Nurse Practitioner vs. Physician Assistant: What’s the Difference?

Both nurse practitioners (NPs) and physician assistants (PAs) help meet a critical healthcare need in the U.S. healthcare system.

While the two healthcare roles may appear similar, NPs and PAs have significant differences in training, certification, day-to-day responsibilities, and more.

If you’re considering becoming an NP or PA, learn about some of the key differences between these two professionals in this guide.

The job duties and responsibilities of an NP and PA share many similarities.

Both NPs and PAs can:

Additionally, both professionals must have completed their required training from an accredited program, passed their board exam, and received their license to practice.

However, there are some important differences between the two healthcare roles.

Regarding education, these roles follow two distinct paths. NPs hold a master’s or doctorate in nursing, while PAs complete a master’s degree.

NPs attend nursing school and follow a patient-centered model of care, as described by the American Association of Nurse Practitioners. In contrast, PAs complete a PA program and follow a disease-centered model of care, according to the American Academy of Physician Associates (AAPA).

The scope of practice for nurse practitioners vs. physician assistants also differs. In 28 states, NPs have a full scope of practice. That means they can treat patients and prescribe medication independently. In the remaining 22 states, NPs practice in collaboration with or under the supervision of a medical doctor. NP practice authority varies among states, so be sure to check practice regulations with your state’s board of nursing.

In contrast, PAs in every state practice under a medical doctor’s supervision.

A nurse practitioner is a type of advanced practice registered nurse (APRN) who provides primary and specialty care.

NP duties often include:

In many states, NPs practice independently, while other states require NPs to collaborate with or work under the supervision of medical doctors.

A PA provides primary and specialty care under the supervision of a medical doctor. Key duties include:

About 24% of PAs work in primary care, according to a 2021 NCCPA report. Physician assistants can also prescribe medication. However, medical doctors supervise physician assistants in all 50 states.

Nurse practitioners and physician assistants share many common duties and responsibilities.

Both NPs and PAs can:

Primary care is the most common work setting for NPs. According to the American Association of Nurse Practitioners (AANP), 70% of NPs deliver primary care services.

In comparison, about 24% of PAs work in primary care, according to a 2021 NCCPA report.

Nearly 39% of PAs work in hospitals, the most common setting, reports the AAPA.

NP practice authority varies by state, with 29 states granting full authority. In 12 states with reduced practice authority, NPs can practice autonomously with some restrictions on their scope of practice.

For example, in Louisiana, NPs must, by law, maintain a collaborative agreement with a physician for at least one aspect of their practice.

NPs have restricted practice in nine states. For example, NPs in Georgia must practice under the supervision of a medical doctor.

An NP’s prescriptive authority also varies by state, with some states restricting the types or the duration of prescription medications NPs can prescribe.

Some states, like Pennsylvania and Florida, require physician involvement to prescribe medication, though they offer full practice in all other areas.

Like nurse practitioners, physician assistants’ scope of practice depends on the state in which they work.

In some states, PAs must always work under the supervision of a medical doctor. Other states allow PAs to treat patients without a medical doctor on-site as long as they have an established collaborative relationship with one.

Depending on state laws, experienced PAs can increase their scope of practice after meeting clinical hour requirements.

NPs and PAs must earn master’s degrees in their respective discipline. NP programs include advanced nursing courses in a specialty, while PA programs follow a medical school curriculum.

However, NP and PA programs feature similar courses like advanced pharmacology, anatomy and pathophysiology, and microbiology.

NPs must be licensed RNs before moving to advanced practice roles.

RNs can pursue a graduate degree to become nurse practitioners. The most common route is a master of nursing practice (MSN), while some NPs earn a doctorate in nursing practice (DNP).

However, there are several pathways to becoming a nurse. Earning a licensed practical nurse (LPN) credential is the fastest way to enter the nursing field. Completing an LPN program takes about 15-18 months.

Another way to become a registered nurse is to complete an associate degree in nursing (ADN), which can take about two years. Lastly, you can complete a bachelor of nursing degree (BSN), which is typically a four-year commitment.

