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

Maura Deering, J.D.
Updated February 13, 2023
Edited by
Reviewed by
Our Integrity Network is committed to delivering content that is objective and actionable. To that end, we have built a network of industry professionals across higher education to review our content and ensure we are providing the most helpful information to our readers.

Drawing on their firsthand industry expertise, our Integrity Network members serve as an additional step in our editing process, helping us confirm our content is accurate and up to date. These contributors:

  • Suggest changes to inaccurate or misleading information.
  • Provide specific, corrective feedback.
  • Identify critical information that writers may have missed.

Integrity Network members typically work full time in their industry profession and review content for as a side project. All Integrity Network members are paid members of the Red Ventures Education Integrity Network.

Explore our full list of Integrity Network members.

Learn the differences between PAs and NPs. Compare factors like salary, education requirements, and skills to help you choose your career.
mini logo

Are you ready to earn your online nursing degree?

Nurse is using digital tablet in hospitalCredit: FS Productions / Tetra images / Getty Images
  • Nurse practitioners (NPs) must earn a master’s in nursing (MSN), while physician assistants (PAs) earn a master’s in physician assistant studies.
  • NPs can specialize in several areas, including gerontology, mental health, pediatrics, and women’s health.
  • PAs are trained as medical generalists, receiving an education in general medicine modeled on medical school education.
  • NPs and PAs earn median annual salaries of around $130,000.

Considering an advanced degree in healthcare? You may want to learn the similarities and differences between nurse practitioners and physician assistants. Both careers are mid-level practitioner roles that are alternatives to working as a physician.

When considering the differences between physician assistants vs. nurse practitioners, keep in mind their different healthcare philosophies, educational options, and specializations to determine the best fit for you.

Comparing Nurse Practitioners and Physician Assistants: Key Similarities and Differences

Nurse practitioners and physician assistants possess some overlapping duties and responsibilities. As mid-level practitioners, both NPs and PAs provide direct patient care, perform assessments, make diagnoses, and develop treatment plans.

The primary difference between nurse practitioners and physician assistants is in their level of supervision and autonomy, depending on the state in which they practice. Nurse practitioners can practice independently and prescribe medications in many states. Physician assistants always work under the supervision of a doctor.

What is a Nurse Practitioner?

After starting their careers as registered nurses (RNs), NPs pursue graduate nursing degrees at the master’s or doctorate level. Many NP programs require one or more years of clinical nursing experience prior to admission.

While enrolled in an NP program, students complete 1,000 hours of supervised clinical practice. NPs focus on primary or acute care and specialize in such areas as family practice, pediatrics, psychiatric-mental health, or women’s health.

The state in which they work determines their level of practice autonomy and prescriptive authority, with some mandating physician oversight and others allowing them to provide care independently. NPs become licensed as advanced practice registered nurses (APRNs).

What is a Physician Assistant?

PAs earn master’s degrees and complete more than 2,000 hours of clinical rotations. Many aspiring PAs work in positions such as athletic trainers, medical assistants, and paramedics prior to entering their PA training programs.

PA master’s curriculums follow a medical school model, and PA students complete clinical rotations in areas that include emergency medicine, internal medicine, family medicine, and general surgery.

PAs work on teams with physicians and other healthcare providers, and most states require practice agreements with physicians. PAs complete certifications exams to earn the credential: physician assistant-certified (PA-C).

Nurse Practitioner vs. Physician Assistant
Nurse PractitionerPhysician Assistant
EducationMaster of science in nursing (MSN) or doctor of nursing practice (DNP)Master of science in physician assistant studies (MSPAS)
Time to Become2-3 years3 years
Average Annual Salary$128,490$130,490
Projected Job Growth45% (2022 to 2032)27% (2022 to 2032)
Practice FrameworkState laws determine whether a nurse practitioner can practice independently or must work under physician oversight.Some physician assistants may be required to work under the supervision of a doctor, depending on the state.
Source: Bureau of Labor Statistics (BLS), 2023

Featured Online MSN Programs

Learn about start dates, transferring credits, availability of financial aid, and more by contacting the universities below.

Loading...Learn More
Visit Site
Loading...Learn More
Visit Site
Loading...Learn More
Visit Site

Duties and Responsibilities

NPs and PAs perform many of the same duties and share similar responsibilities. The main differences lie in their educational backgrounds and abilities to provide patient care autonomously and prescribe medications.

