The Difference Between Nurse Practitioner and Physician Assistant

Healthcare is an industry that is expected to grow up to 30% within the next decade and continue to grow. There are so many career opportunities within healthcare, some requiring a just a two-year degree while others require advanced medical degrees. Regardless of where you start there is no denying that an advanced degree will provide added autonomy, opportunity and income.

Two such careers that require an advanced degree but no doctorate degree are a nurse practitioner and physician assistant. Each of these positions plays a very key role within the healthcare system and requires an advanced degree but also offer greater opportunities for growth and increased income. Though these two roles within the healthcare system may seem to overlap and be similar there are some key differences between the two positions.

First, what are the similarities between an NP (nurse practitioner) and a PA (physician assistant)? Both an NP and PA offer direct patient care. Under direct patient care, they are authorized to perform exams, diagnose illness, and prescribe treatment and prescriptions. This was typically done under the direct supervision of a certified physician but in recent years with a shortage of physicians and increased demand, NPs and PAs have been given more autonomy in such responsibilities. Recently both NPs and PAs have been able to perform many of the routine exams and preventative exams for patients young and old. This shift in responsibility has opened the doors of healthcare to more rural and underserved areas than ever before. What does this mean? For NPs and PAs, there is a greater need and a higher demand—and when demands increase so does the opportunity. Yet the necessary education has remained the same to be a PA or NP in the healthcare industry.

One might argue that they are one in the same, but at the core of each profession, there is a great deal that sets them apart as two distinct and different career choices.

What makes an NP and a PA different?

When a student sets out to be an NP or a PA the very essence of what they are educated in is different. The medical model and focus used to educate each one is entirely different. A nurse practitioner is educated and trained under the nurse model of patient care—the same foundation used for RNs, NPs, and every other career under the umbrella of nursing. The nurse model is a holistic method of patient care that takes into account the patient’s physical, mental, and emotional needs. Whereas a PA will be trained using a medical model to treat patients. Within the medical model, students use disease pathology and the anatomy and physiological systems to diagnose and treat patients. In a nutshell, a nurse practitioner will use a patient-centered model and a physician assistant will use a disease-centered model. This might seem like a basic nuance, but each makes a very notable difference, especially when looking at the higher education specializations each model offers. The career opportunities take two very different paths based on the model and education. For instance, a nurse practitioner will choose to specialize in a specific patient population, such as pediatrics or geriatrics. A physician assistant, on the other hand, will not specialize in a patient population but rather a particular area of medicine such as emergency or internal medicine.

Below you will learn similarities and contrasts between a nurse practitioner and a physician assistant as we discuss the necessary education, certification and licensing, daily responsibilities and annual salary of each of these two healthcare careers.

Education

Degree requirements:

PA: Master of Science in Physician Studies. This is typically a three-year graduate program that requires clinical rotations.

NP: Master of Science in Nursing (MSN). This is typically a two-year graduate program specializing in becoming a nurse practitioner. The AACN has recommended that those requirements be changed to require a Doctorate of Nursing Practice to practice as a nurse practitioner but those changes have not been made as of yet, but in the future that may become the case.

Programs:

PA: Most physician assistant programs will require a minimum of 1,000 hours of classroom time and at least 2,000 hours in a clinical setting.

NP: Most nurse practitioner programs will require students to specialize in one of the following areas: pediatrics, geriatrics, women’s health, neonatal pediatrics, or mental health. A minimum of 500 classroom hours will need to be completed along with a minimum of at least 700 clinical hours.

Accreditation:

PA: Programs must be accredited by the Accreditation Review Commission on Education for the Physician Assistant.

NP: Programs must be accredited by either the Commission of Collegiate Nursing Education or through the Accreditation Commission of Nursing Education.

Continuing Education Requirements:

PA: Physician assistants must complete 100 credit hours, pass a recertification exam every 5 years, and log their time officially through the National Commission on Certification of Physician Assistants. It is currently under a 10-year certification cycle, testing twice during the ten years.

NP: Nurse practitioners recertify every five years by taking between 75 to 150 continuing education credits and completing at least 1,000 documented clinical hours. It is important to know what the requirements are for state recertification, as they may require more education and clinical hours than the national requirements.

