Nurse Practitioner or Physician? Training, Prescribing and Practice Authority by State

Two training paths

This guide looks at one question in detail: what changes when your clinician is a nurse practitioner instead of a physician. For the other titles you may see, such as PA, CNS or DO, see our credentials guide.

Physicians (MD and DO)

The Bureau of Labor Statistics handbook entry for physicians and surgeons says physicians typically need a bachelor's degree and a degree from a medical school, which takes another 4 years, followed by 3 to 9 years in internship and residency programs depending on the specialty. Subspecialists may add a fellowship of 1 to 3 years. All states require physicians to be licensed, after passing standardized national exams, and requirements vary by state. Board certification in a specialty is not required. You can check whether a physician holds it on Certification Matters.

Nurse practitioners

NPs are one of the four advanced practice registered nurse (APRN) roles, along with certified nurse midwives, certified registered nurse anesthetists and clinical nurse specialists, as the National Council of State Boards of Nursing (NCSBN) explains on its APRN page. The BLS handbook entry for APRNs lists the steps to become an NP:

• a registered nurse (RN) license;
• at least a master's degree in one of the APRN roles; some NPs hold a Doctor of Nursing Practice (DNP) or a Ph.D.;
• a national certification exam;
• an APRN license in the state.

The BLS notes that NPs typically care for a certain population, such as adult and geriatric health, pediatric health, or psychiatric and mental health, and that many work independently, prescribe medications and order laboratory tests, consulting with physicians when necessary.

Practice authority: why your state matters

A physician's license lets them practice medicine in their state. An NP's scope of practice is defined by the state's nurse practice laws, and the BLS notes that it varies from state to state. In broad terms, states fall into two groups:

• states that let NPs evaluate patients, diagnose, treat and prescribe without a formal agreement with a physician;
• states that require a collaborative or supervisory agreement with a physician for some or all of an NP's practice or prescribing.

The rules change over time. The BLS observes that as states change their laws on APRN practice authority, APRNs are being allowed to perform more services. NCSBN's APRN Consensus Model, a framework for state regulation, recommends that APRNs be granted authority to practice and to prescribe without physician oversight such as a collaborative or supervisory agreement. Not every state has adopted it.

How to check the rules in your state

Because the rules differ and change, we do not publish a state-by-state table. The authority is the state board of nursing, which licenses NPs and publishes its nurse practice act and rules. You can look up an NP's license and any public discipline in Nursys QuickConfirm, a free lookup from participating boards of nursing, or on the board's own site. Physicians are licensed by the state medical board, listed by the FSMB in its directory of state medical boards. Our license guide walks through a license record.

Prescribing

NPs prescribe medications, but the conditions differ by state. In some states an NP prescribes on their own license alone; in others prescribing, or prescribing certain drugs, is tied to an agreement with a physician. Prescribing controlled substances also depends on state rules. If a prescription matters to you, for example a medicine you have taken for years, ask the practice at the first visit whether the NP can continue it or whether a physician will need to be involved.

How Medicare covers NP services

Medicare.gov's page on doctor and other health care provider services lists nurse practitioners among the providers whose services Part B covers. The federal rules add some detail:

• Who qualifies: under 42 CFR 410.75, an NP billing Medicare must be a registered nurse authorized by the state to practice as an NP. Those who first got Medicare billing privileges on or after January 1, 2003 must also be certified as an NP by a recognized national certifying body and hold a master's degree in nursing or a DNP.
• What is covered: the same rule says Part B covers NP services in all settings, in rural and urban areas, when the service would be covered if a physician furnished it, the NP is legally authorized to perform it in the state, and the NP works in collaboration with a physician. Collaboration follows the state's law; the collaborating physician does not need to be present or to evaluate each patient.
• Assignment: the rule says NP services are provided on an assignment-related basis, and an NP may not charge you more than the amounts Medicare permits. If you paid more, the NP must refund the difference.
• Payment: under 42 CFR 414.56, Medicare's allowed amount for NP services may not exceed 85% of the physician fee schedule amount for the same service. Your Part B coinsurance, generally 20% after the deductible, is figured on the allowed amount.

Medicare Advantage plans and other insurers set their own networks and payment rules, so check with your plan.

NPs in specialty practices

The BLS describes NPs as primary and specialty care providers, and you may meet an NP in a specialist's office as well as in primary care. The NUCC Health Care Provider Taxonomy, the code set used in NPI records, lists NP specializations including family, adult health, gerontology, pediatrics, acute care, women's health, obstetrics and gynecology, and psychiatric/mental health. In a specialty practice it is reasonable to ask how the NP and the physicians share care, for example who reviews new diagnoses or decides on procedures. Our guide to choosing mental health care covers psychiatric nurse practitioners in more detail.

How NPs appear in NPI records and on T-MedInfo

In the NPI record, an NP usually lists the taxonomy code 363L00000X (Nurse Practitioner) or a more specific code such as 363LF0000X (Family Nurse Practitioner). NUCC's definition describes an NP as a registered nurse with a graduate degree in nursing prepared for advanced practice, and notes that the tasks NPs perform vary with practice requirements. Physicians use codes from the Allopathic & Osteopathic Physicians group. Profiles on this site show these codes and the credential letters the provider entered. Both are self-reported: they do not prove a license or a certification, so check the license with the state board. Our taxonomy guide explains how to read the codes.

Questions to ask

If you have a preference for an NP or a physician, say so when you book. Questions that help at the first visit:

• Who will I usually see at my visits, and can I see a physician if I ask?
• When would you involve a physician or refer me to a specialist?
• Can you prescribe and manage all of my current medicines?
• Do you accept my plan, and, under Original Medicare, do you accept assignment?

On T-MedInfo you can browse nurse practitioner and physician listings by city from the city listings below. Our primary care guide explains how to choose a regular clinician of either kind.