Healthcare is a broad field with all kinds of opportunities at many different levels. As you move through your career you might find yourself wondering at some point where an advanced degree could take you.
Nurse practitioners (NPs) and physician assistants (PAs) hold an important place in the healthcare system. These advanced roles offer some of the best opportunities available for healthcare professionals looking to expand their scope of practice, enjoy greater autonomy, take on more responsibility, and, of course, earn a better salary.
Both NPs and PAs hold advanced degrees, and both usually provide direct patient care under the auspices of a physician, and in recent years, professionals in both roles have been gaining a greater level of independence as a growing number of states relax requirements for physician collaboration and oversight. This comes as a direct response to a growing physician shortage at a time when there are more demands being placed on the healthcare system than ever before. There’s no doubt that NPs and PAs are a big part of the solution. Both nurse practitioners and physician assistants routinely serve the primary and preventative care needs of diverse patient populations, and nowhere is this more true than in medically underserved rural and inner-city areas.
It would be easy to argue that there are just as many similarities between NPs and PAs as there are differences, but there’s still plenty that sets them apart.
Check out the video Nursejournal.org made on nurse practitioners vs. physician assistants. Watch it now!
Nurse Practitioner and Physician Assistant Differences
One of the main differences between the two professions can be seen in the different ways they approach patient care, and the training they receive around the different practice models used to prepare them for clinical practice. While nurse practitioners are 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 and philosophies about patient care.
Nurse practitioners follow a patient-centered model, while physician assistants adhere to a disease-centered model. This is a pretty complex and nuanced distinction that starts to make a lot more sense when you start to study nursing or medicine at an advanced level, but in simplest terms it can be explained like this:
- The nursing model looks more 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 different specializations available to NPs and PAs. From the time they enter their graduate program, every NP chooses a specific patient population focus as a primary specialty. This might be pediatrics, geriatrics or women’s health, for instance. Physician assistants, on the other hand, more often specialize in a particular area of medicine, like emergency medicine or internal medicine.
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 diagnose illnesses and injury, perform examinations and provide treatment plans, and routinely do so without any direct supervision from an MD. The role of the physician assistant is largely to perform services within the scope of their training and legal authority that might otherwise be performed by a physician, which often includes prescribing medication.
NP: Nurse practitioners also diagnose and treat various illnesses and injuries, and also place a strong emphasis on 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 they are permitted to practice and prescribe completely independently without any kind of physician collaboration required.
PA: Even though most PAs work in collaboration with a designated physician, this rarely means working under direct supervision. Naturally, PAs are found in doctors’ offices, hospitals, skilled nursing facilities, and other settings where they work as part of a team alongside MDs and other healthcare professionals, but they also often work for or manage stand-alone PA-led clinics, and can even be found working in schools and other settings.
NP: Nurse practitioners also work in a wide variety of settings where direct physician oversight is rarely part of the day-to-day routine. These settings include 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.
PA: Physician assistants can specialize in many areas that typically center on disease type or area of medicine. Examples include everything from dermatology to 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: 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, PAs are required by law to work under some form of collaborative agreement with an MD, but very little of what they do day-to-day 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.
NP: Progressive laws are in place for advanced practice registered nurses in about half the states, granting NPs total freedom to practice independently to the full extent of their education and training. This means that in states where laws have been aligned with the APRN Consensus Model, NPs are allowed to 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, and though NPs in these states would 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, though most NPs work in hospitals as part of a larger healthcare team.
Education & Programs
PA: Physician assistants typically complete a three-year graduate program that includes clinical rotations and results in a Master of Science in Physician Assistant Studies.
NP: A master’s degree in nursing is the minimum requirement to become a nurse practitioner. The American Association of Colleges of Nursing and other organizations have 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.
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Certification & Licensing
PA: All 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 (2016, US Bureau of Labor Statistics).
NP: Nurse practitioners earn an average salary of $104,610 per year, or roughly $50 an hour. The top ten percent, typically those with considerable experience, earn an average of $140,930 per year (2016, US Bureau of Labor Statistics).
PA: As of 2016, there were 104,050 physician assistants practicing in the United States (2016, US Bureau of Labor Statistics).
NP: As of 2016, there were around 150,230 nurse practitioners practicing in the United States (2016, US Bureau of Labor Statistics).
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 to 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.