Nurse Practitioner vs. Physician Assistant: Key Differences

Nurse practitioners and physician assistants are advanced healthcare practitioners who have similar responsibilities, such as diagnosing illnesses and prescribing medications. However, their training and paths toward certification differ in significant ways. This blog post unpacks the key differences between NPs and PAs to help you determine which career path best aligns with your goals. 

What Is a Nurse Practitioner?

A nurse practitioner (NP) is a licensed clinician who provides comprehensive healthcare to patients of all ages. An NP can work in virtually any healthcare setting, diagnosing patient conditions and prescribing medications. As of January 2021, nurse practitioners have full practice authority in 24 states, meaning that they can practice independently without the supervision of a physician.

The key responsibilities of a nurse practitioner include:¹ 

• Diagnosing and treating acute and chronic conditions 
• Prescribing medications, therapies, and other treatments
• General patient care 
• Performing and interpreting diagnostic tests (e.g., x-rays, lab work)
• Educating patients about healthy lifestyle choices and disease prevention
• Counseling patients about their care plan
• Other specialty-specific responsibilities

What Is a Physician Assistant?

A physician assistant (PA) is a mid-level medical provider who is licensed to provide many of the same clinical services as physicians when working in primary care settings. These services include performing physical exams, diagnosing and treating illnesses, and prescribing medications.²   

The key responsibilities of a physician assistant include:³  

• Taking medical histories
• Ordering and interpreting lab tests
• Performing physical exams
• Diagnosing and treating illness 
• Assisting in surgery
• Educating patients about their treatment plan

NP vs. PA: Key Differences

The two most fundamental differences between NPs and PAs are the training they receive and the environments where they work. Nurse practitioners are trained in the advanced practice of nursing, where they focus on a specialized role, such as that of neonatal nurse practitioner. Physician assistants, on the other hand, are educated in general medicine; their training follows the medical model and covers all foundational aspects of medicine and specialties.

Educational Differences

Both nurse practitioners and physician assistants are required to earn a graduate degree, complete a rigorous schedule of clinical training, and acquire certifications. The differences lie in the type of training and certification requirements.

To become a nurse practitioner, you’ll need to complete the following:⁴

1. Earn your Bachelor of Science in Nursing (BSN) degree: A full-time BSN program typically takes four years to complete.
2. Pass the NCLEX-RN: Passing this examination is a requirement to practice as a registered nurse (RN) in your state. Once you pass the exam, you will receive your RN license.
3. Earn a graduate degree: You will need either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP) with a nurse practitioner role specialty, such as Family Nurse Practitioner (FNP). In addition to coursework, NP programs typically include a clinical practicum of at least 500 hours under the supervision of a preceptor.
4. Become a Certified Nurse Practitioner (CNP): You must take a national certification exam through one of the five national certification boards to become licensed as a nurse practitioner.
5. Option to Recertify: For certification renewal, nurse practitioners are required to take 100 hours of continuing education and 1,000 clinical hours every five years. 

To become a physician assistant, you’ll need to complete the following:⁵ 

1. Earn your master’s degree: You must graduate from an accredited PA program—typically a Master of Science in Physician Assistant Studies. You must also complete at least 2,000 hours of supervised clinical practice in various medical and surgical settings before graduation. 
2. Pass the Physician Assistant National Certifying Examination (PANCE): Once you pass the PANCE exam, administered by the National Commission on Certification of Physician Assistants (NCCPA), you can receive your state license. 
3. Maintain national certification: PAs must complete 100 hours of continuing medical education (CME) every two years. They are required to take a recertification exam every 6 to 10 years.

Work Environment Differences

Nurse practitioners and physician assistants work in primary, acute, and specialty care across a wide range of healthcare settings, including medical offices, hospitals, nursing homes, VA facilities, correctional institutions, and community clinics. 

