UPDATE: 2019 open enrollment for the Affordable Care Act plans runs from November 1, 2018 to December 15, 2018. Find out more here.
By Grace Gedye
When you go to the doctor’s office, it can feel like a parade of white lab coats and scrubs. One person takes you back to the exam room, another takes your vitals, another does a physical exam, and you’re sent to a fourth person for a blood draw. To get the most out of visits, it can help to know who’s who and what they can do for you.
When you check in
First you interact with non-medical staff—the people who deal with scheduling appointments, billing health insurance, and other administrative duties.
Registration Associate: Also known as a receptionist, this person will check you in when you arrive and collect your insurance information and any required payment.
Practice Manager: The practice manager oversees the business operations of the clinic. You may not come into contact with them unless you have a question about billing, in which case they should be able to field your question or direct you to someone who can.
When you go back to the exam room
Next, there’s the person who walks you back to the exam room, asks you a whole bunch of questions about your medical history, and takes your vitals. Who’s that person?
Medical Assistant: In addition to the usual intake routine (weight, blood pressure, and some questions), medical assistants should make you feel welcome. The chart notes they take save valuable time later on in the appointment. Medical assistants aren’t licensed to administer medical care on their own—they might tell you about the flu shot, for example, but would only administer it if directed to by the attending MD, nurse practitioner, or physician’s assistant.
Registered Nurse (RN): There’s also a chance that you will see a registered nurse before you see your primary care provider. In a clinic setting, nurses might administer diagnostic tests or conduct physical exams. (In hospitals, RNs are often in charge of day-to-day care—whether it’s setting up IVs, giving you medication, or keeping your family updated about your care.)
When “the doctor” comes in
For most of your routine medical care you will see your primary care provider (PCP)—and this person might not be an MD. Your PCP is your go-to person for non-emergency medical needs. If you have an HMO health insurance plan, you are required to choose a PCP who will then refer you to specialists or hospitals. Your PCP can be an MD, but you could also choose a nurse practitioner (NP) or a physician’s assistant (PA) depending on who is regularly available and whom you like.
Doctor of Medicine (MD): MDs have undergrad and medical degrees, plus years of residency training under their belt. Some have special certifications in fields like family medicine, emergency medicine, or pediatrics. MDs can diagnose and treat illnesses, prescribe medications, interpret test results, refer you to specialists, and more. Their time is at a premium, but they shouldn’t make you feel rushed. MDs will ask you questions, but they aren’t mind readers—here’s how to get what you want and need out of your visit.
Doctor of Osteopathic Medicine (DO): DOs are fully licensed physicians and have the same level of training as MDs. Like MDs, they are licensed to practice medicine, perform surgeries, and prescribe medications. DOs pay special attention to how your muscular and skeletal systems impact your overall health, and many are trained in spinal manipulation and massage therapy.
Nurse Practitioner (NP): Nurse practitioners are clinicians with a master’s degree or doctorate in nursing. Like physicians, NPs can diagnose and treat illnesses, prescribe medications, and interpret test results. Also like physicians, nurse practitioners can run their own practices in many states. NPs can also specialize in areas like women’s health, pediatric care, or adult primary care. One benefit of seeing an NP is more face time: Linda Dominguez, a nurse practitioner at Southwest Women’s Health in Albuquerque, NM, estimates that NPs can give you 25-50% more time than a physician can. Because of their nursing background, NPs are known for their holistic approach and may be more likely to ask you questions about family and relationships when developing a health plan.
While NPs can handle most health issues that come up in a clinic setting, there are health issues that go beyond the scope of their training. According to Dr. Mike Policar, MD, MPH, and Clinical Professor of Obstetrics and Gynecology at UCSF School of Medicine, “nurse practitioners’ scope of practice is mainly limited by their lack of ability to do surgical procedures (they can do some office procedures but they don’t do them in the operating room) and handling really complex health issues like cancer or very complicated hormonal issues.” The bottom line is that NPs can handle a whole lot of what MDs do, and can consult with a physician or refer you to one when needed.
Physician’s Assistant (PA): Like NPs, PAs are “advanced practice practitioners,” but they work under the direct advisement of a physician, they may have fewer years of training than NPs, and they cannot run their own practice. You might be seen by a PA for an intake visit or for very straight-forward health problems. For more complex problems, PAs might leave the room to consult with the doctor, or send the doctor in to see you. And if a PA isn’t explaining something in a way that makes sense or you want a second opinion, Dr. Policar says it’s your prerogative to respectfully ask to see the attending physician: “Any PA who has professional pride in what they do is not going to be insulted by that. They should be perfectly willing and happy to arrange that.”
When they refer you to a specialist
If a health concern arises during your appointment that your PCP cannot address, they might refer you to a specialist. Make sure you know exactly why you are being referred—you will save a lot of time if you can give the specialist a short run-down. To avoid surprises, Dominguez also reminds patients to do some research in advance: “Go on their website and see if you’re going to be charged if you don’t show up on time, or if your appointment is going to be canceled if you are 15 minutes late.”
There are SO many specialists, so we won’t go through all of them here. But OB/GYNs are worth a special mention, because most people with vaginas will see them on a regular basis.
Obstetrician/Gynocologist (OB/GYN): Gynecologists specialize in women’s reproductive health, and obstetricians care for a woman during and after pregnancy. Someone with specialization in both is an OB/GYN. They will counsel you on birth control, screen for cancer, and perform pap smears and breast exams—so it’s important that you find an OB/GYN you trust. Some people think of their OB/GYN as their primary care provider because they see them on a regular basis. But Dr. Policar warns that that “terribly fragments the care that a woman gets.” He argues that since OB/GYNs have limited training on non-reproductive health issues, they are more likely to refer their patients to specialists for simple, non-reproductive health problems that an internist or family practice doctor could handle.
Many of the services that OB/GYNs provide are considered “preventative services” under the Affordable Care Act (ACA) and are completely covered without copays or deductibles (i.e. 0$ out of pocket). The ACA also mandates that women be able to see OB/GYNs without a referral from another health care provider, so it’s easier than ever to make an appointment.
When you need a test or prescription medication
Once you leave your appointment, there might be some follow up steps.
Technician: If your health care provider can’t come to a conclusive diagnosis without test results, odds are you will see a technician. Technicians draw blood, administer x-rays, and analyze urine samples, but they don’t interpret test results. If you’re appointment was at a small clinic or practice, you might have to make an appointment with a separate lab. If you are in a large clinic or hospital, you might be able to get the requisite test just down the hall.
Pharmacist: Your local licensed pharmacist has a four-year professional doctorate degree and can do more than fill prescriptions—pharmacists can explain dosage information, discuss side effects, and review all of your medications with you for potential interactions. (Bonus for people in California and Oregon: pharmacists in those states can prescribe birth control as well!)
These are the key folks you will interact with in a typical health care visit, but there are many others—from medical directors, to social workers, to nurse midwives, to medical students and residents. Knowing who you’re talking to, what their qualifications are, and who you will be seeing next helps you get the most out of your appointment. And never hesitate to say something like “Sorry, but I didn’t catch what exactly your role or title is.”
If you’re thinking, “this is all very well and good, but I don’t visit the doctor that much because I don’t have health insurance,” we’ve got good news for you. Open enrollment for health insurance via HealthCare.gov goes until December 15, 2017. Most people can find plans for $75 per month or less, so there’s no time like the present to enroll.
— Grace Gedye is a former Bedsider intern and a student at Pomona College, where she studies Political Science, Media Studies, and Computer Science. She loves running, making food with friends, and listening to podcasts. (Oh, and talking about reproductive health—that’s a big one!)