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Nurse Practitioner vs. Physician Assistant: What’s the Difference?
Maura Deering’s writing has received silver medals from Parenting Publications of America and the Council for Advancement and Support of Education. She earned a BA in English (creative writing) and anthropology from the University of Washington and a.
Updated November 9, 2023
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Joey Morris is an editor for NurseJournal who is passionate about researching and visualizing data to communicate complex healthcare concepts in their simplest form. He earned a bachelor’s degree in information communication technology from Florida S.
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Elizabeth Clarke is a board-certified family nurse practitioner. Her experience spans emergency departments, cardiac units, pediatric urgent care, and occupational health settings. She earned her bachelor of science in nursing and master’s in nursing.
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There are unique differences between PAs and NPs. This guide compares factors like salary, education, and skills to help you choose your career.
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- 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 $125,000.
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 | Physician Assistant | |
|---|---|---|
| Education | Master of science in nursing (MSN) or doctor of nursing practice (DNP) | Master of science in physician assistant studies (MSPAS) |
| Time to Become | 2-3 years | 3 years |
| Average Annual Salary | $124,680 | $125,270 |
| Projected Job Growth | 45% (2022 to 2032) | 27% (2022 to 2032) |
| Practice Framework | State laws determine whether a nurse practitioner can practice independently or must work under physician oversight. | All physician assistants work under the supervision of a doctor. The state does not permit independent work, |
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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 work under the supervision of physicians. 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.
Specializations
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.
| Nurse Practitioner Specialization | Percentage 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% |
| Physician Assistant Specialization | Percentage of Physician Assistants |
|---|---|
| Surgical Subspecialties | 27.3% |
| Other | 26.9% |
| Primary Care | 19.2% |
| Internal Medicine Subspecialties | 13.6% |
| Emergency Medicine | 7.4% |
| No Specialty | 4% |
| Pediatric Subspecialties | 1.6% |
Salary and Career Outlook
As this section details, the BLS lists average annual salaries for NPs and PAs around $125,000, and both occupations can expect job growth rates above the national average during 2022-2032.
$124,680
Average Annual Nurse Practitioner Salary
Source: BLS, 2022
$125,270
Average Annual Physician Assistant Salary
Source: BLS, 2022
Nurse Practitioner Salary and Career Outlook
NPs currently earn average annual salaries of $124,680 or $59.95 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 $148,960 a year, while those employed in physician’s offices earn $121,880.
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 $125,370 a year or $60.23 per hour. PAs in outpatient care centers earn the highest salaries, averaging $137,040 annually. Washington, California, and Alaska PAs make the most among U.S. states, with average annual salaries around $145,000.
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 2022 BLS data, PAs make an average annual salary of $125,270 compared to NPs, who average $124,680 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 22 states and Washington, D.C. The remaining states require physician supervision. PAs, on the other hand, work under physician oversight. Just three states — North Dakota, Wyoming, and Utah — allow PAs the most administrative independence.
Page last reviewed on October 29, 2023
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Nurse Practitioners vs. Physician Assistants: A Side-By-Side Comparison
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Physician assistants (PA) and nurse practitioners (NP) are advanced medical professionals. There are many similarities between these two roles like diagnosing and treating illnesses and writing prescriptions. However, from education and working environment to career path and job outlook, these professions are different.
This article will discuss the similarities and differences between a nurse practitioner and a physician assistant. It’ll help you make the most informed decision to choose the field that’s right for you.
TL;DR: The Difference Between NPs and PAs
Both nurse practitioners and physician assistants are primary care providers. The PA programs train individuals based on a medical model that emphasizes general medicine practices like diagnosis and treatment procedures. Whereas, a nurse practitioner follows a nursing model to serve as the advanced practice registered nurse. They focus on nursing care and specialize in patient populations like women’s health and geriatric. It’s important to note that both PAs and NPs are mid-level medical professionals. They’re basically at the same level. However, NPs can work independently in many states that PAs can’t. So, it places nurse practitioners above physical assistants in terms of practice independence. Understanding the differences and similarities between the two professions will help you determine which profession is better for you.
Nurse Practitioners vs Physician Assistants Differences and Similarities Compared In Detail
The biggest difference between the two professions is the training and education they receive. Here’s a side-by-side comparison of nurse practitioners and physician assistants.
Education
Both nurse practitioners and physician assistants need to enroll in a graduate/master’s level program after completing a bachelor’s degree. They also need to undergo clinical training to complete their degree.
NP (Nurse Practitioner)
First, you need to earn a BSN (Bachelors of Science in Nursing) or graduate degree that typically takes four years to complete. After that, you can earn your RN (Registered Nurse) license by passing the NCLEX-RN exam if you want to practice as an RN.
Then, you’ll need to earn your graduate degree with a role specialty like FNP (Family Nurse Practitioner). The advanced practice nursing degree can be either a DNP (Doctor of Nursing Practice) or MSN (Master of Science in Nursing). It’ll also involve clinical training under an instructor’s supervision.
In order to become a CNP (Certified Nurse Practitioner), you’ll need to pass the national certification exam through any of the following certification boards:
- PNCB (Pediatric Nursing Certification Board)
- ANCC (American Nurses Credentialing Center)
- NCC (National Certification Corporation)
- AACN (American Association of Critical-Care Nurses)
- AANP-CP (American Academy of Nurse Practitioners)
Once you have the certificate, you’ll need to renew it after a specific period of time. The duration of recertification can vary depending on your board.
PA (Physician Assistant)
If you want to become a physician assistant, you’ll need to complete your bachelor’s degree in any healthcare-related field. In addition, for most physician assistant programs PAs need to have some prior experience working in a healthcare environment like a surgical technician, respiratory technician, radiology, or paramedic work.
