Who are all these people? Who is in charge? Different Roles of Hospital and Medical Office Staff

Today, office visits and hospital stays can be overwhelming.  The list of providers you can encounter during your care is astounding. Medical Assistants.  Hospitalists. Nurse Practitioners. Physician Assistants. Specialists. CNAs. PCTs. Interns.  Students. Different colored scrubs. Lab coats. And not a familiar face in any uniform. Who do you reach out to? Where do you start?  Who is in charge of your care? 

Back in the day, going to the doctor’s office used to be simple.  Sign in at the reception desk, sit in the waiting room, head back with the nurse and then meet with your doctor.  Same with a hospital stay – if you found yourself admitted as a patient – your primary doctor would see you every day and manage your care.  This isn’t the way it works anymore, and the list of providers you can encounter has grown.

Let’s start with the many people who can be involved in your care.

Primary Care Providers (PCPs)

First, what does “primary care provider” actually mean?  Originally, the term “PCP” referred to ‘primary care physician’, ie. your primary doctor or family physician.  With our changing healthcare team, this has evolved to the term ‘primary care provider’. They are the ones who will perform your yearly physical, manage medications, as well discuss preventative health care options, and usually the one you visit in times of illness or injury.  

There are three groups of providers who can provide this care.  Physicians, Nurse Practitioners and Physician Assistants. In the whole realm of healthcare, your primary care provider should be the one who is most involved with your care. 

Physician

Most everyone in healthcare is familiar with the role of the physician.  They can be referred to as physician, doctor, osteopath, general practitioner, internist and pediatrician.  All of these providers treat adults in an office, or outpatient setting. Pediatricians are for those ages 0-18, and some pediatricians continue into college years as patient transition to a primary adult practice. 

Nurse Practitioner (NP) 

While many believe Nurse Practitioners are a new specialty, nurse practitioners as a profession has been going strong for 54 years.  Founded in 1965 by Dr. Loretta Ford, EdD, PNP, FAAN, and Henry Silver, MD, at the University of Colorado, the nurse practitioner evolved to help respond to the declining physician presence in urban and rural communities.  Nurse practitioners (NP) have additional educational training beyond their initial RN (registered nurse) education program. NP program preparation is either a Masters (MSN) or Doctoral (DNP) degree, that includes both classroom and clinical rotations.  Following completion of the MSN or DNP degree, nurse practitioners must be credentialed by either the American Association of Nurse Practitioners (AANP) and the American Nurses Credentialing Center (ANCC).

Nurse Practitioners can assess, diagnose and treat diseases, educate and promote prevention management, and provide patient centered care.  Over the past 54+ years, the cost effective care provided by nurse practitioners has demonstrated improved clinical outcomes and helped promote quality health care in all settings.  

Physician Assistant (PA)

Physician Assistants also have been around since 1965.  Dr. Eugene Stead Jr at Duke University Medical Center formed the first class of physician assistants, also in response to the anticipated shortage & maldistribution of physicians.  Physician Assistant (PA) is also a Masters degree program, that includes both classroom and clinical training. The clinical rotation is slightly different then NP programs including medical and surgical discipline rotations such as family medicine, internal medicine, general surgery, pediatrics, obstetrics and gynecology, emergency medicine and psychiatry. 

Both Nurse Practitioners and Physician Assistants provide quality patient care and offer to many individuals improved healthcare access they might not otherwise have.

Ancillary Staff

There are many other medical staff members within the office or hospital setting that could be involved with your care.  

Registered Nurse (RN):  This can be an associate degree or bachelor degree prepared registered nurse, with the scope of practice including assessment, diagnosis, planning, implementation, and evaluation of nursing care. RNs can be employed almost anywhere and are vital in the hospital (acute care) setting, and often found in the office (primary care) setting assisting working with patients and providers.  

Licensed Practical Nurse (LPN):  Traditionally a one-year program degree that focuses on patient care, observation, medication administration and reporting concerns to appropriate providers (including Registered Nurse, MD, NP, PA).  While LPNs can be found in the office setting, few hospitals employ LPNs because of the level of care that is needed with acute care patients. They usually work in long term care and assisted living facilities.

