NP vs PA: Understanding the Differences
Est. Time: 11 mins
From understanding each profession’s unique education, scope, and career outlook to breaking down the factors that are important to you and picking your path, learn how NPs and PAs compare.
When you go in for routine check-ups and exams, you often don’t see a medical doctor anymore. Instead, these visits are handled by either a nurse practitioner (NP) or physician assistant (PA). NPs and PAs are often considered interchangeable because both sets of professionals carry out similar duties. While it is true they have similar education levels, duties, and skill levels, being a PA is not synonymous with working as an NP. If you’re considering an advanced healthcare path and are unsure whether to become an NP or PA, your confusion is understandable, but no longer needed; this guide will clear up any uncertainty about what NPs and PAs do. It also guides you through the graduate program applications, requirements during graduate school, and licensing procedures so you can decide which career best suits your lifestyle, professional goals, and learning preferences. Let’s decide once and for all if you should become an NP or PA!
The 3 Key Career Differences
There are several notable differences between careers for NPs and PAs. In this section, we highlight three of the most significant features that distinguish the two. The differences we’ll consider here concern the foundational training model, scope of practice for working professionals, and the level of autonomy professionals can have. Let’s dive in.
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1
Training Model
While both tracks focus on similar topics, including pathophysiology, advanced health assessment, and pharmacology, the training model is not the same for both degrees. These different training models foster variations in approaches among these care providers.
Nurse Practitioner
NPs follow a nursing-based education that generally focuses on holistic patient treatment practices. Training for NPs does not focus on one particular health issue such as disease prevention or management. NPs do, however, develop specialization areas in larger categories or patient populations such as pediatrics, geriatrics, mental health, and women’s health. Their coursework and clinically focused, hands-on education reflect this population-centered approach.
Physician Assistant
PAs follow a more medicine-focused education. Their training still readies them for hands-on work with patients, but PAs focus more on outcome-based evaluations. Physician assistants also hone their studies on specific disease-types or areas of medicine such as emergency medicine, dermatology, and surgery.
2
Scope of Practice
Both nurse practitioners and physician assistants can work in the same hospitals and clinicals, carrying out similar duties and roles. There are, however, fundamental differences in how these providers may practice.
Nurse Practitioner
PAs train as generalists and can practice in practically any field with a collaborating physician. Unlike NPs, PAs can switch specialties without the need for a new certification and/or education other than on-the-job training. There are less regulations about their scope of practice, and the scope of PA’s practice to be decided at the state level. In almost every state, they can perform physical examinations, diagnose illnesses, develop treatment plans for patients, prescribed medications, and more.
Physician Assistant
PAs train as generalists and can practice in practically any field with a collaborating physician. Unlike NPs, PAs can switch specialties without the need for a new certification and/or education other than on-the-job training. There are less regulations about their scope of practice, and most states allow the scope of PA’s practice to be decided at the state level. They can perform physical examinations, diagnose illnesses, develop treatment plans for patients, prescribed medications, and more.
3
Level of Autonomy
The level of autonomy for nurse practitioners and physician assistants depends on the healthcare setting. In other words, NPs’ and PAs’ level of independence based on if they work in a hospital, private practice, or another healthcare setting. The level of oversight by a physician in each setting is often set by state law.
Nurse Practitioner
NPs in most states can become licensed, independent practitioners. They may practice in coordination with other healthcare professionals or operate on their own depending on the location. In states where NPs can engage and full-practice scenarios, they work directly with patients to provide diagnoses, diagnostic tests, and treatment management. They can also prescribe medications and controlled substances under the exclusive licensure of the state board of nursing.
Physician Assistant
Upon completion of their training and certification processes, PAs work with a physician under the guidelines of a collaborative agreement. Their daily tasks, however, do not necessarily require direct oversight from a physician. Depending on state regulations, PAs’ level of autonomy is determined at the practice level, by the state medical board, or by state law.
Picking Your Path: Questions to Ask Yourself
The good news? Both NP and PA careers are highly rewarding and often lucrative. The big question, however, is which career path best suits your academic interests, personal needs, and learning style. While these professionals may sometimes be competing for similar positions, they come from different professional histories and traditions, receive education in separate departments or schools, and have to adhere to different professional guidelines. When choosing between beginning the journey toward a career as an NP or PA, consider these key questions.
