June 18, 2020 · 8 min read

What Are the Differences Between Physician Assistants and Nurse Practitioners?

The two jobs are very similar—but a number of things set them apart. Find out which one is right for you.

rob bhatt

By Rob Bhatt

male nurse palpates injured hand of male patient
male nurse looks at hand of male patient

Because their roles are similar, the jobs of physician assistants (PAs) and nurse practitioners (NPs) are often confused. But there are many things—from philosophy to salary to eligibility requirements—that set them apart.

PAs and NPs are both non-physician providers (NPPs) whose duties can include performing physical exams, treating patients, and prescribing medications, but that’s where the two jobs begin to diverge.

The differences between their respective approaches to care, the levels of specialization they allow, and the types of education they require are among the key factors that might make one field a better fit for you than the other.


What Do Physician Assistants and Nurse Practitioners Do?

Thanks to the rigorous education and training standards for each profession, today’s PAs and NPs are qualified to perform a wide range of primary- and acute-care tasks. In addition to the duties described above, it’s common for PAs to administer immunizations, set broken bones and close incisions during surgery. The nurse practitioner can also assist in ERs and ORs, and they often also order and analyze tests, treat patients with chronic conditions and manage patients’ overall health.

While PAs are trained in general medicine, NPs specialize in chosen areas of medicine or population groups, such as pediatrics, gerontology, women’s health, or mental health.

NPs tend to have more autonomy. Twenty-two states plus the District of Columbia allows them to work independently, under the oversight of the state’s nursing board. 

“This is a broad generalization, but you would typically find PAs in settings where they work directly with a specialist physician and often gain significant skill in technical or procedural tasks,” explains Leslie Flores, co-founder of Nelson | Flores Hospital Medicine Consultants, based in La Quinta, California. “NPs more often work in cognitive medical fields like family medicine, pediatrics and internal medicine. Also, NPs tend to be more specialized.”

At a Glance: PAs vs. NPs

Job duties:

Primary- and acute-care tasks of general medicine.

Philosophy:

Follows a disease-centered model, which focuses on identifying and treating a patient’s immediate ailment.

Workplace:

Medical offices, hospitals, outpatient care facilities.

Licensing/certification:

National certification and a license from a state medical or PA board.

Education:

Master’s degree from an accredited program, combining classroom instruction with about 2,000 hours of clinical rotations. Doctoral programs available.

Salary:

$112,410

Salary data: U.S. Bureau of Labor Statistics, 2019 Occupational Employment Statistics

Job duties:

Primary- and acute-care tasks within a certified specialty.

Philosophy:

Advanced nursing skills, with an emphasis on holistic patient-centered care.

Workplace:

Medical offices, hospitals, outpatient care facilities.

Licensing/certification:

Specialty certification and a license from a state nursing board.

Education:

Master’s degree from an accredited program, combining classroom instruction with about 1,000 hours of clinical training. Doctoral programs available.

Salary:

$111,840

Salary data: U.S. Bureau of Labor Statistics, 2019 Occupational Employment Statistics


Which Job is Right for You?

nurse shares a laugh with elderly patient in wheel chair

An NP career is a smart choice for those with a passion for any of the profession’s specialty areas. Among those already working in healthcare, RNs have a head start, by virtue of the admissions policies for NP educational programs.

And if you’re an aspiring NP who has not yet completed your undergraduate education, you’d be wise to start working toward a BSN as soon as possible.

The PA profession, on the other hand, is great for those who want to perform a broad range tasks and procedures, without committing to specialization. The PA profession also gives those already working in a number of different healthcare occupations an opportunity to take the next step in patient care.

As a rule, of the two professions, NPs tend to have more autonomy, which may make the nurse practitioner job more desirable for those who prefer to work on their own. Twenty-two states plus the District of Columbia grant NPs full-practice authority, which allows them to work independently, under the regulatory oversight of the state’s nursing board.

Elsewhere, NPs work in collaboration with healthcare organizations, or under their supervision. PAs almost always work under the supervision of a physician.

No matter which path you choose to follow, the good news is that you’re likely to find high demand for your services. As Flores puts it, “The coming physician shortage is real, and the healthcare system will continue to be pressed to become more financially efficient.

“Since NPs and PAs are both quicker to train and less expensive than physicians, there will be an increased reliance on them going forward. Not only are the job prospects hot, but most NPs and PAs will find their career choice to be very rewarding.”


What Are the Education Requirements for NPs and PAs?

Aspiring PAs and NPs both typically need a master’s degree from an accredited program, though doctoral programs are available for both professions. (There’s been buzz in the industry for years about requiring those who hold advanced nursing degrees—like NPs and PAs—to earn a doctorate degree instead of just a master’s degree. There’s been no decision made yet.) Many are drawn to the professions because they allow practitioners to take on roles similar to those performed by medical doctors—without multiple years of medical school.

In addition to classroom instruction, the programs include training in clinical settings (about 2,000 hours for PAs; 1,000 hours for NPs), and usually take two to three years to complete. But this is about where the similarities end.

Eligibility Requirements for NP and PA Studies

The most significant differences between the two professions begin with the eligibility requirements. Most NP schools only accept registered nurses (RNs) with a Bachelor of Science in Nursing (BSN), although some offer “bridge programs” for nurses with an associate’s degree or diploma.

The prerequisites for most PA programs include undergraduate courses in basic and behavioral sciences (think chemistry, physiology, anatomy, and others). Applicants typically also need between 500 and 1,000 hours of hands-on patient care experience, gained by working as a lab or emergency-room technician, paramedic, RN, certified nursing assistant (CNA), or other recognized occupation. (The requirements for patient-care hours and occupations vary by school.)