Medical Assistant (MA): These roles are usually found in the office setting.  They are often mistaken as the nurse in the office setting.  During an office visit they can take vitals (blood pressure, temperature, weight, pulse), draw blood, administer vaccines, review medications and call back patients with test results, etc. per provider instructions.  

Certified Nursing Assistant (CNA):  Some organizations use different terms for this position such as care tech, PCT, nursing assistant.  They are frontline staff who help the patients with basic patient care needs and report changes in patient condition to the nursing staff.  They usually assist with ADLs (Activities of Daily Living) including dressing, grooming, bathing, eating and toileting needs.  

Receptionist/Unit Secretary: Either in the office or hospital setting, these are people who keep the office or nursing unit on task.  They answer the phones, triage the calls, relay messages to staff and help schedule appointments. While they are the first person you speak with, they usually have no medical training.  This is important to keep in mind as you need to give them information to help them direct who best to help you; but don’t be surprised if they stop you from telling your story in depth as they will not be the one to ultimately help solve your problem. 

Answering Service/Call Center: This team involves those you would only interact with over the phone when you call the office after it is closed, or during lunch hours.  There is a good chance they have no direct connection between your provider or office staff – they just deliver the message that you called. They are important especially after hours, when you need to reach your provider when you have a concern about your health. 

So, who is in charge?

So, now that we know everyone we might encounter, who is actually in charge of your care? 

In our busy society, when we need to see our provider, we want to see our provider.  Waiting 2-3 weeks for a “sick” visit isn’t desirable, especially when you are ‘actually sick’.  Even follow-up visits after a long illness, injury or emergency room visit can be difficult to schedule.  To maximize a provider’s availability during office hours, they need to be there more which means rounding at the hospital when you are sick isn’t the best use of time.  That’s why, when you are in the hospital, the hospitalists are so important.  

What is a hospitalist?  

Hospitalists teams are a group of physicians, nurse practitioners an physician assistants that oversee patient care as the attending provider while in the hospital.  This hospitalist team will round on you daily, help direct care and any consulting providers needed, and ultimately coordinate your discharge. While in the hospital, they are usually the one “in charge” of your hospital stay.  

This is the first difference many patients realize when they are admitted to the hospital.  Their primary care provider isn’t going to visit or oversee their care. While this might be disappointing, keep in mind this allows for your provider to be in the office to focus on your recovery once you are back home.

Outpatient Setting

Once you are discharged back home, you are considered in the outpatient (or primary care) setting and your primary care provider takes charge once again.  They are critical to helping you transition from the hospital back home. A visit to the provider office should be at the top of your to-do list once home.  This will ensure your provider is up to date on your health status, manage your medications and ensure you are on the right path to recovery. When you do call the provider office – be sure to tell the receptionist that you were just discharged from the hospital so they know the proper steps to take in order to get you the appointments you need.

While this can be overwhelming, the best decision you can make is to establish a relationship with a primary care provider.  FInd the provider that is right to fit your needs and that you feel comfortable with talking about your own health concerns. They will help navigate preventative healthcare, wellness visits, immunizations and yearly vaccines.  They manage your medications, chronic diseases and when the unexpected happens, help guide you to the resources you need. Remember, your primary care provider’s focus is to be the one in charge to steer you on the best path towards your optimal health.  

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Nursing Decoded

Nursing decoded was created to share, educate, and collaborate with EVERYONE (patients, caregivers) and aspiring nurses, students, care technicians, nurses, APN's, and all medical providers. We have over 50 years of experience in medicine and have climbed the ladder through this amazing profession. Medicine and nursing is often complicated, exhilarating, exhausting, challenging, loving, and passionate. As Nurse Practitioners, we want to engage and educate people, patients and providers on how to decode, interpret, and navigate our healthcare world through the viewpoint of nursing. Our goal is to provide a consistent, easily accessible resource that clearly outlines, educates and informs on various topics of healthcare to help them interpret, decode and navigate their healthcare world.

