Physician assistants (PAs) and nurse practitioners (NPs) hold important positions in the healthcare system. Additionally, these advanced roles offer some of the best opportunities for healthcare professionals looking to expand their scope of practice, enjoy greater autonomy, take on more responsibility, and earn a higher salary.
Both NPs and PAs hold advanced degrees and provide direct patient care under the auspices of a physician. In recent years, professionals in both roles have gained a greater level of independence as a growing number of states have relaxed requirements related to physician collaboration and oversight. This comes as a direct response to a growing physician shortage at a time when more demands are being placed on the healthcare system than ever before.
There’s no doubt that NPs and PAs can help address these healthcare shortages. Both nurse practitioners and physician assistants routinely serve the primary and preventative care needs of diverse patient populations; this is especially true in medically underserved rural and inner-city areas.
Check out the video Nursejournal.org made on nurse practitioners vs. physician assistants. Watch it now!
Physician Assistant and Nurse Practitioner Differences
One of the main differences between these two professions can be seen in the different ways they approach patient care, as well as the training they receive through the different practice models used to prepare professionals for clinical practice. While nurse practitioners receive training in accordance with the nursing model, physician assistants attend programs more in line with the medical model.
Nurse practitioners follow a patient-centered model, while physician assistants adhere to a disease-centered model. This complex and nuanced distinction starts to make more sense when you study nursing or medicine at an advanced level. However, in simplest terms, it can be explained as follows:
- The nursing model looks holistically at patients and their outcomes, giving attention to a patient’s mental and emotional needs as much as their physical problems.
- The medical model places a greater emphasis on disease pathology, approaching patient care by looking primarily at the anatomy and physiological systems that comprise the human body.
This important difference influences the various specializations available to NPs and PAs. From the time they enter their graduate program, NPs choose a specific patient population as their primary specialty; these specializations include pediatrics, geriatrics, and women’s health. Alternatively, physician assistants more often specialize in a particular area of medicine, such as emergency or internal medicine.
Below, you’ll find comparisons between NPs and PAs in terms of what their jobs look like on a day-to-day basis, the education needed to enter each profession, how to get licensed and certified for each role, and the job outlook for each field over the next several years.
Physician assistants routinely diagnose illnesses and injuries, perform examinations, and provide treatment plans without any direct supervision from an MD. Physician assistants perform various services within the scope of their training that might otherwise be performed by a physician. This often includes prescribing medication.
Nurse practitioners diagnose and treat various illnesses and injuries, strongly emphasizing preventative care and health promotion. They frequently practice autonomously without direct physician oversight, even when under a collaborative agreement with an MD. In a growing number of states, these professionals can practice and prescribe medication completely independently.
Even though most PAs work in collaboration with a designated physician, this rarely means working under direct supervision. PAs work in doctors’ offices, hospitals, skilled nursing facilities, and other settings where they serve as part of a team alongside MDs and other healthcare professionals. They may also work for or manage stand-alone PA-led clinics and can be found working in schools and other settings.
Nurse practitioners work in a variety of settings where direct physician oversight is rarely part of the day-to-day routine, including hospitals, private physician practices, skilled nursing facilities, and even schools and summer camps. NPs also frequently establish independent NP-led clinics and partner practices with other NPs.
Physician assistants can specialize in areas that typically center on a disease type or specific area of medicine, such as dermatology, emergency medicine, and surgery.
Nurse practitioners receive their primary certification within a particular patient concentration. Examples include family, acute, or primary adult-gerontology; women’s health; neonatal; acute or primary pediatrics; and psychiatric-mental health. They can further specialize based on their practice setting (e.g., emergency medicine) or disease type (e.g., oncology).
The level of independence granted to physician assistants has a lot to do with how the laws read in each state, but autonomy and independence mean something different when defining the scope of practice in healthcare. In all but a few states, the law requires PAs to work under some form of collaborative agreement with an MD, but very little of what they do on a day-to-day basis actually requires any direct physician oversight. In this sense, virtually all PAs spend most of their time working autonomously. PAs can even operate independent PA-led clinics where physician involvement may be limited to little more than a couple on-site visits per month.
About half the states in the country feature progressive laws for advanced practice registered nurses, granting NPs total freedom to practice independently to the full extent of their education and training. This means that in states where laws align with the APRN Consensus Model, NPs can practice and prescribe without having any kind of collaborative agreement in place with a physician.
