Healthcare 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. Nurse practitioners (NPs) and physician assistants (PAs) hold an important place in the healthcare system. These advanced roles also offer two of the most engaging career options available to healthcare professionals working in direct patient care.
Aside from the fact that both professions require considerable education, they are also among the most advanced healthcare professions available without actually becoming a physician.
Both NPs and PAs work with patients under the auspices of a physician, though that is changing for nurse practitioners who are now frequently allowed to practice and prescribe independently. 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 to be trained in accordance with the nursing model, physician assistants attend programs that are more in-line with the medical model, so consequently they emerge with different viewpoints regarding healthcare and medicine.
While the nursing model places an emphasis on patients and their outcomes, the medical model places a greater emphasis on disease pathology. This means nurse practitioners follow a patient-centered model, while physician assistants adhere to a disease-centered model.
This important difference also influences the different specializations available to NPs and PAs, with NPs choosing a patient population focus as a primary specialty and PAs more often specializing in a particular area of medicine. While a nurse practitioner might specialize in pediatrics, geriatrics or women’s health, for instance, the physician assistant would more often focus in an area like emergency medicine or internal medicine.
They two career tracks also diverge from one another in many other ways as described below. Here you’ll find comparisons between NPs and PAs in terms of what the job looks like day to day, the education needed to enter each profession, how to get licensed and certified in each role, and the job outlook for each role 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 doctors provide, all while under physician supervision.
NP: Nurse practitioners also diagnose and treat various illnesses and injuries, though they also place a strong emphasis on promoting health and preventing disease and illness. They frequently practice independently without physician oversight, and in many states, they are even permitted to prescribe medication independently.
PA: Because physician assistants work under physicians and surgeons, they are typically found in doctors’ offices, hospitals, and other healthcare settings.
NP: Nurse practitioners work in a wide variety of settings, including hospitals, private physician practices, NP-lead independent clinics, skilled nursing facilities, and even schools and summer camps.
PA: Physician assistants can specialize in many areas. Examples include dermatology, urgent care, emergency medicine or surgery.
NP: Nurse practitioners receive their primary certification in a particular patient population (family, adult-gerontology (acute or primary), women’s health, neonatal, pediatrics (acute or primary), or psychiatric-mental health). They can further specialize by practice setting (like emergency medicine) and disease type (like oncology).
PA: Physician assistants usually work directly under a practicing surgeon or physician, and are unable to practice on their own.
NP: Unlike physician assistants, nurse practitioners are able to practice and even prescribe medication independently in many 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 in nursing is the minimum requirement to practice in any state. However, the American Association of Colleges of Nursing has recommended that in the future, nurse practitioners be required to hold a Doctor of Nursing Practice (DNP), but the current nursing shortage has made this impractical for the time being.
PA: Physician assistant programs typically involve 1,000 classroom hours and 2,000 or more hours in a clinical setting.
NP: Programs for nurse practitioners include a focus in a particular patient population (family, adult-gerontology (acute or primary), women’s health, neonatal, pediatrics (acute or primary), or psychiatric-mental health) and involve about 500 classroom hours and between 500 and 700 clinical hours (usually 8-12 hours per week are spent in a clinical setting).
PA: Programs must be accredited through the Accreditation Review Commission on Education for the Physician Assistant.
PA: Beginning in 2014, a 10-year certification maintenance cycle was implemented, replacing the six-year cycle that was previously in place. Physician assistants must complete 100 credit hours and pass a recertification exam every 5 years (twice within each renewal cycle) and log their time officially through the National Commission on Certification of Physician Assistants.
NP: Recertification for nurse practitioners typically requires between 75 and 150 continuing education credits and 1,000 documented clinical hours every 5 years. Some certification agencies accept passing exam scores in place of continuing education hours. State BONs may require continuing education beyond what is required to maintain national certification.
Featured YouTube Video
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: Nurse practitioners are certified in at least one patient population focus, and can also earn additional specialty certification. The certifying agencies for NPs are the American Academy of Nurse Practitioners, American Nurses Credentialing Center, American Association of Critical Care Nurses, Pediatric Nursing Certification Board, and the National Certification Corporation.
PA: State licensing is necessary to practice and requires holding a graduate degree and national certification. No previous license is needed.
NP: State licensing is necessary to practice and requires a master’s degree at minimum, an RN license, and national certification through one of the above-named certification agencies.
PA: Maintaining certification requires the completion of continuing education credit hours, as stated above.
NP: Continuing education hours, a minimum number of practice hours and/or examination are typically required for recertification.
Salary & Outlook
PA: The average income for physician assistants is $102,090, or about $49 an hour, though at the high end of the salary range they may make more than $142,000 per year.
NP: Nurse practitioners earn an average salary of $104,610 per year, or roughly $50 an hour, slightly more than physician assistants. The top ten percent, typically those with considerable experience, earn an average of $140,930 per year.
PA: As of 2016, there were 104,050 physician assistants practicing in the United States.
NP: As of 2016, there were around 150,230 nurse practitioners practicing in the United States.
PA: According to the Bureau of Labor Statistics (BLS), the number of jobs for physician assistants is expected to increase by roughly 28,700 between 2014 and 2024. That’s a 30 percent growth rate, which is much faster than average.
NP: The number of nurse practitioner jobs is expected to grow at a rate of 31 percent between 2014 and 2024 according to the BLS, also much faster than average.
Whatever position you choose, you’ll be glad to know that both nurse practitioners and physician assistants report a high degree of job satisfaction. Careful consideration of the different aspects of each profession will ensure you choose the position that best aligns with your personality and career goals.
If your long-term goals include earning a doctoral degree that will help you advance your knowledge and skills in direct patient care, you may find that choosing the nurse practitioner route is your best option. Traditional nursing doctorates (PhD) prepare nurses for careers in research and academia, but with the practice-focused Doctor of Nursing Practice (DNP) now widely available, it’s now common for NPs to earn a doctorate and remain working as clinical practitioners.