Although PAs can serve as primary care providers, they are required to work under the direct supervision of a physician or surgeon. NPs must work under the supervision of a physician in 11 states. However, in 24 states and U.S. territories, nurse practitioners can operate their own practice with full autonomy. (The remaining 16 states and U.S. territories have regulations that are somewhere in between.)⁶ 

Specialization Differences 

There are also legal distinctions between nurse practitioners and physician assistants. NPs can work across a variety of nursing specialties, earning certifications for the specialties that require it. If an NP desires to switch specialty certifications, such as from neonatal to family nurse practitioner, they need formal education and licensure for that new role. As for PAs, once licensed, they can switch specialties without the need for a new certification or additional job training.⁷   

NP vs. PA Career Outlook

Employment for both nurse practitioners and physician assistants is projected to grow over the next decade at faster rates than the average for other occupations. 

The U.S. Bureau of Labor Statistics predicts a 45 percent growth for NP roles⁸  and a 31 percent growth for PA roles⁹  between 2019 and 2029. Also, the U.S. News & World Report ranks these professions as the top two roles in 2021: physician assistant sits at #1 and nurse practitioner at #2 in the publication’s 2021 Best Healthcare Jobs list. 

Salaries of NPs and PAs

As of 2020, the median salary of a nurse practitioner is $117,670, while the median salary of a physician assistant is $115,390. 

How to Choose the Right Career Path 

Comparing the educational requirements, work environments, and scope of practice can help you make career decisions. For example, NPs spend more time providing bedside care for hospitalized patients. Physician assistants, on the other hand, may take up a surgical specialty.¹⁰ 

Resources for Nurse Practitioners

The following organizations give nurse practitioners access to professional development opportunities, events, and other benefits:

• American Association of Nurse Practitioners (AANP)
• National League for Nursing (NLN)
• American Nurses Association (ANA)

Resources for Physician Assistants

Should you pursue a career as a physician assistant, these organizations will give you a chance to participate in seminars, networking events, and professional development opportunities:

• National Commission on Certification of Physician Assistants (NCCPA)
• The Physician Assistant Foundation 
• American Academy of PA (AAPA)

Whether you decide to explore a career as an NP or PA, it’s encouraging to know that the demand for both is increasing within the healthcare field. Both are rewarding roles that can help patients live healthier and longer lives.    

The University of St. Augustine for Health Sciences (USAHS) offers Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), and Post-Graduate Nursing Certificates designed for working nurses. Our degrees are offered online, with optional on-campus immersions.* Role specialties include Family Nurse Practitioner (FNP), Nurse Educator,** and Nurse Executive. The MSN has several options to accelerate your time to degree completion. Earn your advanced nursing degree while keeping your work and life in balance.

*The FNP role specialty includes two required hands-on clinical intensives as part of the curriculum.

**The Nurse Educator role specialty is not available for the DNP program.

1. American Association of Nurse Practitioners (AANP), “What’s a Nurse Practitioner?”: https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner [↩]
2. Physician Assistant Education Association (PAEA), “What is a PA?”: https://paeaonline.org/how-we-can-help/advisors/what-is-a-pa [↩]
3. American Academy of PAs (AAPA), “What is a PA?”: https://www.aapa.org/what-is-a-pa/ [↩]
4. Nursing License Map, “How to Become a Nurse Practitioner,” July 2020: https://nursinglicensemap.com/advanced-practice-nursing/nurse-practitioner/ [↩]
5. National Commission on Certification of Physician Assistants (NCCPA), “Certified PAs: Improving health, saving lives, making a difference,” 2020: https://www.nccpa.net/public [↩]
6. American Association of Nurse Practitioners, “State Practice Environment,” updated Jan. 1, 2021: https://www.aanp.org/advocacy/state/state-practice-environment [↩]
7. Ryanne Coulson, “PA vs. NP: A Simple Explanation of the Fundamental Differences,” Be a Physician Assistant, May 2, 2017: https://beaphysicianassistant.com/blog/difference-between-pa-and-np [↩]
8. Bureau of Labor Statistics, Occupational Outlook Handbook, “Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners,” last modified April 9, 2021: https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm [↩]
9. Bureau of Labor Statistics, Occupational Outlook Handbook, “Physician Assistants,” last modified April 9, 2021: https://www.bls.gov/ooh/healthcare/physician-assistants.htm [↩]
10. Nurse.org, “Nurse Practitioner or Physician Assistant: Difference in Salary and Benefits,” September 5, 2019: https://nurse.org/articles/rise-of-non-physician-roles-in-medicine/ [↩]