Still, many states do require NPs to maintain collaborative agreements. Although NPs in these states can still routinely work autonomously without direct supervision, they are not considered independent practitioners. Many NPs — in both independent practice states and states where physician collaboration is required — form private practices or partner practices with other NPs, although the majority of nurse practitioners still work in hospitals as part of a larger healthcare team.
Education and Training for Nurse Practitioners
NP and PA training programs vary between schools. Each nursing school has its own strengths based on available resources and the specialty areas of its faculty. As you research programs, be sure that all of your prospective schools hold accreditation. All credible NP and PA programs hold accreditation from the Commission on Collegiate Nursing Education or the Accreditation Commission for Education in Nursing.
Admission Requirements for a Nurse Practitioner Program
Aspiring NPs must take several steps in order to enter the medical field. First, students earn their registered nurse (RN) credentials through an accredited associate or bachelor’s program. Students who wish to pursue a career as an NP must earn a bachelor’s degree as a prerequisite for graduate school.
Most students earn an undergraduate degree in nursing, but a degree in a related field may also be appropriate. Additionally, many graduate nursing programs require applicants to hold some work experience in the field, although some programs assume that students will gain enough experience while working toward a graduate degree.
To become an NP, individuals must earn a master of science in nursing. Most nursing students must also pass a background check. Common application materials include resumes, transcripts, personal statements, proof of RN credentials, GRE scores, and application fees.
Concentrations Offered for a Nurse Practitioner Program
|Concentrations Offered for a Nurse Practitioner Program|
Family Nurse Practitioner
Students following an FNP concentration take classes in advanced physiology, physical assessment, diagnostic reasoning, and population health. This concentration typically requires 600-650 clinical hours. Popular careers for FNP majors include pediatric nurse practitioner, nurse-midwifery, oncology nurse practitioner, psychiatric nurse practitioner, and clinical nurse specialist.
This concentration prepares professionals to administer local and general anesthetics, perform nerve blocks, sedate patients, and facilitate pain management processes. Students in this area complete approximately 2,500 clinical hours and administer 850 anesthetics before earning their certification. In most cases, these professionals work in hospitals or dental offices and prepare patients for all types of invasive surgeries.
Nurses in this area work with newborn infants dealing with medical issues related to premature birth, infections, heart issues, birth defects, and surgical problems. They may also work with babies who have long-term problems, up until they are two years old. Neonatal nurses generally work in hospitals, and most students who pursue this field need to accrue 550-1,000 neonatal clinical hours.
These professionals work with patients suffering from mental illness. While in school, students learn how to diagnose symptoms, develop treatment plans, and prescribe appropriate medication as needed. Psychiatric-mental health nurse practitioners need to log approximately 500-620 clinical hours. This relatively small area of the field accounts for about 3.2% of the NP workforce.
These NPs offer medical care for children of all ages. They focus on preventative health, growth and development, managing chronic illnesses, and primary care. They often need to accrue 500-600 clinical hours, and most students complete their master’s degree and clinical requirements in 2-3 years. Upon graduation, individuals can pursue careers as pediatric NPs in hospitals, medical centers, and clinics.
Sample Courses for a Nurse Practitioner Program
- Practice Management of Clients and Families: Students engage in advanced study of patient management and explore ways to deal with patients’ acute and chronic illness and health and developmental problems. Participants develop diagnosis skills and learn to prescribe pharmacological agents. This is often a required course for individuals pursuing careers as family nurse practitioners and similar focus areas.
- Gerontology Nursing Care: This course covers advanced topics in the care of aging patients. Students explore the impact of ethnicity on aging and learn how to promote wellness and self-care among this population.
- Health Policy Issues: Students explore the political structures and hurdles involved in healthcare policy. This course shows how modern technology and cultural and societal components influence healthcare. Students focus on issues in finance, regulatory systems, social justice and consumer groups, and economics. Upon completion of the course, students can identify the major challenges in healthcare reform and describe the essential building blocks of the system.
- Pharmacology: Courses in clinical pharmacotherapeutics build foundational knowledge in drug classification, drug prototypes, and side effects. Students also explore the legal considerations involved with drugs. This class is required for students seeking careers where it is commonplace to diagnose illnesses and prescribe drugs as treatment.
