Physician Assistants vs. Nurse Practitioners: What's the Difference?

Nurse practitioners and physician assistants each play a critical role in patient care, and in some ways the two professionals are practically indiscernible. Both NPs and PAs typically see patients independently, diagnose and treat medical conditions and, in most cases, prescribe medications. Nonetheless, NPs and PAs are two distinct career groups, and their differences can impact everything from how they train to how much they will earn. The following guide provides some insight into the education, earnings and career trends that define each field.

Snapshot: PAs and NPs at a glance

American Academy of Nurse Practitioners President Mary Jo Goolsby once told The Washington Post that both PAs and NPs are important members of the health care team. Their differences may matter very little to patients in a practical sense, she said, but to other clinicians, they define them. Among them:

  • Both NPs and PAs must earn graduate degrees, but the nature of those credentials vary
  • All states recognize PAs; not all states recognize NPs
  • NPs and PAs are paid comparably, but regional trends may vary
  • NPs and PAs are both in demand, but, once again, regional trends may vary
  • NPs and PAs each have distinct licensing and certification requirements and processes

Let's review how NPs and PAs differ (and do not) in greater depth.

On the job: typical NP, PA duties

It is no secret that nurse practitioners and physicians assistants seem quite similar on the surface, thanks in part to their shared duties. According to the Bureau of Labor Statistics (BLS.gov), both NPs and PAs perform the following tasks:

  • Reviewing and updating patients' medical histories
  • Examining patients
  • Diagnosing and treating medical problems
  • Ordering and interpreting diagnostic tests
  • Educating patients and their families in matters of health
  • Researching the latest treatments and technologies impacting their fields

The BLS reports that both NPs and PAs serve as primary and specialty care providers, often specializing in a particular area of medicine, like dermatology, geriatric medicine, emergency care and even psychiatry. Both professionals also tend to work fairly independently, though they may at times report to or collaborate with doctors, surgeons and other medical professionals. All of these similarities may leave you wondering how NPs and PAs differ, if at all. Their differences are subtle, but important. For instance, according to the BLS, all states allow PAs to prescribe medications; not so for all NPs. Goolsby also told The Washington Post that some states require NPs to maintain collaborative relationships with physicians and other providers; PAs tend to have a bit more independence universally. But perhaps the most significant differences between NPs and PAs have less to do with their day-to-day work than their career training and licensing requirements.

NP and PA education requirements: key differences

Both NPs and PAs are highly trained medical professionals who must complete a great deal of training before they can practice, but their journeys can vary. Goolsby told The Washington Post that while PAs tend to act more as clinicians, entering the field right out of school, NPs usually have at least 10 years of nursing experience under their belts before entering their practitionerships. On the other hand, the amount of time spent in the classroom is comparable for both professionals. Here is a quick review of typical NP and PA training requirements:

Nurse practitioners. According to the BLS, a nurse practitioner must earn at least a master's degree from an accredited program. These programs typically require at least two years of postgraduate study in addition to time spent earning undergraduate degrees or accruing experience in the field. The BLS reports that though many NP training programs prefer to admit applicants with bachelor's degrees in nursing -- often called bachelor of science in nursing, or BSN, degrees -- some schools offer bridge programs for registered nurses with lower degrees who want to segue into the field more efficiently. In all cases, budding NPs should expect to complete both classroom and laboratory work in addition to supervised clinical work under the direction of practicing NPs or physicians. The BLS reports that while master's degrees remain the most popular training path for NPs, some choose to invest in even more education, earning Doctor of Nursing Practice, or DNP, degrees. NPs may also choose to specialize their training through voluntary professional certifications.

Physician assistants. Like nurse practitioners, physician assistants are required to earn at least a master's degree before they can practice. These programs also tend to require at least two years of full-time postgraduate study in addition to any time spent earning bachelor's degrees or logging professional hours in a relevant field. Virtually all PA degree programs require candidates to hold relevant bachelor's degrees for admission; the bridge programs that help experienced nurses become NPs more efficiently are unheard of in this field. PAs can also choose to tailor their training to one (or more) specific areas of medicine, but unlike NPs, this specialization occurs through the course of their postgraduate studies rather than via voluntary professional certifications down the road.

NP and PA licensing requirements

All states that recognize NPs and PAs require that they be licensed to practice. The kicker: The BLS reports that while all states recognize PAs, not all states recognize NPs. Each state's board of nursing can clarify licensing requirements and regulations that could impact NPs in the field. For states that do recognize both professionals, the processes are as follows:

Nurse practitioners. The BLS reports that all states that recognize NPs require that they be licensed to practice, a process that typically requires candidates to meet minimum education and experience requirements and pass a national licensing exam. NPs must invest in continuing education courses, or CECs, to maintain licensure. Some nurses go on to earn additional, voluntary professional certifications from organizations like the American Nurses Credentialing Center or the Pediatric Nursing Certification Board.

Physician assistants. All states recognize PAs, and all states require that they be licensed to practice. According to the BLS, PAs must meet certain minimum training and experience requirements, including the accrual of clinical hours. PAs who meet these requirements can then sit for the Physician Assistant National Certifying Examination, which is offered through the National Commission on Certification of Physicans Assistants. Like NPs, PAs must complete CECs to maintain licensure. They must also recertify every 10 years.

By the numbers: NP and PA salary trends

There are several similarities between NPs and PAs, including tremendous overlap in day-to-day duties and the amount of time they must invest in formal training. Because of this, NPs and PAs tend to earn comparable wages, though factors like education, experience and geographical location can impact them. With this in mind, the BLS reports that that the mean annual wage for NPs in May, 2013 was $95,070 nationally, which was right on par with the $94,350 mean wage earned by PAs that same year.

Looking ahead: NP and PA career projections

One more key characteristic NPs and PAs share: They are in demand, thanks in large part to an aging population requiring more medical care and shifts in health legislation that expand patient access. The BLS projects that demand for nurse practitioners will grow by about 34 percent nationally between 2012 and 2022, which is much faster than the average for all occupations. Demand for PAs is expected to grow by a slightly even more robust 38 percent over the same period. Demand for both NPs and PAs may be especially strong in medically underserved areas like rural and inner city communities. Training and certification may also influence one's career potential. For instance, the BLS reports that primary care PAs are often in even higher demand than PAs specializing in other areas of medicine.

Next steps: find the right program

If you think one of these career paths might be for you, you may wish to research a number of NP and PA degree programs before settling on one. You can request information about specific programs from prospective schools directly, and can even ask to speak directly with an admissions representative. Also take the time to research NP and PA training and licensing requirements within your state by visiting your state's board of nursing online.

Sources:

Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners, Occupational Outlook Handbook, Bureau of Labor Statistics, January 8, 2014, http://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm

Nurse Practitioners, Occupational Employment and Wages, May 2013, Occupational Employment Statistics, Bureau of Labor Statistics, http://www.bls.gov/oes/current/oes291171.htm

"Nurse Practitioner v. Physician Assistant," The Washington Post, January 9, 2011, http://www.washingtonpost.com/wp-dyn/content/article/2011/01/07/AR2011010704936.html

Physician Assistants, Occupational Employment and Wages, May 2013, Occupational Employment Statistics, Bureau of Labor Statistics, http://www.bls.gov/oes/current/oes291071.htm

Physician Assistants, Occupational Outlook Handbook, Bureau of Labor Statistics, January 8, 2014, http://www.bls.gov/ooh/healthcare/physician-assistants.htm

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