This Post Has 34 Comments

  1. What a clear explanation of all the different roles we find in a hospital! Will bookmark for future reference!

  2. Wow! Lots of great information here!

  3. Great breakdown of the different roles and responsibilities. It truly can be challenging to know who is in charge! The face of medicine has changed drastically since the beginning of my nursing career 23 years ago.

  4. Great post!! It is important to understand the medical world today..I feel like a number today but the nurses seem to be the ones to connect the patients with the doctors…Thank you o those wonderful nurses who show us that we matter!

  5. Wow there is so much to it! I had no idea about the ins and outs of how a hospital is ran. This will be useful to me when I become a care coordinator for an insurance company. Very informative. Thank you!

  6. It is hard to know who is in charge when you go to the hospital, this was very informative. If you are considering a career in Healthcare it is good to know where you want to be.

  7. Great in depth descriptions of the various provider roles! I work on the business side of healthcare, and often hear how confusing it is to patients to navigate today’s medical world! What makes it even trickier is introducing the insurances – we are with Tricare, so our Primary Care Provider is the main primary care physician at a location and our rendering provider is the person we see most of the time – so the physician is our PCP but we see the PA he is supervising – this confuses so many patients as well! Keeps it interesting!

  8. Very nice breakdown for those of us who are unfamiliar with the responsibilities associated with each role. Thanks for sharing!

  9. Thank you for the breakdown of each profession. It can get so confusing.

  10. excellent resource and a very handy explanation of different kinds of practitioners. thank you for posting

  11. This is SUPER helpful, thanks! And I had NO IDEA there was even such a thing as a hospitalist. 😮

  12. There is so much that goes into running a hospital and it is hard to know who to ask what to!

  13. I have spent quite a lot of time in hospitals this past year with a cancer diagnosis, but it can still be confusing whether to go through my specialist oncologist, my local oncologist, or my primary care provider. I never knew there were so many types of health care providers, but I think I’ve seen them almost all of them now! Bless everyone who goes into the medical profession.

  14. This is actually very helpful, I never really considered all the options out there for medical professionals.*

  15. I see a Nurse Practioner and I just feel like she is more accessible than a regular doctor where I would have to talk to their nurse instead of them. She will personally answer my email.

  16. This is such a helpful post-especially when yourself or loved one is in a situation where they are having to see a lot of these people! Thanks for sharing!

  17. Great breakdown of some of the most common roles in healthcare.

  18. This is a great resource. I recently spent a day in a hospital, nothing serious, but was confused the entire time by who was what. Some of it was caused by my physical state, but there were just so many people coming in and out! Thank you for ‘decoding’ this for me!

  19. oh great breakdown! i was brought up in a medical family so I was aware of everyone and everything but it can be very overwhelming and stressful for so many. great info

  20. I love the clear explanations of everyone’s roles and responsibilities. I often get confused by who’s who and who I need to talk to, so this is excellent!

  21. Wow! Super clear, helpful explanations of who is who in the hospital setting! Thanks for such a great breakdown.

  22. Great information on all the roles! We’re in the medical field and even we get confused at times. Thank you for breaking it down.

    1. I have had great experiences with both – it really depends on the style of provider you are looking for. MD offers a traditional medicine approach where DO offer a more holistic approach (sort of like PA and NP!), but often you don’t realize the difference between their practice styles. What is important is you feel comfortable with them as you discuss your health concerns!

  23. Great information here. I am still overwhelmed by it all. I never see my physician but always see my PA. In fact, the PA is the only one I want to see going forward 🙂

  24. With three kids, I’ve spent more time in waiting rooms this decade than all of my other years combined. It’s really helpful to have an idea who you are seeing and what he/she might be able to provide.

  25. Thanks for clearing up the mystery.

  26. So much info! Thanks for breaking it all down!

  27. Great overview of the roles people fill in medical care! My daughter is an RN who worked in the hospital a couple of years before switching to working for a neurologist is an office. She was a CNA while going to school. So I’m familiar with terms. However you did a wonderful job explains who is who!

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