- Comparative Health: This course builds on the general patient assessment skills that all nursing students acquire in their undergraduate programs. Students further develop their interviewing skills, record-keeping and assessment techniques, and physical examination abilities. They also study the effects of cultural history and genetics on patients’ healthcare needs.
How Long Does It Take to Complete a Nurse Practitioner Program?
It usually takes a total of 6-8 years for full-time students to become nurse practitioners, including time alloted for coursework and licensure. Initially, students earn a bachelor of science degree, which usually consists of about 120 credits and takes four years of full-time study to complete. Next, aspiring NPs obtain state licensure by taking an exam, such as the National Council Licensure Examination for Registered Nurses. Those who do not pass the exam on the first try may take it up to eight times a year.
Future NPs must also obtain a master’s degree, which usually takes students an additional 1-3 years. Both the graduate and undergraduate experiences may be longer for online students or hybrid students who enroll part time. Additionally, some master’s programs require incoming students to have one or two years of work experience in the field, thus extending this prospective timeline. Lastly, graduates of master’s programs must pass a certification exam and complete approximately 750-1,400 clinical hours over the course of roughly six months.
Internships for Nurse Practitioners
Most nursing programs require students to complete internship or clinical hours. These help students gain hands-on experience in their chosen area under the guidance of seasoned professionals. The number of required hours depends on the program and specialty area, although students typically need to complete 500-700 hours of clinical experience. However, some specializations, such as neonatal care and anesthesia, require as many as 2,500 clinical hours. These assignments take place in clinics, hospitals, long-term care facilities, and doctors’ offices.
Students completing practica can expect to help with clinical paperwork and spend time observing nurses on the job. Alternatively, students in clinical rotations or internships typically acquire more training related to direct patient care. They may learn to administer medication, assist with procedures, develop patient care plans, and help patients with daily necessities.
Certifications and Licenses for Nurse Practitioners
After earning a master’s degree in nursing, aspiring NPs should seek out certification and licensure as a certified nurse practitioner. All states require NPs to acquire board certification. Students take a national certification exam in their chosen population focus or specialty area, such as adult nurse practitioner, family nurse practitioner, and adult-gerontology primary care nurse practitioner. Other popular national certifications include school nurse practitioner, pediatric nurse practitioner-primary care, women’s health nurse practitioner, and psychiatric-mental health nurse practitioner.
For state licensure, NPs must hold a master’s degree, national certification, and a current RN license. Certification boards and national certification corporations help determine the professional boundaries of the practice. In some states, NPs establish a collaborative practice agreement with a physician, although 21 states allow NPs to practice independently.
Additionally, any national certification or state licensure requires maintenance, which professionals complete by taking continuing education courses on a regular renewal cycle. States and certifying agencies determine renewal guidelines. Some states require courses in professional ethics, pharmacology, and HIV/AIDS education. The American Association of Nurse Practitioners, American Nurses Credentialing Center, American Association of Critical-Care Nurses, Pediatric Nursing Certification Board, and National Certification Corporation serve as certifying agencies for NPs.
Education and Training for Physician Assistants
All PA programs must hold accreditation from the Accreditation Review Commission on Education for the Physician Assistant. However, despite this blanket certification, PA programs possess different characteristics that influence their course offerings. Each school builds on its faculty’s strengths to diversify the classes and specialty training it offers.
Admission Requirements for a Physician Assistant Program
All aspiring PAs must obtain a bachelor’s degree. While an undergraduate education in a particular field is not necessarily a requirement for admission into a graduate program, successful applicants often possess bachelor’s degrees in physiology, chemistry, mathematics, or biology. In addition to an undergraduate degree, graduate programs typically expect applicants to have some work experience in the nursing field. However, applicants do not need an RN license for admission.
Applicants submit several types of materials when applying to graduate school. In most cases, aspiring PAs show documented experience in clinical situations, shadowing experiences, and/or community service activities. Programs may also require undergraduate transcripts that illustrate a successful history of courses in the sciences as well as GRE scores and letters of reference. These master’s programs also usually require applicants to pass background checks.
Concentrations Offered for a Physician Assistant Program
|Concentrations Offered for a Physician Assistant Program|
These PAs assist orthopedic surgeons with various duties; evaluate new patients; write treatment plans; administer local anesthesia; and educate patients about medications, recovery processes, and follow-up appointments. Students in this concentration typically complete at least 2,000 hours of clinical rotations. Orthopedic PAs usually work in hospitals, clinics, and urgent care facilities.
