As many patients know, you don’t always see a medical doctor for routine exams anymore. In some cases, it’s more common that standard visits are handled by one of two seasoned healthcare professionals; a nurse practitioner or a physician assistant. In many healthcare settings, NPs and PAs have become almost interchangeable due to the similarities in their education, training, skill level, and duties. And while this can be great for healthcare staffing, the similarities can lead to confusion for aspiring students deciding which advanced path to pursue. Before you start sending in your graduate program applications, read this guide to learn what important factors differentiate an NP from a 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 defining features that distinguish the two. The differences we’ll consider her concern the foundational training model, scope of practice for working professionals, and the level of autonomy professionals can have. Let’s dive in.
While both tracks focus on many similar topics, including pathophysiology, advanced health assessment, and pharmacology, the training model is not uniform for both degrees. These different training models foster variations in approaches among these care providers.
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.
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 a specific disease-types or areas of medicine such as emergency medicine, dermatology, and surgery.
Scope of Practice
Both nurse practitioners and physician assistants can work in the same hospitals and clinicals, carrying out duties in similar roles. There are, however, fundamental differences in how these providers may practice.
NPs train in either primary care or acute care, which is then refined into specialty areas depending on the population. In terms of scope of practice, these professionals provide diverse healthcare services for patients but can also function as healthcare researchers and independent consultants. NPs need to obtain certification to work with specific patient populations, including but not limited to areas such midwifery, family health, neonatal, and pediatrics. They can also diagnose and treat various illnesses and injuries within their specialty training areas.
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.
Level of Autonomy
The level of autonomy for nurse practitioners and physician assistants depend on the healthcare setting. In other words, NPs’ and PAs’ level of independence relates directly to how much oversight by a physician is required by law.
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.
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
Careers for nurse practitioners and physician assistants are highly rewarding and often lucrative. The big question, however, is which career path best suits your academic interests and personal needs or learning style. While these professionals may sometimes be competing for similar positions in medical facilities, they come from different professional histories and traditions, receive education in separate departments or schools, and have to adhere to different professional guidelines. Here are a few questions to consider when choosing between beginning the journey toward a career as an NP or PA.
What if I am more interested in receiving training in a specialty area than receiving training as a generalist? Is an NP program a better fit for me?
Yes. NP programs help you focus on particular patient populations in specialty areas.
I am interested in studying and practicing in an area of medicine, like dermatology, rather than working with one kind of patient. Does the PA track make the most sense?
Yes. PAs get to cast wide nets but within their dedicated area of the field, such as urgent care, orthopedics, dermatology, and surgery.
I’m interested in a pretty autonomous career with less red tape and hurdles. Should I consider NP programs over PA programs?
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.
I think I’d like to pursue education beyond a master’s degree at some point. Is the NP track better suited for that kind of thing?
Yes, as it is increasingly common for nurse practitioners today to pursue a Doctor of Nursing practice degree.
I’m worried that it’ll be hard to find a job. Is the demand for PAs greater than NPs?
Yes. While comparable, the demand for PAs is slightly higher. According to the Bureau of Labor Statistics, the demand for physician assistants will increase by 31% by 2028, compared to 26% for nurse practitioners.
NP vs. PA: Education & Training Breakdown
There’s a wide variety of career paths for nursing professionals and many training programs to consider. Both NPs and PAs 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.
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.
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.
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.
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 in 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
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.
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.
Certification & Licensure
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
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.
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 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.
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.
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.
By 2028, the Bureau of Labor Statistics (BLS) projects that the number of nurse practitioner positions will increase by 26%.
PAs will enjoy an equally bright future, with BLS projecting a 31% job growth by 2028.
Salary Average by Industry
|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|
|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|
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: Pediatric Provider Resources
National Association of Pediatric Nurse Practitioners: Student 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
Inside PA Training: Resources
Physician Assistant Education Association
ThePAlife.com: Physician Assistant Resources