Programs Available for NP and PA Students

There are more than 250 accredited PA programs across the country, and they all typically progress from classroom instruction to clinical rotations focusing on the major areas of medicine, including family medicine, internal medicine, surgery and pediatrics.

By the time a program is finished, a student will have a deep understanding of medical knowledge, patient care, interpersonal communication skills, professionalism, and the other core competencies of the profession. Most programs culminate with a Master of Physician Assistant Studies (MPAS), but other degrees, including Master of Medical Science certified (MMSc) and Master of Science Physician Assistant (MSPA), are available.

Family nurse practitioner programs are among the most common, but gerontology, adult care, emergency medicine, and mental health are among the other options.

NP programs, on the other hand, are offered by specialty, such as family nurse practitioner, adult-gerontology acute care nurse practitioner, or pediatric primary care nurse practitioner. So, in addition to considering a school’s location and fees, you should also make sure it offers a program in your preferred concentration.

Family nurse practitioner programs are among the most common, but gerontology, adult care, emergency medicine, and mental health are among the other options, according to Sean DeGarmo, a director with the American Academy of Nurse Practitioners. Most specialties are further segmented by a focus in primary care or acute care, DeGarmo says. The AANP offers useful information about the major certifying bodies (there are five) and the certifications they offer (18 total). Overall, approximately 400 institutions offer accredited NP programs, and the most common degrees are Master of Science in Nursing (MSN) and Doctor of Nursing Practice (DNP).


Can I Study to Be an NP or PA Online?

computer and lamp on desk

Most NP programs are now also offered online, either partially (72%) or completely (13%), says Robert Rosseter, chief communications officer for the American Association of Colleges of Nursing.

Online and hybrid programs typically combine virtual classes with clinical training in approved facilities in or near students’ hometowns. But even completely online programs usually require two to three campus visits for immersive on-site education and training.

In contrast, distance learning is still rare among PA programs. However, as a possible sign of things to come, Yale School of Medicine introduced its online PA program in 2018, making its MMSc the university’s first degree offered through an online program.


How Do Physician Assistants and Nurse Practitioners Get Certified?

After completing their educational program, PAs need to pass the Physician Assistant National Certification Exam (PANCE) and apply for a state license. As you gain additional skills, you can seek a certificate of added qualification (CAQ), but these are only available for seven specialties, including emergency medicine, pediatrics and psychiatry. CAQs are optional, but all PAs need to complete 100 hours of continuing medical education every two years and pass a recertification exam every 10 years.

NPs will need to pass the certification exam for their chosen specialty and apply for an advanced practice license from their state’s nursing board upon completion of the NP program. To maintain certification, NPs typically need to complete 1,000 clinical work hours and 100 hours of continuing education in their specialty every five years. Post-masters (and post-doctoral) programs, which usually require about a year of study and clinical training, are available for those seeking certification in a sub-specialty.


How Do PA and NP Philosophies Differ?

The modern educational standards and training programs for both PAs and NPs were established in the mid-1960s, and their respective job titles reflect their traditions. The curriculum in PA schools was created by physicians and is modeled after medical schools, with a disease-centered approach to care, which places the focus of treatment on the ailment or injury.

Similar to advanced practice registered nurses (APRNs) (a designation also held by nurse anesthetists, nurse midwives, and other nursing positions that require a master’s or doctorate), NPs follow standards that are steeped in the holistic, patient-centered approach of nursing. In this approach, NPs consider factors such as a patient’s lifestyle and long-term health in developing treatment plans.


Where Do They Work?

The economics of healthcare has created demand for PAs and NPs in just about every healthcare setting. Americans are living longer, and as the population ages, the need for primary-care physicians keeps outpacing availability.

While NPs and PAs are well-paid, they tend to earn a little more than half as much as physicians. This makes both physician assistants and nurse practitioners attractive to healthcare administrators seeking cost-effective ways to add staff and treat more patients. That said, the lion’s share of jobs for both professions are in physicians’ offices and hospitals. According to the most recent figures from the U.S. Bureau of Labor Statistics (BLS):

  • 55% of PAs worked in physicians’ offices
  • 26% worked in state, local, or private hospitals
  • Of the remainder, 8% worked in outpatient care centers, such as HMO medical centers, kidney dialysis centers, outpatient mental health and substance abuse centers, and other non-hospitals offering outpatient care

The lion’s share of jobs for both NPs and PAs are in physicians’ offices and hospitals.

When it comes to NPs:

  • 47% worked in physicians’ offices
  • 27% in hospitals and 9% in outpatient care centers

Though BLS does not further separate the data by APRN profession, NPs represented nearly 95% of the APRN population.


What’s the Career Outlook?

The most recent BLS figures reports that there were 118,000 PAs compared to 189,100 NPs. The agency expects the number of PA jobs to increase 31% by 2028, while NP jobs are expected to grow 28%. Both rates are considered much faster than the average for all occupations.


How Much Do They Make?

The BLS also reports that the mean, or average, salary for physician assistants was $112,410 in 2019. In general, PA’s working in outpatient care centers out-earned peers in other workplaces, followed by those working in general medical and surgical hospitals, physicians’ offices, and other settings.

At $111,840, the average salary for NPs in 2019 was a just a touch less than that for PAs. Top earnings, in order of workplace, like PAs include outpatient care facilities, hospitals, and physicians’ offices.

But those working in the offices of other health professionals still did pretty well—all averaging six figures—as did those working at colleges, universities, and professional schools.

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