PAs in these positions perform postmortem examinations, compile summations of patients’ medical histories, collect tissue samples, and prepare samples for lab processing. They often serve as part of forensic teams to develop toxicology reports. They may also work with coroners’ departments and governmental agencies. PAs specializing in this area can expect to complete around 2,000 clinical hours. Additionally, this position earns one of the highest salaries among PAs.
The dermatology concentration leads to lucrative careers in the medical field. These professionals help diagnose, treat, and prevent diseases of the hair, nails, skin, oral cavity, and genitals. They typically have an extensive background in nursing, including RN and PA licensure. Under the supervision of a physician, these professionals may prescribe medications and interact directly with patients in private practice facilities, hospitals, and emergency care centers. They need a certain number of clinical hours to start and must complete continuing education courses to maintain their eligibility to practice.
Professionals in these roles serve as the primary care PAs for transplant patients, working in operating rooms while transplants take place. They help patients understand their procedures, recovery plans, and follow-up appointment schedules. Most states require these PAs to have post-graduate training or a residency in clinical care. Students typically complete at least 1,000 clinical hours to prepare for this role.
These PAs work at hospitals in cardiac, medical, and surgical intensive care units. They provide comprehensive care for patients, including intensive monitoring. They often work as part of a team of practitioners to help develop personalized recovery plans for patients. They may also serve as the primary care provider for critically ill patients, depending on the location and resources of a healthcare center. Students can expect to complete approximately 400 clinical hours for this concentration.
Sample Courses for a Physician Assistant Program
- Human Anatomy: This course introduces students to clinically relevant topics in human anatomy. Learners gain a deep knowledge of anatomical structure and function. PA students focus on clinical correlation pathology and diseases, and required laboratory assignments involve working with cadavers, dissection, spatial relationships in the body, anatomic variation, and relationships between human organ systems.
- Professional Communication: PAs must have excellent communication skills. This course covers the communicative roles of healthcare professionals, including teamwork skills, patient interviewing techniques, and coping skills. Students conduct practice interviews and complete team projects, working on relationship-building exercises.
- PA Roles in Surgery: This course covers the fundamentals of care for surgical patients and how PAs must function in these environments. Students learn practical skills by examining case studies and apply their knowledge in various projects and simulated patient encounters. Upon completion of the course, students understand the important supportive roles and responsibilities required of PAs during these critical procedures.
- Imaging and Diagnostics: Students in this course explore the various skills that PAs need to assess the results of radiologic examinations and work in supportive roles at imaging facilities. Coursework focuses on identifying predictable variants and typical pathologies in various imaging scenarios. Students study many common imaging modalities, including X-rays, CT scans, MRIs, and nuclear studies.
- Internal Medicine: This clerkship course teaches students the basic knowledge they need to handle common health issues and patient situations. Students learn how to create the appropriate documents doctors need for full patient evaluation, including medical histories, physical exam information, and daily rounds logs. PA students also learn about complex diseases, diagnoses, and how PAs support other medical professionals.
How Long Does It Take to Complete a Physician Assistant Program?
It can take a total of six or more years to complete the necessary steps to become a PA. A bachelor’s degree takes full-time students four years to complete and usually requires participants to earn about 120 credits. Master’s programs take approximately two additional years to complete and typically require 35-46 credits. Some students choose to pursue both degrees at once through rigorous BA-PA programs.
Most master’s programs include clinical hours as part of their training requirements, although the number of required hours depends on the school and one’s chosen area of specialty. In some cases, this means that students complete up to 2,000 clinical hours before entering the field. Some graduate programs help students earn these clinical hours through established shadowing or internship opportunities.
No matter their academic pathway, students should only attend schools that hold accreditation from the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).
Internships for Physician Assistants
Internships or clinical rotations for students pursuing a career as a PA vary in duration and focus area. Most schools require students to complete eight-week rotations in private, public, inpatient, and outpatient care locations. Master’s programs offer rotations in dozens of fields, including dermatology, emergency medicine, and surgery. Rotations expose students to a variety of PA roles in the medical field and help individuals learn the principles of medicine in established and ambulatory patient care settings.
Overall, PA students can expect to complete 10-12 rotations. Internships and rotations also help students further refine their skill sets and determine which area of the field best suits their needs and career aspirations.
