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. But what’s the difference between a nurse practitioner vs. physician assistant? From a career standpoint, the two healthcare roles may appear similar at first glance. But if you’re considering becoming an NP or PA, you’ll want to dig into the key differences.

The job duties and responsibilities of a nurse practitioner and physician assistant share many similarities. Both nurse practitioners and physician assistants can:

However, there are some key 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 the patient-centered model of care. In contrast, PAs follow a disease-centered model of care.

The scope of practice for nurse practitioners vs. physician assistants also differs. In 28 states, nurse practitioners 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. In contrast, PAs in every state must practice under a medical doctor’s supervision.

Nurse practitioners and physician assistants share many common duties and responsibilities. Their overlapping duties include:

Doctor’s offices are the most common work setting for both nurse practitioners and physician assistants. Among APRNs such as NPs, 47% work in doctor’s offices, compared with 52% of physician assistants, according to the Bureau of Labor Statistics. Hospitals are the next most common work setting for both careers, representing 25% of APRNs and 24% of PAs.

The 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. In nine states, NPs have restricted practice and must practice under the supervision of a medical doctor.

The NP prescriptive authority also varies by state, with some states restricting what types of prescription medications NPs can prescribe or the length of their prescriptions. 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 some states, PAs must work under the supervision of a medical doctor at all times, while other states allow PAs to treat patients without a medical doctor on-site as long as the PA has an established collaborative relationship with a medical doctor. In some states, experienced PAs increase their scope of practice after meeting clinical hour requirements.

NPs and PAs must earn master’s degrees in their respective discipline. Both NP programs and physician assistant programs feature similar coursework and focus on topics like pharmacology, pathophysiology, and advanced health assessment.

Nurse practitioners need to become an RN before moving to advanced practice roles. That means completing a bachelor’s in nursing, passing a national licensure exam, and receiving an RN license.

RNs can then pursue a graduate degree to become a nurse practitioner. A master of nursing practice (MSN) is the most common route, while some NPs earn a doctorate in nursing practice (DNP). During an NP program, nursing students complete coursework in:

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

NP programs incorporate supervised clinical practicums to gain experience in treating patients. Board certification, which is required for licensure, as a nurse practitioner requires at least 500 clinical hours, and some NP programs add additional clinical hours. MSNs generally take 2-3 years, while DNPs take 3-5 years.

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

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. Even if it’s unnecessary for your bachelor’s degree, future PA students should complete common PA master’s program prerequisites, including ethics, physics, and statistics.

PA program applicants also need healthcare experience (HE) or patient care experience (PCE). Most programs require at least 1,000 HE or PCE experience hours. Common paths include working as emergency medical technicians, paramedics, nursing assistants, RNs or licensed practical nurses, and surgical technicians.

PA master’s degrees take about three years to earn 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. 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. After PAs get certified and have work experience, they may obtain specialty certification, but PAs do not need specialty certification.

NPs choose their specialization areas while completing their graduate nursing programs. Then, they sit for a board certification exam in their specialty and focus solely on that NP specialty for their entire career. Most NPs become family nurse practitioners, providing care to patients across the lifespan with various healthcare needs. The remainder pursue specialties in acute care and mental health or work with specific patient populations, like 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 retraining for each specialty.

Almost a third of PAs focus on surgical care. 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 below.

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, experience, and location. NP salary data by state indicate the highest salaries in California, Washington, New Jersey, and Oregon.

The BLS also projects 45% job growth for nurse practitioners from 2022-2032, exponentially faster than the average 3% growth for all occupations.

The median physician assistant salary was $130,020 in May 2023, according to BLS data. Outpatient care centers and ambulatory healthcare services reported above-average salaries. The top-paying states for physician assistants are Nevada, California, Washington, and Connecticut.

Physician assistants also benefit from much faster-than-average job growth, with 27% projected job growth from 2022 to 2032.

Nurse practitioners and physician assistants serve an important role 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.

If you’re stuck 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 two 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 school. While both career paths offer a strong outlook, the best fit depends on your unique goals.