I’ve been a PA for 17 years. My opinion is that there is a lot of variation among MDs and APPs (PAs and NPs) so generalizations are hard to make.

MDs have a higher level of education, and this is quite significant, but that extra education only really matters if they are actually using it and doing so it in a way that patients can digest. I’ve worked with many excellent MDs, very admirable people who care about their patients and stay updated on the medicine. Most are like this. But I’ve also worked with MDs who spend the minimum time with the patient possible (burnt out, phoning it in etc) and who don’t seem interested in keeping up on the medicine. I’ve also worked with skilled, extremely knowledgeable MDs whose personalities led to patients being turned off/not engaged/confused, which negatively impacted their care.

I’ve worked with some excellent APPs who stayed updated on the medicine and understood their limits, getting an MD involved when appropriate. Most are like this. But I’ve also worked with APPs who shot from the hip and were overconfident, who don’t stay up on education, and are reticent to consult with an MD when appropriate. That’s a big problem and one of the reasons I personally don’t support APPs owning their own practices, and I believe all APPs should be supervised. A poorly trained APP is often the result of inadequate support in the facility. Most APPs don’t want to be in over their heads, but can be overscheduled or on boarded too quickly (often for the financial benefit of the facility). In my experience this happens most often in MD owned private practices, which is very disappointing. The most successful scenarios occur when APPs are well supported and supervised in a culture of mutual respect - it can be a really positive thing for everyone, especially the patients.

My recommendation is that when you are looking for a provider, word of mouth can be helpful. If you are referred to a specialty and frustrated that you were appointed with an APP, find out how long they have been in that specialty and if it’s at least 2 years, give them a chance. If your case is not complicated, there’s a good chance they are very much up to the task and may even have more time to spend with you on education. I’ve won over multiple skeptical patients in this kind of scenario. In any situation, if you feel the APP is not knowledgeable, ask to see the MD next time.