LPNs must pass the National Council Licensure Examination for Practical Nurses (NCLEX-PN), while ADN and BSN-prepared nurses must pass the National Council Licensure Examination (NCLEX-RN) to receive an RN license in their state.

During an NP program, nursing students complete coursework in:

They also take courses in specialty areas, such as family care, acute care, pediatrics, or psychiatry.

NP programs incorporate supervised clinical practicums so students can gain experience in treating patients. Board certification for NPs, which is required for licensure, requires at least 500 clinical hours, and some NP programs add additional clinical hours. Earning an MSN generally takes 2-3 years, while a DNP takes 3-5 years.

With an MSN or DNP, nurse practitioners must complete a national board certification process demonstrating their eligibility for an APRN license. NPs must then apply for a license through their state’s board of nursing.

NPs must complete certain clinical hours and continuing education (CE) courses to recertify. NPs only take a recertification exam every 5 years by choice or if they don’t meet certification requirements.

The first step to becoming a PA requires earning a bachelor’s degree, preferably in a science-based field, in preparation for a PA master’s program.

Future PA students should complete common PA master’s program prerequisites, including anatomy, physiology and biochemistry.

PA program applicants also need healthcare experience. Most programs require hands-on patient experience as a medical assistant, paramedic, or nurse before applying.

PA master’s degrees take about three years and focus on coursework and clinical rotations in general medicine. PAs complete clinical rotations in different specialties, such as:

PA students should only attend programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Attending an accredited program ensures you qualify for physician’s assistant licensure and roles after graduation.

Graduates take the Physician Assistant National Certifying Exam (PANCE) and apply for their physician assistant-certified (PA-C) credentials with their state board.

PAs must pass a recertification exam every 10 years and complete 100 hours of continuing medical education (CME) every two years.

NPs choose a specialization before applying to a graduate nursing program. After graduation, they sit for a board certification exam in their specialty.

NPs can switch specialties or obtain post-master certifications to advance their careers. They can also get certified in a subspecialty.

Most NPs become family nurse practitioners, providing care to patients across the lifespan with various healthcare needs. Other NPs pursue specialties in acute care and mental health or work with specific patient populations, such as pediatrics or adults.

Rather than focusing on one specialty area, PAs receive training as medical generalists, gaining skills in all areas of medicine. They complete clinical rotations in multiple specialties so they can adapt to different care areas and change specialties without additional training.

According to AAPA, about 26% of PAs practice in an inpatient unit (excluding intensive care and critical care units), 23% work in the emergency room, and 17% work in the operating room.

Other popular practice areas include primary care and internal medicine subspecialties.

Both nurse practitioners and physician assistants benefit from above-average salaries and strong demand. Learn more about the salary and career outlook for nurse practitioners vs. physician assistants.

The median nurse practitioner salary was $126,260 in May 2023, according to BLS data. Earning potential varies based on several factors, including work setting, specialty, experience, and location. NP salary data by state indicates the highest salaries in California, Washington, New Jersey, and Oregon.

The BLS also projects 46% job growth for nurse practitioners from 2023-2033, over 10 times faster than the average growth for all occupations.

According to BLS data, the median PA salary was $130,490 as of May 2023. Outpatient care centers and ambulatory healthcare services reported above-average salaries. Nevada, California, Washington, and Connecticut are the top-paying states for physician assistants.

Physician assistants also benefit from much faster-than-average job growth, with a robust 28% projected job growth from 2023 to 2033.

Nurse practitioners and physician assistants are important in the healthcare system, particularly in meeting the high demand for advanced practice providers. Both careers report strong demand and six-figure median salaries, and both report similar work settings and educational requirements.

When deciding between becoming an NP or PA, consider your timeline, the demand in your area, your interests, and your professional goals. While both career paths can take as little as three years after earning a bachelor’s degree, NPs need undergraduate-level nursing training before entering grad school.

As an NP, you’ll have greater autonomy than a PA, and NPs follow the patient-centered care model of the nursing profession. PAs draw on a disease-centered model that aligns with medical schooling. While both career paths offer a strong outlook, the best fit depends on your unique goals.