Assistant (PA) as your PCP. These professionals can provide comprehensive care similar to physicians, often with a focus on patient education and preventative care.

 

Family Medicine Physicians offer all-encompassing care suitable for all ages, making them ideal for families, especially in rural settings where they might be the only healthcare option. Internists are experts in adult medicine, perfect for managing complex health conditions common in adulthood and old age. Geriatricians specialize in the care of older adults, with a keen focus on optimizing treatment for age-related conditions and medication management.

 

Choosing the right PCP means selecting a provider who understands your medical history and anticipates future health challenges, ensuring personalized care that enhances your overall well-being. Whether you choose a doctor, NP, or PA, consider a provider who aligns best with your health philosophy and the level of specialized care you require. This decision is pivotal in managing your health effectively, particularly as your needs evolve with age. By choosing a PCP that fits your life stage and health needs, you ensure a tailored approach to your healthcare, facilitating better management of your conditions and overall well-being.


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GeriScope offers general insights and information about navigating the different phases of aging, empowering seniors, loved ones, and caregivers to make informed decisions. While some topics involve ethical and legal considerations, GeriScope does not provide legal or medical advice. The views expressed are those of the authors and should not replace personalized advice from legal and medical professionals. Users are encouraged to seek advice tailored to their specific circumstances from qualified professionals in their state.

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