NP vs Doctor: Differences Between a Nurse Practitioner and a Physician

What’s the difference between a nurse practitioner (NP) and a physician? Whether you’re weighing career paths or just planning your next checkup, it’s valuable to understand the differences between these two highly trained but distinct healthcare professions.

While there are many similarities when it comes to NPs vs. doctors, there are also some critical differences in their scope of practice, education, work settings, and salaries. We’ll dive in here to describe, compare, and contrast both fields.

Doctors and NPs are both healthcare providers. In many states, NPs are able to serve as independent clinicians. Both are trained to diagnose conditions, prescribe medications and other treatments, and provide primary patient care.

What are the key career differences between NPs vs. doctors? Perhaps the main difference is that NPs are not able to practice independently in some states — check the NP practice authority laws to find out what NPs are empowered to do in your state. In all cases, however, properly trained physicians are permitted to perform certain procedures — surgery, for example — that NPs are not.

Another important difference is that the career path to becoming an NP typically takes less time than becoming a physician, while the training for doctors is much longer, intense, and much more expensive. After training, however, physicians command substantially higher salaries than NPs. And while both physicians and nurse practitioners are in strong demand, job growth for NPs will be higher in the next decade.

While physicians and NPs can specialize in different areas, most NPs work in primary care. Due to the ongoing shortage of primary care providers, this keeps demand for NPs high. Physicians in primary care and specialty roles also benefit from strong demand.

Both physicians and NPs provide primary and specialty healthcare. Like physicians, NPs can evaluate and diagnose patients, order and interpret diagnostic tests, and prescribe medication; however, some states limit the autonomy of NPs.

NPs in 28 states and Washington, D.C. have full prescriptive authority. The remaining 22 states allow either reduced or restricted authority. In reduced practice states, NPs can diagnose and treat patients, but they need physician oversight to prescribe medications. NPs who work in restricted states cannot prescribe, diagnose, or treat patients without physician oversight.

Doctors are able to prescribe, diagnose, and treat patients in all 50 states and Washington, D.C.

Practice settings for NPs vs. physicians depend on their specialty area. Because many NPs specialize in primary care, they often work in family care settings. Surgeons typically work in hospitals or surgical centers, while many psychiatric mental health NPs and psychiatrists work in psychiatric clinics.

Nurse practitioners and physicians work in many similar settings, including emergency rooms, outpatient clinics, primary care practices, and urgent care facilities. They also work in public health, government, and academic settings.

Sources: American Association of Nurse Practitioners; American Medical Association

Physicians and nurse practitioners must hold a license to practice, and many pursue board certification in specialty areas.

As advanced practice registered nurses, nurse practitioners hold an RN license and an NP license. That includes passing the NCLEX-RN exam, graduating from an accredited NP program, and applying to their state board of nursing to practice. States may use NP certification exams and/or additional requirements for licensure.

Board certification is available to NPs in many different specialty areas, such as:

Once a prospective doctor has earned their medical school degree and completed their residency, they are eligible to apply for their medical license. Every state requires physicians to hold a license to practice, and to have successfully completed properly accredited programs.

For board certification, doctors must show proof of completion of an accredited residency program. They must also demonstrate expertise in their chosen medical specialty. According to the Association of American Medical Colleges, there are more than 160 specialties and subspecialties in the U.S. Some of the most popular specialties include:

Both physicians and NPs enjoy salaries well above the national average, with physicians at or near the top of the curve for all occupations in the U.S.

The median annual salary for NPs reached $126,260 as of 2023, with the highest-paid NPs earning $168,030.

According to 2023 BLS data, physicians reported an average annual salary of $248,640, with a surgeon’s annual salary averaging nearly $344,000. Certain subspecialists can earn even higher pay. For example, neurosurgeons average about $452,000 in annual salary as of August 2024, according to Payscale. However, the most lucrative medical specialties can be extremely competitive.

Additional factors affecting salary for both professions include geographic location, experience level, work setting, specific work functions, and more.

Both physicians and NPs receive extensive training. Both allopathic and osteopathic physicians hold doctorates in medicine, while NPs earn a master of science in nursing (MSN) or doctor of nursing practice (DNP) degree.

The education timeline for nursing school vs. medical school differs. After meeting challenging undergraduate prerequisites, prospective doctors spend at least four years in medical school and a minimum of 2-3 years completing their residency. NPs must complete an undergraduate nursing program and earn an MSN or DNP, which includes a minimum of 500 hours of clinical training. After earning a bachelor’s degree, NPs typically spend 2-5 years in graduate-level training.

Medical school and nursing school represent major investments. Because medical school takes longer and because residency salaries are considerably lower than physician salaries, medical students tend to graduate with far more debt.

Graduates from public universities hold an average medical school debt of $194,280, compared with $218,746 for private universities. The average debt for MSN programs is $49,047. NPs and physicians can both participate in loan forgiveness programs.

Both NPs and physicians can expect above-average salaries and high demand for their skills, so many consider the cost and debt a good investment.

If you’re debating between NP vs. doctor, you’ll need to weigh the pros and cons of both. With its faster timeline and patient-focused approach, becoming an NP can be fulfilling professionally and personally. And while med school requires a major commitment of time and resources, becoming a physician offers many paths for specialization, high earning potential, and a host of professional opportunities.

But deciding between becoming an NP or physician is more complicated than job growth projections or specialization opportunities. Consider your motivations and find the path that best fits your unique circumstances, such as your prior education and specific professional desires. For example, if you are already an RN, it’s relatively fast and cost-effective to become an NP. On the physician side, with many medical schools routinely reporting single-digit admission rates, you’ll need a stellar academic record to get in.

Both career paths offer opportunities to challenge yourself, specialize in diverse areas, and provide exceptional care to patients. By weighing your motivations, timeline, and career goals, you can find the right healthcare career path for you.