1
Yes. NP programs help you focus on particular patient populations in specialty areas.
2
Yes. PAs get to cast wide nets but within their dedicated area of the field, such as urgent care, orthopedics, dermatology, and surgery.
3
Yes. State regulations are more restrictive of PAs’ practices than NPs’. Depending on the state, you may still need to work in collaboration with a medical doctor. There are increasing loose restrictions for NPs in many states, however, to help meet healthcare demands.
4
Yes, as it is increasingly common for nurse practitioners today to pursue a Doctor of Nursing practice degree.
5
Yes. While comparable, the demand for NPs is higher. According to the Bureau of Labor Statistics, the demand for physician assistants will increase by 28% by 2028, compared to 40% for nurse practitioners.
NP vs. PA: Education & Training Breakdown
There’s a wide variety of career paths for NPs and PAs and many training programs to consider. Both must pursue master’s or doctoral degrees and follow the certification processes for each role. The specifics of their education and training, however, differ substantially. Let’s take a closer look at the configuration of degrees for NPs and PAs.
Degree Paths
Nurse Practitioner
Master of Science in Nursing
The Master of Science in Nursing is the foundational degree needed to pursue NP credentials. This is also a viable path for professionals who have an undergraduate degree in an unrelated field. Our Master of Science in Nursing page details the importance of the MSN for NPs-in-training.
RN to MSN Bridge
This degree path best serves professionals who possess an associate of science in nursing and currently work as resident nurses. The RN to MSN bridge is also good for students who completed a licensed practical nursing (LPN) program and then moved on to an LPN to RN bridge program. Take a look at our RN to MSN program page for more information and our survey of online programs.
BSN to DNP
If you currently work as an RN and want to move toward the highest degree in the field, the BSN to DNP program may be a good fit. These professionals typically obtain careers working in highly specialized nursing subfields or in academia as researchers or teachers. Our BSN to DNP and DNP program pages will direct you to the best online programs for this option.
Physician Assistant
Master’s Degree
Admissions counselors often know a program and what it takes to gain acceptance better than anybody. Go online or call your school’s admission office and schedule a time to meet with your program’s admission counselor. These counselors will give you expert advice on how to strengthen your application and better your chances of acceptance. Make sure you schedule your appointment well in advance of the admissions dealing so you have an appropriate amount of time to heed their advice. Giving yourself a couple months of leave time also allows you to ask follow-up questions or schedule a second meeting if necessary.
Doctoral Degree
Professionals who currently practice as physician assistants who want to pursue more research- or education-focused careers in the field should consider a doctoral program. Depending on your interests, the doctoral program may give you a chance to develop specialized knowledge in areas such as human resource management, organizational behavior, neurology, or healthcare policy.
Program Admissions
Nurse Practitioner
After you decide that pursuing a career as a nurse practitioner is a good fit, it’s important to consider all of the admissions requirements. Initially, you will need your RN credentials. You can consider an ADN or ASN, LPN to RN, or BSN track.
Secondly, if you didn’t follow the BSN route, you must obtain a bachelor’s degree from an accredited institution in order to apply for graduate school. Your undergraduate degree does not necessarily need to be in nursing, but a degree in a closely related field is highly recommended. Many students with their eyes on pursuing an NP choose RN-to-BSN programs or accelerated BSNs.
Next, students need to gain field experience prior to applying to graduate programs. To become an NP, you will need to earn a master of science in nursing through a traditional or online MSN program or an RN-to-MSN program. You also need to earn your NP license. License requirements vary by location and are highly dependent upon the state board of nursing where you plan to practice.
Physician Assistant
Your first step toward becoming a physician assistant is to earn a bachelor’s degree. This undergraduate credential does not necessarily need to be in a particular field but many students in this track possess degrees in chemistry, math, biology, or physiology. It’s important that students finish this four-year degree with a respectable GPA such as a 3.0 or higher.
Before applying to a physician assistant program, you will likely need at least three years of hands-on healthcare experience as a medical assistant, certified nursing assistant, emergency medical technician, or a registered nurse. Common application documents for physician assistant programs include your GRE scores, two letters of recommendation, and a statement of objectives. You may also need to participate in an online or in-person interview with the admissions committee.
