Choosing a new doctor - MD, DO, PA, FNP?

[mountainsoft]

We just signed up on an ACA plan and need to choose new doctors. I've had a PA (physicians assistant) at Kaiser for many years and have been happy with him. But I'm not sure how all the different designations rank when searching for a new doc.

MD seems the obvious choice, but I haven't seen many locally, most aren't accepting new patients, and those that are have really long wait times.

Even PA's seem fairly slim and overbooked.

My wife just chose a DO doctor, which I've read is similar to an MD? I might choose the same doc, I'm not sure. Of course, she's booked out to mid-December too.

There's also an FNP doc available at the same clinic, but I don't know how good they are for basic care.

For basic routine doctor visits (aches and pains, colds and flu's, prescriptions and vaccinations, etc.) does it really matter what letters they have after their names? Personality matters a lot.

 

[Philliefan33]

For routine visits, I’ve had more luck with PAs and NPs. They seem to not be as rushed as the doctors in the office. If I had a complex medical issue I might prefer an MD.

PAs are trained in the medical model, meaning they treat the disease. NPs (FNP stands for “ family nurse practitioner”) in the nursing model, meaning they treat the patient. To get into NP school, one needs a BSN and at least a year of experience as an RN. To get into PA school, you need a bachelor’s degree but you won’t have direct patient care experience since you haven’t been licensed. PAs and NPs usually specialize in a specific area. For example, my DD is an NP who specializes in cardiac care and works in a hospital. My nephew is a PA who works with a neurosurgeon in his office and pain clinic. At a family practice you are going to encounter PAs or NPs who specialize in internal medicine/family medicine.

PAs and NPs can do the same things (there may be slight differences in prescribing rules, depending on your state of residence). Each need to be affiliated with an MD or DO, usually working in the same practice. In Pennsylvania, the providers that staff the Minute Clinics and such in the drugstores are NPs but I don’t think PAs are allowed to do that.

 

[OldShooter]

If you're shopping anyway I suggest that you see what concierge medicine programs might be available to you. We have been in one such program for five years or more and are very happy with it. There are essentially no wait times for appointments ("What time do you want to come in?") and everyone is on a first-name basis. There are three docs and one of them is always carrying a cell phone that we can call 24xl7 as needed. They monitor what's going on with our other doctors or when one of us in the hospital. They will also make house calls and hospital visits if necessary through we have never needed this.

When we were shopping we found that there was absolutely no standardization of offices, services, prices, or interaction with insurance and Medicare. Our docs are in a physically separate area of a large care organization, so we have instant access to all kinds of resources. Only two chairs in the waiting room and I have rarely seen anyone sitting there. Other programs we looked at were sometimes just one doc. So if you decide to investigate you'll really have to do your comparison shopping homework. It's kind of a BTD option but what a more important thing to spend on?

 

[tutan]

We just signed up on an ACA plan and need to choose new doctors. I've had a PA (physicians assistant) at Kaiser for many years and have been happy with him. But I'm not sure how all the different designations rank when searching for a new doc.

Mountainsoft, is Kaiser not available under ACA in your state? I signed up with Kaiser in California.

 

[Ian S]

My last two PCPs have been DOs and I've been very pleased with both. They seem to be willing to spend a little more time explaining things and answering questions. I have not had a PA or NP for primary care but have been seen by both when it was short notice and the doctor was unavailable. The experience has been generally good but there was one occasion when a couple of them were perplexed by my problem and finally called in the doctor. He immediately made the correct diagnosis of a neuroma and referred me to specialist.

 

[pacergal]

I have had experience with all.
NPs work independently, and have MDs in the practice to consult with.
PAs work under an assigned MD, who oversees their work.
In my experience, NPs and DOs have had a more holistic approach.

OP--ARE you not able to still sign up for Kaiser and keep your PCP? Kaiser is available through ACA in Oregon, my son has it.

 

[mountainsoft]

Tutan and PacerGal.

Yes, Kaiser is available on the ACA exchange here, but it costs more this year than other plans in our area. Kind of surprised me as they have always been one of the more affordable options (before we signed up with ACA).

So, we went with Regence. Cost less, better coverages.

 

[Act2]

I’ve had good and bad MD’s, good and bad DO’s (mostly good), good and bad NP’s and PA’s. They are all credible professionals. Patient experience varies more depending on the individual provider than title, in my experience.