The role of a doctor often overlaps with other healthcare professions, so when considering a job in medicine it is important to think about other vocations that can spark the same enthusiasm and reflect on whether they are of greater interest compared to a career in medicine. The most similar roles to a doctor include that of a physician associate (PA) and an advanced nurse practitioner (ANP). This blog explores the differences between a doctor and an ANP. You can read our post here on the difference between a doctor and a physician associate.
No, ANPs are not doctors, nor are ANPs substitutes for doctors. They are specialist nurses who have completed additional qualifications to allow them to act in a similar capacity to doctors. Essentially, ANPs are a hybrid of the roles of a nurse and doctor. This means they have a blend of the caregiving responsibilities of a nurse and treatment decision-making of a doctor. In fact, evidence suggests that within their competency they can provide at least equivalent quality of care compared to doctors.
Advanced nurse practitioners (ANPs) are specialist nurses who have undertaken additional qualifications in addition to their nursing training which allows them to assess and treat patients and be accountable for their decisions. They are not doctors and have not completed medical training.
The nursing background of an ANP can improve the holism of care a patient receives by focussing on the patient experience rather than biomedicine, thereby limiting their medical decision making compared to doctors. Their insider knowledge of the healthcare system from experience in providing direct care as a nurse helps bridge the mistakes and delays that can occur when there are multiple healthcare professionals involved in the same care of a single patient. (e.g. a doctor prescribing a treatment which is then carried out by a nurse). Like doctors, ANPs can also have a role in research, health promotion and teaching other members of the healthcare team.
Depending on their level of competency, ANPs can assess and examine patients, make a diagnosis, order investigations, refer and provide advice and treatment as necessary. If they have passed their prescribing qualification, they are also able to prescribe medications. Their roles can be very similar to that of doctors and PAs, and they are often confused for each other. However, ANPs are generalists and see patients with specific long-term illnesses and common illness presentations. This generally excludes pregnant women and children who usually must be seen by a doctor. ANPs cannot usually progress through training programmes and become specialised in the same way doctors can.
ANPs can work in a variety of healthcare settings. They may work in a general practice, and review patients in a similar way to a GP. Equally, they can work on medical or surgical wards and assessment units in a hospital. They often work as generalists in these areas, so you are unlikely to find an ANP who has specialised in a particular field (e.g. renal medicine, respiratory).
A nurse or a midwife can become a prescriber by completing a prescribing programme. This is either a community course which allows limited prescriptions of dressings and 13 medicines or an independent prescribing (IP) course which allows the prescription of most medicines.
An advanced nurse practitioner must firstly be a nurse and is therefore registered with the nursing medical council (NMC). They will then undertake a postgraduate masters degree in advanced clinical practice (list here: https://www.rcn.org.uk/professional-development/professional-services/accreditation/rcn-accredited-advanced-nursing-practice-programmes ). These masters courses are generally part time and are completed over a period of 2-5 years. They are often funded by Health Education England or an employer e.g. the NHS trust or GP practice. Therefore, the time taken to become an advanced nurse practitioner is three years (nursing course) plus 2-5 years (masters).
In reality, however, nurses often will choose to undertake the masters course when their trust/GP are in demand of them and are willing to fund some/all of the course for them so it is difficult to give an average timeline. Advanced nurse practitioners will generally also have a prescribing qualification as mentioned above too.
Nurses are paid via the Agenda for Change system and advanced nurse practitioners, like Physician Associates are within the Band 7 bracket and so earn £41,659 - £47,672 per year as of August 2022.
Whilst ANPs act in a similar capacity to doctors, it is important to remember that not all ANPs set off wanting to be ANPs. They have chosen to study nursing which involves a lot more patient care compared to medicine, which focuses on the medical management of patients. As they progress in their career, they may want to develop their skills further and evolve in their role, so they undertake a masters if their employer (GP practice / trust) needs it. Becoming an ANP is a more difficult and unpredictable route than medicine.
So if you’re somebody that knows they want to be involved in the medical management of patients, you’re better off going down the medicine or PA route directly. However, if you’re thinking of going into nursing (or debating between medicine and nursing), it’s worth remembering that this option exists, where you can become a hybrid of the two roles.
Author: Dhillon Hirani
Editor: Dr Latifa Haque