After that, you can enroll in an accredited master’s degree program like Physician Assistant Studies and Master of Science. You can go through the PAEA (Physician Assistant Education Association) list of PA programs to find the one that suits you best. Other organizations such as AAPA and PA Foundation can also help you with professional development.
Once you have completed your graduation, you’ll need to take the PANCE (Physician Assistant National Certifying Exam). The exam is supervised by the NCCPA (National Commission on Certification of Physician Assistants) and passing it will provide you with your state license. Just like a certified nurse practitioner, you’ll need to retake the certification exam after a certain amount of time.
Job Duties
A nurse practitioner can work in all types of healthcare settings and also possesses full practice authority in 24 different states across the nation. It means nurse practitioners can work independently with the supervision of physicians. That’s not the case with the Physician Assistants as they need to work under the direct supervision of physicians.
NP (Nurse Practitioner) Key Responsibilities
- Examining patients and treating chronic conditions.
- Helping patients in community clinics and hospitals as well as outpatient settings.
- Interpreting as well as performing different diagnostic tests.
- Guiding patients about disease prevention and a healthy lifestyle.
- Supporting patients emotionally and helping them to understand their treatment plans.
- Writing prescriptions and providing treatment.
PA (Physician Assistant) Key Responsibilities
- Reading and understanding patient histories
- Examining patients physically and treating diseases
- Ordering and reading diagnostic and lab tests
- Writing prescriptions to and helping patients understand their treatment plans
- Working in emergency medicine and assisting in surgeries
Job Outlook
The number of patients with severe health problems and chronic diseases is on the rise. That’s why the demand for healthcare providers is also increasing. According to BLS (Bureau of Labor Statistics), the demand for nurse practitioners is expected to grow by 45% from 2020 to 2030.
On the other hand, BLS also predicts a 31% growth from 2020 to 2030 in the demand for physician assistants. These stats show that people planning to choose any of these professions will have a bright future.
What Pays Better Nurse Practitioner or Physician Assistant?
The US Bureau of Labor Statistics states that the average annual salary of nurse practitioners is $120,680. It is lower than nurse anesthetists but higher than nurse-midwives. The average median salary of all these professions collectively is $123,780 or $59.51 per hour.
Whereas the BLS reports that the average physician assistant salary in the US is $121,530 or $58.43 per hour. It means that physician assistants get paid slightly more than nurse practitioners.
Which Position Is Higher Physician Assistant or Nurse Practitioner?
Nurse practitioners and physician assistants have similar responsibilities, or scopes of practice, and primarily offer primary care. are mid-level medical roles. So, it’s safe to say that neither of them ranks higher when compared. While they both need to work in the healthcare environment, they have different educational backgrounds, qualifications, and job duties. They also need to work in different medical specialties.
However, physician assistants work under the supervision of a physician but a nursing practitioner can work independently. So, in this sense, you can say that nurse practitioners have more autonomy than a physician assistants
What Can a PA Do That an NP Cannot?
Nurse practitioners need to train in acute care or primary patient care. It’s then further focused on the basis of specific patient populations like geriatrics, adult-gerontology, mental health, pediatrics, and FNPs (Family Nurse Practitioners). NPs get their license based on the training they get and they need to practice in that field.
Whereas PAs don’t get training related to a specific field. Instead, they’re trained as generalists, which means they can practice in any field they want under a physician’s supervision. They can also switch their specialties without undergoing further education or needing to obtain a new certification. That’s why many physician assistants switch their fields during their careers.
Does a PA or NP Get Paid More?
Currently, a nurse practitioner is near the top of the list of best health care jobs in terms of annual salary.On the other hand, the physician assistant job is the second number on that list. People working as NPs or PAs are highly trained professionals and that’s why they get paid more than many mid-level healthcare workers.
AAPA reports that the annual salary of physician assistants rose by 4.5% from 2020 to 2021. Another report suggests that the annual salary of NPs rose by 12% from 2020 to 2021.
According to the AACM (American Association of Medical Colleges), the demand for assistant physicians and registered nurses is also expected to continue to increase. It can further increase the salaries of these two professions.
What Are the Pros and Cons of Being a Nurse Practitioner vs Being a Physician Assistant?
Just like any other profession, there are advantages as well as downsides to being a nurse practitioner or a physician assistant.
Pros of Being an NP
- Allows you to make a positive change in people’s lives.
- Can generate lucrative earnings based on your location, experience level, and employer.
- The demand for NPs is rising continuously and it’s expected to grow by 45% from 2020 to 2030.
- Provides you with the opportunity to specialize to earn more and follow your passion.
Cons of Being an NP
- You need to be on an on-call schedule all the time.
- You may need to work other than your working hours as well which can be a stressful experience.
- Increases the risk of catching illnesses and viruses.
- Need to obtain certification or study more to switch fields.
Pros of Being a PA
- The demand for PAs is increasing continuously.
- You’ll have a better work-life experience working as a PA.
- It allows you to switch fields easily without any certification or education.
- It’s a highly paid job with a positive job outlook.
- The work environment allows you to make a difference every day.
Cons of Being a PA
- You need to expose yourself to working conditions that can be dangerous to your health.
- You’ll always be working under the supervision of a physician.
- It can be stressful because you may need to work for long hours.
- You’ll never get paid as high as physicians.
Final Words
Both nurse practitioners and physician assistants have many similarities. But they’re different healthcare professionals with different educational backgrounds and work environments. We hope this guide will help you understand the differences and similarities between these two professions to choose the right career path.
