NP vs PA: Understanding the Differences

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.

Author: Timon Kaple

Editor: Edumed Editing Staff

Editorial Practices

Updated: 06/02/2023

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.

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.

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.

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.

Yes. NP programs help you focus on particular patient populations in specialty areas.

Yes. PAs get to cast wide nets but within their dedicated area of the field, such as urgent care, orthopedics, dermatology, and surgery.

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.

Yes, as it is increasingly common for nurse practitioners today to pursue a Doctor of Nursing practice degree.

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

BSN to DNP

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

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

Family 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.

Pediatric Nurse Practitioner

Psychiatric Nurse Practitioner

Adult Gerontology Nurse Practitioner

Neonatal Nurse Practitioner

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

Dermatology

Transplant Surgery

Critical Care

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