Medicine is a broad field with many opportunities at many different levels. As you move through your career (or even if you are very motivated from a young age) you may start to wonder about an advanced degree in healthcare. Two of the most engaging careers at higher levels are as a nurse practitioner and as a physician assistant.
Aside from the fact that both require considerable education, these two occupations share the similarity that they are among the most advanced degrees you can get in medicine without actually becoming a physician. Usually, they also both work with patients under the auspices of a physician (though that is changing for nurse practitioners). Despite these similarities, many differences exist between the two occupations.
Nurse Practitioner and Physician Assistant Differences
One of the main differences between the two occupations is the training involved. While nurse practitioners go to nursing schools, physician assistants attend medical school, so consequently they emerge with different viewpoints regarding medicine. While nursing school emphasizes the patient, medical school emphasizes the pathology; nurse practitioners therefore follow a patient-centered model, while physician assistants adhere to a disease-centered model.
This also means impacts specialties, which follow either the patient (in the case of the nurse practitioner) or the type of medicine (as with the physician assistant). While a nurse practitioner might specialize in pediatrics, geriatrics or women’s health, for instance, the physician assistant may focus on emergency medicine, family practice or internal medicine.
They two career tracks also diverge in many other details, contrasted below. Because there are quite a few to keep track of, we have grouped these so you can get an overview of what the job looks like, the education needed to attain each degree, how to get licensed and certified, and the outlook for each job over the coming decade.
PA: Physician assistants may diagnose patients for illness and injury, perform examinations and provide treatment plans. The role of the physician assistant is to perform services the physician himself might provide, under the supervision of that physician.
NP: Nurse practitioners also diagnose and treat various illnesses and injuries, though they focus on promoting health and preventing disease and illness in the first place. In some cases they can prescribe medication.
PA: Because physician assistants work under physicians and surgeons, they typically work in doctors’ offices and hospitals, and other healthcare settings.
NP: Nurse practitioners work in a wide variety of settings, including hospitals, offices, clinics, schools, camps and nursing care facilities.
PA: Physician assistants can specialize in many areas. Examples include dermatology, urgent care, emergency medicine or surgery.
NP: Nurse practitioners can choose from a wide variety of specialties, which normally focus on populations. Examples include geriatric, pediatric and family medicine.
PA: Physician assistants usually work full-time under a practicing surgeon or physician, and are unable to practice on their own.
NP: Unlike physician assistants, nurse practitioners are able to operate independently in some states. However, most still work within larger healthcare settings or as part of a healthcare team.
Education & Programs
PA: Most physician assistant positions require candidates to possess a master’s degree.
NP: A master’s degree is required to practice in any state. However, the American Association of Colleges of Nursing has suggested that in future, nurse practitioners receive the Doctor of Nursing Practice, or DNP, but this has not yet happened. For now, a graduate degree suffices.
PA: Because physician assistants are trained in general medicine so that they can serve wide subsections of the population, they require lots of education. Usually programs require 1,000 classroom hours and 2,000 or more hours in a clinical setting.
NP: Programs for nurse practitioners are usually shorter than those for physician assistants. They typically require nurse practitioners students choose a specialty and complete between 500 classroom and 500-700 clinical hours.
PA: Programs must be accredited through the Accreditation Review Commission on Education for the Physician Assistant, Inc. A list of accredited programs is available here.
NP: Nurse practitioner programs must also be accredited, either through the Commission on Collegiate Nursing Education or the Accreditation Commission for Education in Nursing, Inc. Find a list of programs here.
PA: Physician assistants must complete and 100 credit hours every 2 years and log their time officially through the National Commission on Certification of Physician Assistants. Every 6 years they must pass an exam, though this is moving to a 10-year cycle.
NP: Nurse practitioners must complete 75 to 150 continuing education credits and log 1,000 clinical hours every 5 years, or they can take a test instead.
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Certification & Licensing
PA: Physician assistants are certified through the National Commission on Certification of Physician Assistants, and must pass the Physician Assistant National Certifying Examination.
NP: Both the American Nurses Credentialing Center and the American Academy of Nurse Practitioners offer certification in a specialty area for nurse practitioners.
PA: Licensing is necessary to practice, and requires a degree and national certification. No previous license is needed, unlike in the case of a nurse practitioner.
NP: Licensing is necessary to practice, and requires a degree, an RN license, and state certification.
PA: Maintaining certification requires the completion of continuing education credit hours, as stated above.
NP: Continuing education credit hours and the minimum practice hours can serve for recertification, as can sitting the exam.
Salary & Outlook
PA: Physician assistants average around $91,000 per year, or about $44 per hour, though at the high end of the salary range they may make more than $134,000 per year.
NP: Nurse practitioners average around $98,000 per year, or roughly $47 per hour, only slightly more than physician assistants. Those NP’s that have been practicing for a while can earn more than $131,000 per year.
PA: As of 2012, there were 86,700 practicing physician assistants.
NP: As of 2012, there were around 122,000 practicing nurse practitioners.
PA: According to the Bureau of Labor Statistics, jobs for physician assistants are predicted to increase by roughly 33,300 by 2022. That’s a 38 percent growth, which is much faster than average.
NP: This career is estimated to grow at a rate of 31 percent between 2012 and 2022, according to the BLS. Although this is faster than average, it is not as fast as the growth predicted for physician assistants.
Whatever position you choose, both nurse practitioners and physician assistants report a high degree of job satisfaction. Chances are that if you carefully think through the contrasts above and choose the position that seems to fit your temperament more closely, you will be happy with your choice and your career in the long run.
Do keep in mind that if the idea of advancing to a doctoral degree appeals to you, it is wiser to choose the nurse practitioner route, as the DNP may soon become a reality. If, however, a master’s degree is enough for you – and especially if you find a disease-centered model of care interesting – you will probably be happier as a physician assistant.