Associate Clinicians Are Team Players

L-R: Betsy Hartman, ANP, Lesley Rae Larsen, CNM, Sylvia Ingerson, PNP, Vivian Calibrisi, PA-C, and Rachael Pelletier, FNP. Not pictured are: Christie Aldrich, FNP, Anne Bowers, FNP, Linda Chasse, FNP, Cynthia Fort, FNP, Megan Garrigan, PA-C, Jane Goodman-Page, ANP, Ann-Marie Licari, FNP, James Lontine, PA-C, Michelle Machesky, PS-C, and Mary Scott, ANP.

NEWPORT, VT - North Country Health System is very fortunate to have a dedicated, caring staff comprised of people with varied backgrounds and educational training.  Some personnel provide medical services and some provide clerical or support services.  Regardless of the service provided, teamwork is the key to success, and that is exactly what physician assistants and nurse practitioners bring to the offices in which they practice.

Physician Assistants (PAs)

Physician assistants see themselves as team members who work side-by-side with doctors.  Trained on the medical model, which is the same model used to train doctors, PAs are health care professionals licensed to practice medicine with physician supervision.  As such, PAs may conduct physical exams, diagnose and treat illness, order and interpret tests, counsel on preventative health care, assist in surgery, write prescriptions, and conduct education research and administrative services.
  
PAs often have years of experience with hands-on training in technical specialties.  They attend intensive accredited medical programs.  PA students are taught, as are medical students, to diagnose and treat medical problems.  A typical PA program applicant has a bachelor's degree and four years of health care experience before beginning the program. The course of study spans approximately 26 months and consists of both classroom and laboratory instruction.  They must take classes such as anatomy, pharmacology, path physiology, clinical medicine, and physical diagnosis.  PAs must also participate in six- to eight-week clinical rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, emergency medicine, and geriatric medicine.  The educational difference between PAs and doctors is the amount of time spent in formal education.  Physicians are required to complete an internship and many complete a residency, whereas a PA does not.

Upon graduating from an accredited program, a physician assistant student must pass the national certifying exam for licensure in the state where he or she will practice. Upon passing the exam, the PA earns the “certified” designation of PA-C. To maintain national certification, PA-Cs must log 100 hours of continuing medical education every two years and sit for a recertification exam every six years.

Nurse Practitioners (NPs)

Nurse Practitioners maintain a close working relationship with doctors.  They may serve as a primary care provider because they provide some of the same care as a physician. NPs have a unique approach and stress both care and cure. They are advanced practice nurses who provide high-quality health care services similar to those of a doctor.  Among the many services that NPs provide: 

• Order, perform, and interpret diagnostic tests such as lab work and x-rays
• Diagnose and treat acute and chronic conditions such as diabetes, high blood pressure, infections, injuries
• Prescribe medications and other treatments
• Manage patients' overall care
• Spend time counseling patients
• Help patients learn how their actions affect their health and well-being

NPs are trained using the nursing model and are holistic caregivers who look at the patient as a whole, not just the disease.  Nurse practitioner training programs require that the candidate be an RN having completed a Bachelor's Degree in Nursing.  Most employers and some states require a Master's Degree in Nursing as a minimal requirement.   Then they must attend a state-approved advanced nursing education program, which includes clinical training.  After completing the education program, the NP candidate must be licensed in the state in which he or she plans to practice. The State Boards of Nursing regulate nurse practitioners, and each state has its own licensing and certification criteria.  Depending upon the licensing state, the NP must recertify every two or three years.  After state licensing, the NP may then apply for national certification in their specialty area from one of several professional nursing organizations, such as the American Academy of Nurse Practitioners.  NPs specialize in many areas, including:  acute care, adult health, family health, gerontology health, neonatal health, oncology, pediatric/child health, psychiatric/mental health; and women's health.  They also often practice in sub-specialty areas such as:  allergy and immunology, cardiovascular, dermatology, emergency, endocrinology, gastroenterology, hematology and oncology, neurology, occupational health, orthopedics, pulmonology and respiratory, sports medicine, and urology.

History of the PA and NP Programs

The PA program began in the mid-1960's when physicians and educators recognized that there was a shortage of primary care physicians.  Dr. Eugene Stead of Duke University put together the first class of PAs in 1965, comprised of Navy corpsmen who had received medical training for the Vietnam War.  The curriculum was based on the fast-track training of doctors during WWII.

Today, how a PA practices medicine varies with training experience, state law, and the supervising physician's practice.  PAs usually see the same types of patients as the doctor.  Referral, or close consultation with the physician, is done for unusual, or hard-to-manage, cases.
Nurse Practitioners have provided excellent health care for more than 40 years.  The first NPs were educated at the University of Colorado in 1965.  Programs soon spread across the U.S.  As of 2006, there were about 115,000 practicing NPs.  Close to 6,000 new NPs are prepared each year at over 325 colleges and universities.

Both NP & PA are Professionally Supported

Supporters of the NP profession include the following: American Association of Critical-Care Nurses, American Psychiatric Nursing Association, Board of Certification for Emergency Nursing, National Certification Board of Pediatric Nurse Practitioners and Nurses, National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties, Oncology Nursing Certification Corporation, and American Holistic Nurses Association. Included among the supporters of the PA profession are:  The American Medical Association, The American College of Surgeons, The American Academy of Family Physicians, and The American College of Physicians.

The Eighth Report to the President and Congress on the Status of Health Personnel in the U.S. declared in 1992, “Physician assistants have demonstrated their clinical effectiveness both in terms of quality of care and patient acceptance.”  The relationship of PA and physician is one of mutual trust and respect.  They are a medical team in the delivery of medical care.
NPs have distinguished themselves from other health care providers by focusing on the whole person when treating specific health problems and educating their patients on the effects those problems will have on them, their loved ones, and their communities.
While they may come to the team with a variety of backgrounds and training, one thing that the nurse practitioners and physician assistants share is their desire to do their jobs the very best they can in order to provide patients with the quality care and treatment they deserve.

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