Certifications and Licenses for Physician Assistants
Graduates from programs accredited by ARC-PA can take the Physician Assistant National Certifying Exam (PANCE), which covers essential topics in the field, including clinical intervention, lab and diagnostic studies, physical examinations, pharmaceutical therapeutics, and basic science concepts. Those who pass the exam earn the physician assistant-certified designation.
PAs must obtain state licensure to practice, and only individuals with national certification and a master’s degree can pursue state licensure. PAs may also add specialty certificates to their physician assistant certification. Specialty certifications for professionals in this field include psychiatry, nephrology, emergency medicine, and pediatrics. To qualify for specialty certification exams, professionals must have at least two years of experience in their chosen area.
PAs must also work to maintain their certification. The National Commission on Certification of Physician Assistants uses a 10-year certification cycle divided into periods. During every two-year period, professionals must earn at least 100 continuing education credits. At the end of each 10-year cycle, PAs must pass a recertification exam: the Physician Assistant National Recertifying Exam (PANRE). Unlike PANCE, PANRE addresses many clinical issues with specific questions that professional PAs with 10 or more years of experience should be able to answer.
Salary and Job Outlook
The job outlook for nurse practitioners in the coming years remains promising. While there were 155,500 jobs in the field in 2016, the Bureau of Labor Statistics (BLS) projects 36% job growth between 2016 and 2026. At this rate, jobs in the field will expand at about five times the national average for all occupations. Additionally, careers commonly held by NPs enjoy salaries well above the national average. The median pay for NPs in May 2017 was $103,880 per year — almost three times the median salary for all occupations.
When comparing the wages of physician assistants versus nurse practitioners, the salaries are quite similar. The two charts below show the wages for nurse practitioners in four popular specialty areas, as well as the top-paying industries in the field.
Salaries by Specialty for Nurse Practitioners
|Specialty||Median Annual Salary|
|Family Nurse Practitioner||$91,573|
|Gerontological Nurse Practitioner||$94,000|
|Pediatrics Nurse Practitioner||$87,040|
|Psychiatric Nurse Practitioner||$101,420|
Top-Paying Industries for Nurse Practitioners
|Specialty||Median Annual Salary|
|Personal Care Services||$139,460|
|Management, Scientific, and Technical Consulting Services||$132,200|
|Offices of Dentists||$117,270|
|Office Administration Services||$115,960|
Source: The BLS
The job outlook for PAs also looks promising. In 2016, there were 106,200 PA jobs, and the BLS projects this number to grow rapidly over the coming years. In fact, the projected growth rate of PA jobs is even higher than it is for NPs. The BLS projects a 37% increase in new jobs for PAs between 2016 and 2026. This rapid growth is largely due to the fact that PAs can finish school more quickly than physicians. In many situations, PAs can also provide the same services as physicians.
In 2017, PAs earned a median pay of $104,860. The 10th-percentile salary for PAs stood at $66,590, while the 90th-percentile salary exceeded $145,000. The charts below show the top-paying industries for physician assistants.
Top-Paying Industries for Physician Assistants
|Industry||Median Annual Salary|
|Individual and Family Services||$114,880|
|Outpatient Care Centers||$110,510|
|Specialty (Except Psychiatric and Substance Abuse Hospitals)||$109,490|
|Management, Scientific, and Technical Consulting Services||$109,350|
Source: The BLS
Additional Resources for NPs and PAs
- American Association of Pathologists’ Assistants: Founded in 1972, AAPA is a nonprofit membership organization. This group of allied health practitioners works to support and connect medical workers who specialize in pathology or work as pathologist assistants. Members can access an active job board, attend annual conferences, and read full-text online publications.
- American Association of Nurse Practitioners: Students and professionals can join this organization to access many online resources and networking opportunities. Members can take advantage of online job boards, regional and annual conferences, continuing education resources, and various professional development opportunities.
- The Physician Assistant Life: Founded in 2012, this site offers useful resources for students and professionals at any level of their career. The PA Life includes extensive certification and licensure exam preparation materials, free downloads, an active blog, and a curated book list.
- Inside PA Training: This site includes full-text online articles, video interviews, forums, and program directories for aspiring PAs. Additional resources include application coaching materials, online ebooks, a smartphone application, and interview tips.
- National Association of Pediatric Nurse Practitioners: This professional association helps support and educate medical professionals who work in pediatrics and related fields. NAPNAP offers educational and networking opportunities for students and professionals through online resources, conferences, and workshops.