NP vs. DNP vs. PA vs. MD: Who’s Who in Healthcare?

Ever looked at a healthcare provider’s name tag and wondered if they were collecting letters like Scrabble points? MD, NP, NDP, PA. At some point, it starts to feel like the alphabet soup of medicine. But those letters actually mean something pretty important when it comes to training, scope of practice, and what they’re allowed to do.

If you’re in Virginia or Maryland, the rules for each of these providers vary a bit. Let’s break it all down so you know exactly who’s treating you the next time you need care.

The Training Path

Let’s start with education and training because this is where these roles differ the most.

MD (Medical Doctor): This is the traditional physician you think of when you hear "doctor." They complete four years of medical school after earning a bachelor's degree, followed by a residency that lasts between three to seven years, depending on their specialty. Some go on to do fellowships for additional specialization.
NP (Nurse Practitioner): NPs start as registered nurses (RNs) and then complete a master's or doctoral degree in nursing. This typically involves two to four years of additional education and clinical training, depending on the program. NPs are trained in a nursing model, which emphasizes patient-centered care, prevention, and education.
DNP (Doctor of Nursing Practice): A DNP is a terminal clinical degree for nurses. It is essentially the highest level of education in nursing practice. Many DNPs are also NPs, and while the DNP itself doesn’t change their legal scope of practice, it reflects advanced training in clinical practice, healthcare leadership, and evidence-based care. A DNP may also hold faculty or administrative roles in addition to treating patients.
PA (Physician Assistant): PAs complete a master's degree program that takes about two to three years after earning a bachelor’s degree. Their training follows a medical model similar to that of physicians, covering general medicine across specialties. They also complete clinical rotations, but they do not specialize in one area during their training the way MDs do.

What They Can Do

All three providers can diagnose and treat illnesses, prescribe medications, and manage patients. The key difference is how independently they can practice and who they need to collaborate with.

MDs

Fully independent providers who can diagnose, treat, and prescribe without oversight.
They specialize in everything from primary care to highly complex surgical fields.

NPs in Virginia and Maryland

Virginia: NPs must complete at least five years of clinical experience before they can apply for "autonomous practice," which allows them to work without physician supervision. Otherwise, they need a collaboration agreement with a physician.
Maryland: NPs have full practice authority, meaning they can evaluate, diagnose, and treat patients independently, including prescribing medications, without physician oversight.
A DNP’s authority depends on whether they are also licensed as an NP. A DNP who is also an NP follows the same practice rules listed above.

PAs in Virginia and Maryland

PAs work under a collaborative agreement with a physician in both states, meaning they need a supervising doctor (though they have a good amount of independence).
In Maryland and Virginia, they can prescribe medications, but the level of supervision depends on state laws and employer policies.

Who Should You See?

If you're visiting a primary care clinic, you might see an NP, DNP, or PA for a routine checkup, medication management, or minor illnesses. They can handle most common medical issues, and in many cases, you won’t need to see an MD unless something more complex arises.

If you're dealing with a specialist referral, surgery, or complex medical condition, you’ll likely be treated by an MD, though PAs and NPs (Including DNPs) often assist in specialized care.

Bottom Line

MDs, NPs, DNPs, and PAs all play vital roles in healthcare. Their education and independence vary, but all three can provide high-quality care. In Virginia, NPs need extra experience to practice independently, while Maryland grants them full autonomy. PAs always work in collaboration with a physician but can still diagnose, treat, and prescribe medications.

So the next time you're at an appointment, you'll know exactly who you're seeing and what they can do. And if you still have questions? Just ask your provider and they’ll be happy to explain!