• A Medical Doctor must complete 4 years of medical school followed by 3 or more years of graduate medical education, which includes at least 15,000 clinical training hours. To compare, Advanced Practice Registered Nurses (APRNs) are not required to complete any training beyond graduate school and obtain only 500 – 1,500 clinical training hours.
Total Training Hours
Total Training Hours
Clinical Training Hours
Clinical Training Hours
Medical Doctor APRN
Graduate Training 4 years in Medical School 1.5 – 3 years in Nursing Program
Post Grad Training 3+ years Residency/Fellowship NONE
Total Training Hours 21,700 5,350
Clinical Training Hours 15,000+ 500 – 1,500
  • According to a 2013 study by the Mayo Clinic, inappropriate referrals to tertiary referral centers by APRNs and Physician Assistants (PAs) could offset any potential savings from the increased use of APRNs and PAs.
  • A JAMA Internal Medicine study found that APRNs and PAs were associated with more ordered diagnostic imaging than primary care physicians.
  • A brief report by the Infectious Diseases Society of America found that ambulatory visits involving APRNs and PAs more frequently resulted in an antibiotic prescription compared with physician visits.
  • Physician supervision is the norm, not the exception:
    • States that do not allow APRNs to practice independently represent roughly 70% of the population.
    • 9 of the 10 most populous states do not allow APRNs to practice independently.

2012 and 2018 surveys conducted by the AMA found that patients overwhelmingly want a coordinated approach to health care, with a physician leading the health care team.
Key findings from the AMA survey include:

  • 91% of respondents said that a physician’s years of education and training are vital to optimal patient care, especially in the event of a complication or medical emergency.
  • 86% of respondents said that patients with one or more chronic conditions benefit when a physician leads the primary health care team.
  • 84% of respondents said that they prefer a physician to have primary responsibility for the diagnosis and management of their health care.