NPs choose a specialization area while earning their nursing master’s degrees, while PAs receive education in general medicine.

NPs can practice autonomously in many states but must collaborate with a physician in others. PAs must work under physician supervision but can prescribe medications without restrictions.

What Does a Nurse Practitioner Do?

Nurse practitioners function as primary care providers, with daily responsibilities spanning those of both registered nurses and physicians. Their authority to prescribe medications and provide independent patient care varies according to state law.

Typical NP duties include:

  • Taking patients’ medical histories
  • Performing physical exams
  • Assessing patients’ symptoms
  • Ordering, administering, and analyzing diagnostic tests
  • Formulating and adjusting treatment plans
  • Administering medications and treatments
  • Collaborating with physicians and other healthcare providers
  • Advising patients and their families on preventative health or illness/injury management

What Does a Physician Assistant Do?

Physician assistants often work under the supervision of physicians, depending on state regulations. Most states require agreements between PAs and specific physicians to practice.

Some states may adopt the American Academy of PAs’ Optimal Team Practice policy that eliminates the need for these agreements.

PA responsibilities include:

  • Taking and reviewing patients’ medical histories
  • Performing physical exams
  • Diagnosing and treating illnesses
  • Ordering and interpreting diagnostic tests
  • Formulating and implementing treatment plans
  • Prescribing and administering medications
  • Advising patients and their families on preventative health or illness/injury management
  • Performing medical procedures

Education and Licensure

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.

NPs can pursue nursing specialties. PAs receive a broad-based, general medical education that allows them to work in any area of medicine, including specialty clinics. PAs seeking postgraduate training can complete specific residencies and specialty certifications.

In contrast, NPs choose an MSN degree specialty before starting their program. For example, they can graduate as a family practice NP or mental health NP.

NPs may be required to obtain commensurate nursing experience in a specialty in order to be admitted to a specialty NP program. Those wanting to practice in a different field later must receive training and nursing certification.

How to Become a Nurse Practitioner

NPs begin their careers as RNs. Some obtain associate degrees in nursing or nursing diplomas, while others earn bachelor’s degrees in nursing. Any of these pathways qualify graduates to take the National Council Licensure Examination (NCLEX) for RNs. Aspiring NPs typically work for a couple of years as RNs and may practice in a specialty area.

The next step to becoming an NP entails earning a graduate nursing degree. Many graduate programs require applicants to hold bachelor of science in nursing (BSN) degrees. However, some grad programs accept RNs with non-nursing bachelor’s degrees, or offer RN-to-master of science in nursing (MSN) accelerated tracks. RNs can also earn their BSNs faster via RN-to-BSN bridge programs.

Graduate nursing students pursue MSNs or doctor of nursing practice (DNP) degrees, both of which prepare them to become NPs. Applicants should make sure their programs hold accreditation from the Commission on Collegiate Nursing Education or the Accreditation Commission for Education in Nursing. MSN and DNP students choose specializations and tailor their coursework and clinical experiences accordingly.

MSN and DNP holders take national board certification exams in their specialty areas to qualify for APRN licensure in the states where they want to practice.

How to Become a Physician Assistant

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 not necessary for graduation, 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 programs take about three years to earn and focus on coursework and clinical rotations in general medicine. PA students should only attend programs accredited by the Accreditation Review Commission on Education for the Physician Assistant.

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.


NPs choose their specialization areas while completing their graduate nursing programs and continue to specialize as practitioners. As the table below illustrates, the majority of NPs become family nurse practitioners, providing care to patients of all ages with a variety of healthcare needs. The remainder pursue specialties in areas like acute care and mental health or work with specific patient populations.

Rather than focusing on one specialty area, PAs receive training as medical generalists, gaining skills in all areas of medicine. Because they complete clinical rotations in multiple specialties, they are able to adapt to different areas of care during their careers.

Almost a third of PAs focus on surgical care. Other popular practice areas include primary care and internal medicine subspecialties.