Certification and Licensing

Certification:

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: There are multiple certification agencies for nurse practitioners that are particular to their patient population specialty. Those agencies are American Academy of Nurse Practitioners, American Nurses Credentialing Center, American Association of Critical Care Nurses, Pediatric Nursing Certification Board, and the National Certification Corporation. They can be certified in more than one area of specialty if they qualify and pass the necessary certification exams.

Licensing:

PA: Both state and national licensing are required prior to practicing, though no prior licensing is needed. They also must have a Master of Science as a physician assistant.

NP: State licensing is required as both a nurse practitioner and as a registered nurse along with national certification.

Recertification:

PA: To maintain certification physician assistants must stay current on their continuing education credit hours and requirements.

NP: Either staying current on continuing education hours and clinical hours or taking a recertification exam will recertify a nurse practitioner.

Daily Responsibilities

Typical Responsibilities

PA: A physician assistant can perform routine exams as well as diagnose illness or injury of patients of all ages. They can perform all routine services within the scope of their training and legal ability without the direct supervision of an MD. They can diagnose, prescribe treatment and medication to those under their care.

NP: A nurse practitioner can likewise diagnose and treat various illnesses and injuries. A great emphasis of their career is placed on preventative care and promoting a healthy lifestyle. They often practice autonomously without direct physician oversight. In some states, they are able to practice entirely separate from a physician collaboration.

Career Settings

PA: Physician assistants work in a variety of settings such as in physician offices, hospitals, skilled nursing facilities as well as any other healthcare facility where they might work alongside a physician. Though a PA may work with a designated physician they still have a great deal of autonomy. Some physician assistants can have a PA led clinic and work independently from a collaboration of physicians.

NP: Nurse practitioners can be found in a variety of settings such as hospitals, physician offices, nursing facilities, schools and even summer camps. They can work directly under a physician, with a physician or in stand-alone NP clinics.

Specializations

PA: A physician assistant can specialize in a variety of areas that will typically center around disease type. Some common areas of specialties include surgery, emergency medicine, or dermatology.

NP: Nurse practitioners, however, receive their certification in a particular patient population including the following: family, adult-gerontology, women’s health, neonatal, pediatrics, or psychiatric-mental health. They can even specialize even further by practice setting such as emergency or oncology.

Autonomy

PA: The degree of independence a PA has on the job really depends on the state in which he/she is practicing. Most states require a physician assistant to work under the supervision of a physician. However, that being said most PAs work independently throughout the day with a physician in the office. Other PAs have a PA-led office with a few on-site visits from a physician. To what extent the physician needs to be present is determined by state laws. In most states, a PA can work independently and autonomously throughout the day.

NP: The freedom a nurse practitioner has within the scope of their training and experience depends largely on the state in which they are practicing. Some state laws have progressed to allow advanced practice nurses the freedom to practice independently to where they do not need a collaborative agreement with a physician in place. On the other hand, some states do require NPs to have a collaborative agreement with a physician in place. Though their day-to-day routine can be very independent from a physician they are not considered independent practitioners in these states. Regardless of which state an nurse practitioner works in, it’s not uncommon to find a private NP practice or partner practices with other NPs. Most, though, work in hospitals as part of a larger healthcare team.

Income and Future

Salary

PA: The average income for physician assistants ranges between $102K to $142K per year. Factors such as experience, specialization and location influence a PA’s yearly salary.

NP: The average income for a nurse practitioner ranges between $100 to $140K per year. Factors such as experience, specialization and location influence an NP’s yearly salary.

Growth

PA: The expected growth rate for physician assistants between now and 2030 is an estimated 30%.

NP: The expected growth rate for nurse practitioners between now and 2030 is an estimated 31%.

Regardless of what path one takes to have a fulfilling career in the healthcare industry, both NPs and PAs have bright futures brimming with opportunities. Choosing the path that best fits your personality and career goals will guarantee high career satisfaction. If a doctorate degree is in your goals perhaps the route of a nurse practitioner is best. If studying disease pathology is your interest then the route of a physician assistant could be ideal. Remembering the core of how each profession approaches healthcare and patient care, as well as the education required, will help you choose the type of care you want to provide.