You can expect to spend about 27 months to complete this program, including clinical rotations and a field internship. Upon completion of this training, you’ll need to pass the Physician Assistant National Certifying Exam. Before they can start practicing, PAs need to make sure that they follow guidelines to meet their state’s requirements for licensure.
Concentrations & Specialties
Nurse Practitioner
These professionals are registered nurses who received specialized training working in clinical family practices. These specialized NPs are trained to work with both adults and children in family practice or clinical settings. Depending on the state, they may work under the supervision of a doctor or independently in areas of family practice. They also frequently work with underserved communities in public or private practice settings.
PNPs specialize in providing healthcare for children, from birth up to the age of 21. They provide a variety of health services, including immunizations, developmental screenings, and physical exams. Depending on the state, they may also be able to write medical prescriptions. These professionals typically possess a master’s or doctoral degree in nursing.
These professionals help address the mental health needs of individuals, families, groups, and communities. They typically help create healthcare plans for patients and evaluate patient progress over short- and long-term periods. They may offer outpatient or in-home care, perform physical or mental health tests, and conduct original research. Additionally, depending on the state, these psychiatric nurse practitioners may be able to prescribe medications.
AGNPs treat patients from adolescence through advanced elderly ages. They may come from acute care or primary care training. Acute care practitioners work in hospital settings or inpatient clinics. They can diagnose and treat patients in emergency departments, intensive care units, or specialty clinics. Adult gerontology primary care nurse practitioners work toward health promotion and illness prevention. They can work in community clinics, private practices, and other community health efforts. AGNPs also commonly work with underserved populations.
Neonatal Nurse Practitioner
NNPs are advanced practice nurses who specialize in providing care for newborns in the first 30 days of their life. Their training qualifies them to work with specialized equipment and educate families regarding neonatal and postpartum care. NNPs also perform diagnostic tests, intubations, and draw blood. They can also dispense medications under a collaborative agreement with a physician.
Physician Assistant
Orthopedics
A concentration in orthopedics for physician assistants can lead to careers as orthopedic surgical assistants. They typically receive extensive training in trauma care, pediatric orthopedic surgery, and hand and upper extremity surgery methods. Students in this concentration often complete clinical rotations in surgical units. While in training, students develop basic skills for surgical techniques and learn how to assist physicians with a variety of non-invasive and invasive procedures.
Pathology
PAs in pathology assist with regular examinations and diagnosing patients’ diseases. They may also play a role in determining causes of death for the deceased. Typical job responsibilities for physician assistants in pathology include conducting patient examinations, offering preliminary anatomic diagnosis, preparing specimens or samples, and keeping meticulous records of patient data.
Dermatology
In collaboration with dermatologists, PAs in dermatology assist in offering diagnoses and treatment for conditions of the skin, fingernails, and hair. Their work can be surgical, medical, or cosmetic. These professionals typically find themselves in a collaborative work environment, working with nurse practitioners, attending physicians, and other healthcare professionals as part of a team effort.
Transplant Surgery
These PAs are both surgery assistants and primary care assistants for transplant patients. They receive specialized training to be able to work in operating rooms during transplant surgeries and can educate patients and families about the complexities of transplantation. Their main duties typically include collecting medical histories, performing physical examinations, educating patients on procedures, providing patient discharge summaries, and assisting surgeons with procedures.
Critical Care
PAs in critical care work in intensive care units and typically offer complete, comprehensive patient care. They help create patient care plans with consulting physicians, nurses, and a variety of specialists that may be needed. Critical care PAs’ diverse responsibilities also include completing patient examinations, monitoring emergency support staff, monitoring treatments, and assisting with making diagnoses.
Certification & Licensure
Nurse Practitioner
Nurse practitioners in all states are recognized as advanced clinical practitioners. Depending on the state and its licensing laws, these professionals receive licensure as an advanced practice registered nurse (APRN) or receive an advanced practice endorsement or certification.
The first step is completing a graduate-level, Commission on Collegiate Nursing Education-recognized nurse practitioner program. NPs then must earn their national survey, or certified nurse practitioner (CNP) credential, through a recognized certification board such as the American Academy of Nurse Practitioners, American Nurses Credentialing Center, Pediatric Nursing Certification Board, or National Certification Corporation. Professionals pursue state licensure after completing their national certification.