Types of Nurse Practitioners
Nurse Practitioner SpecializationPercentage of Nurse Practitioners
Family Nurse Practitioner (FNP)70.3%
Adult-Gerontology Primary Care Nurse Practitioner (AGNP)8.9%
Psychiatric Mental Health Nurse Practitioner (PMHNP)6.5%
Acute Care Nurse Practitioner (ACNP)2.9%
Pediatric Primary Care Nurse Practitioner (CPNP)2.4%
Adult-Gerontology Acute Care Nurse Practitioner (AGACNP).9%
Women’s Health Nurse Practitioner (WHNP)2.2%
Source: AANP, 2022
Types of Physician Assistants
Physician Assistant SpecializationPercentage of Physician Assistants
Surgical Subspecialties27.3%
Primary Care19.2%
Internal Medicine Subspecialties13.6%
Emergency Medicine7.4%
No Specialty4%
Pediatric Subspecialties1.6%
Source: AAPA, 2023

Salary and Career Outlook

As this section details, the BLS lists average annual salaries for NPs and PAs around $115,000, and both occupations can expect job growth rates above the national average during 2022-2032.

Average Annual Nurse Practitioner Salary

Source: BLS, 2023

Average Annual Physician Assistant Salary

Source: BLS, 2023

Nurse Practitioner Salary and Career Outlook

NPs currently earn average annual salaries of $128,490 or $61.78 per hour. Earning potential can depend on the state or industry in which NPs practice, the specialty area, and education level. For example, NPs in home health services average $146,850 a year, while those employed in physician’s offices earn $122,780.

BLS employment growth projections for NPs sit at a well-above-average 45% for 2022-2032. States and areas with a shortage of primary care positions may offer more opportunity and higher pay.

Physician Assistant Salary and Career Outlook

PA wages average $130,490 a year or $62.74 per hour. PAs in outpatient care centers earn the highest salaries, averaging $144,160 annually. Nevada, California, and Washington PAs make the most among U.S. states, with average annual salaries around $150,000.

The BLS projects a 27% increase in job growth during 2022-2023 for PAs. Areas experiencing primary care provider shortages, such as rural communities, may pay more and offer more employment opportunities, especially in states that adopt the Optimal Team Practice policy.

How to Choose Between Becoming an NP vs. a PA

Consider each position’s salary, educational requirements, scope and flexibility of practice, and job duties before choosing your career path. Your state’s scope of practice laws may also influence your decision-making process.

Although both NP and PA academic paths require graduate degrees, they differ in several ways:

  • NPs pursue nursing education, first earning RN licensure before completing graduate NP programs.
  • PA programs seek students with some experience in healthcare, including areas outside of nursing, like a paramedic, respiratory technician, radiology, or surgical technician.
  • PAs must complete a recertification exam every 10 years. NPs typically complete recertification requirements every five years and may be able to maintain certification with a combination of clinical practice hours and continuing education or by passing a recertification exam.

While most nurses choose the NP route, it is not unheard of for nurses to become PAs. The decision reflects the person’s goals, interests, and chosen specialty area.

NPs and PAs may choose to specialize in general or primary care:

  • NPs are advanced practice registered nurses, which includes an advanced nursing education with a specific population focus or field of practice.
  • PA programs emphasize general medical practice, diagnosis, procedures, and treatment.

Frequently Asked Questions About NPs and PAs

Is NP higher than PA?

Neither profession ranks “higher” than the other. Both NPs and PAs work in the healthcare field but with different qualifications, educational backgrounds, and responsibilities. They also work in different specialties. In addition, although both nurse practitioners and physician assistants work with more independence than nurses or aides, both often need some physician oversight.

Do PAs make more than nurse practitioners?

PAs and NPs earn similar wages. According to 2023 BLS data, PAs make an average annual salary of $130,490 compared to NPs, who average $128,490 per year.

Can nurse practitioners and physician assistants prescribe medications?

Yes, physician assistants and nurse practitioners can prescribe medications, although the specific types of medications they can prescribe may vary by state. While they have broad prescribing authority in most cases, restrictions typically apply to Schedule II medications, with each state establishing its own regulations.

Does an NP have more autonomy than a PA?

Although NPs have full practice authority in 28 states including Washington, D.C., the remaining states require physician supervision. In many states, PAs typically work under physician oversight or have some sort of collaborative agreement with physicians.

Page last reviewed on October 29, 2023

Are you ready to earn your online nursing degree?

Whether you’re looking to get your pre-licensure degree or taking the next step in your career, the education you need could be more affordable than you think. Find the right nursing program for you.