Physician Assistant
Graduates of programs accredited by the Accreditation Review Commission on Education for the Physician Assistant, who possess an unrestricted license to practice as a physician assistant and two years of hands-on experience, can sit for the Physician Assistant National Certifying Examination (PANCE) to earn the PA-C designation. The PANCE exam is a 300 multiple choice question test that you must complete within 180 days of your graduation date. In order to maintain this certification, PAs need to complete at least 100 continuing education credits during every two-year period.
After a ten-year cycle, PA-Cs need to complete the Physician Assistant National Recertifying Exam (PANRE) for their certification to remain valid. The PANRE is similar to the PANCE exam but covers more generalized knowledge and broader clinical issues in the field.
Clinicals & Internships
Nurse Practitioner
Clinical placements for nurse practitioners provide them with essential and unique learning opportunities to apply the concepts they’ve learned in school and obtain more hands-on experience with patients. As a kind of intensive internship, clinicals also provide MSN students a chance to network with professionals in their specialized areas. Sometimes clinical locations can become your first place of employment after you complete your master’s degree.
Physician Assistant
PAs can find themselves in public, private, outpatient, orientation care locations for their clinicals. Clinicals for PA students entail making the rounds through four- or eight-week rotations in particular corners of healthcare, including pediatrics, emergency medicine, internal medicine, primary care, and women’s health. These in-person, intensive learning scenarios help PA students put into action what they’ve learned in the classroom and to build upon prior work experience under the guidance and supervision of professionals at a new clinical site.
NP vs. PA: Career Comparison
While NPs and PAs can find themselves working in many similar environments and earning comparable salaries, each career offers professionals unique career advancement opportunities, growth potential, and average salary. Let’s breakdown the differences.
Career Advancement
Nurse Practitioner
Many nurse practitioners seek out management roles in healthcare to climb the professional ladder. Popular careers in this category include chief nursing officer and director of nursing services. Alternatively, experienced NPs with a desire to teach can pursue professorships at colleges and universities. While professorships may not be the most lucrative of positions, they can be highly rewarding and offer notable job security for professionals who earn a tenured position.
Physician Assistant
Career advancement for PAs can sometimes mean returning to academia to pursue further education. Along with more classes, professionals can also plan on completing additional training in a medical facility for more hands-on experience. For those who do not wish to return to school for more specialized training in neurology, cardiology, or emergency medicine, for example, a move into a management role in a medical facility is also a way to bolster one’s career and earning potential.
Growth Potential
Nurse Practitioner
By 2028, the Bureau of Labor Statistics (BLS) projects that the number of nurse practitioner positions will increase by 26%.
Physician Assistant
PAs will enjoy an equally bright future, with BLS projecting a 31% job growth by 2028.
Salary Average by Industry
Nurse Practitioner
Industry | Median Salary |
---|---|
Hospitals; state, local, and private | $120,540 |
Outpatient care centers | $115,720 |
Officers of other health practitioners | $112,740 |
Offices of physicians | $111,440 |
Educational services; state, local, and private | $104,310 |
Physician Assistant
Industry | Median Salary |
---|---|
Hospitals; state, local, and private | $115,560 |
Outpatient care centers | $111,540 |
Officers of other health practitioners | $109,890 |
Offices of physicians | $107,230 |
Educational services; state, local, and private | $102,870 |
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NP Resources
Advanced Practice Education Associates: Clinical Resources
American Association of colleges of Nursing: APRN Clinical Preceptor Resources Guide
American Association of Nurse Practitioners: Student Resources
Barton Associates: Nurse Practitioner Hub
ClinicalAdvisor.com: Student Resources for NPs
Melissa Decapua, DNP: Nurse Practitioner Blog
NPstudent.com: Your Passport to the NP Workforce
National Association of Pediatric Nurse Practitioners: Student Resources
PA Resources
American Academy of Physician Assistants: Student Society Resources
AP the PA: A Physician Assistant’s Journey
Barton Associates: Physician Assistant Resources Hub
BeaPhysicianAssistant.com: The Most Highly Recommended Tools of Current PA Students
EduMed.org: How to Become a Physician Assistant
Global Pre-Meds: Organizations and Associations for Pre-Physician Assistant Students