When considering popular careers in health care, the physician assistant (PA) vs. nurse practitioner (NP) comparison often comes up. Both careers are extremely rewarding and offer the opportunity to make a positive impact. A wide variety of patients depend on the important work that physician assistants and nurse practitioners do. Additionally, the salary and job outlook for these careers promise competitive wages with healthy job security compared with the national average.
What exactly are the differences between a physician assistant and a nurse practitioner? How do you decide between the two career paths? Although some overlap in the roles exist, the main differentiators between them involve educational requirements, scope of practice, and approach to health care delivery.
If you’re considering advancing your career in the medical field, now is the perfect time to select your path. The journey to become a physician assistant or nurse practitioner can be challenging, so it’s important to figure out which career appeals to you most early on. The best way to do that is to understand the distinctions between them.
What does a physician assistant do?
Physician assistants typically work under the supervision of a team of physicians or surgeons. The majority of them work in physician offices or in state, local, or private hospitals. One benefit of being a physician assistant vs. a nurse practitioner is that a physician assistant can work in any area of medicine, including emergency medicine, surgery, psychiatry, and primary care, without specializing a degree or certification.
The job duties of a physician assistant may include any of the following:
- Performing patient assessments and providing diagnosis
- Ordering applicable patient diagnostic tests, such as blood tests, lab tests, CT scans, and radiography
- Educating patients on how to prevent disease and maintain optimal health
- Providing patient treatment: administering vaccinations, suturing a wound, setting a broken bone, etc.
- Prescribing medication
- Tracking patient progress and recovery
- Engaging in continuing education and research into the latest treatment methodologies to ensure high-quality patient care
The field of medicine that PAs work in typically dictates their duties. For example, a PA serving with a team of surgeons may perform tasks such as closing incisions and providing postoperative patient care. A PA working in family medicine may perform physical examinations and administer routine vaccinations.
A PA’s scope of practice depends on the state. In some states, PAs are allowed to prescribe medication, and although all PAs must be affiliated with collaborative physicians, the strictness of supervision can vary widely. Many PAs operate with full autonomy as primary caregivers to their patients, particularly in rural areas.
What does a nurse practitioner do?
Nurse practitioners are advanced practice registered nurses (APRNs). They generally work in outpatient centers, urgent care centers, hospitals, and other health care facilities.
NPs provide acute and primary care along with specialty health care services. Both NPs and PAs perform patient assessments, order and interpret diagnostic tests, provide treatment, prescribe medication, and educate patients on how to achieve and maintain optimal health. The core job functions of the two roles share overlap considerably.
When comparing a physician assistant vs. nurse practitioner, perhaps the biggest difference between the two occupations is the number of areas that NPs can specialize in. Specialty areas include the following:
- Acute care nurse practitioner
- Adult-gerontology nurse practitioner
- Cardiac nurse practitioner
- Certified nurse-midwife
- Certified registered nurse anesthetist
- Clinical nurse specialist
- Dermatology nurse practitioner
- Emergency nurse practitioner
- Family nurse practitioner
- Holistic nurse practitioner
- Hospice nurse practitioner
- Neonatal nurse practitioner
- Orthopedic nurse practitioner
- Pediatric nurse practitioner
- Psychiatric nurse practitioner
- Surgical nurse practitioner
- Women’s health nurse practitioner
An NP’s specialty area ultimately determines the day-to-day job functions. For example, adult gerontology nurse practitioners work with a patient base comprising older adults, so for aging populations, they treat illnesses and conditions such as dementia, osteoarthritis, and osteoporosis. Pediatric nurse practitioners work exclusively with children and adolescents, so they focus on providing preventive care and treating injuries.
The numerous specialties and subspecialties make becoming an NP the ideal option for those who want to practice a highly specific form of health care or work with a particular patient base. However, some definitive trends exist as regards NPs and the specialties they work in.
According to 2021 data from the American Association of Nurse Practitioners (AANP), 88.9% of NPs are certified in primary care. The distribution of primary care certification areas breaks down as follows: 69.7% family, 10.8% adult, and 7% adult-gerontology primary care, with the remaining primary certifications, such as acute care and women’s health, coming in at 5% or less.
How to become a physician assistant
Becoming a physician assistant requires earning a master’s degree — usually an MPAS, a Master of Health Science (MHS), or a Master of Medical Science (MMS) — from a program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). These PA training programs generally take three years and have the following entrance requirements:
- At least two years of college coursework that includes classes in anatomy, biology, microbiology, physiology, and chemistry
- Hands-on patient experience working with patients (hours of experience vary); experience can include working as a registered nurse (RN), EMT or paramedic, phlebotomist, medical technician, medical assistant, or certified nursing assistant
The majority of students entering a PA program have a bachelor’s degree in a scientific or health care-related field and about three years of experience working in health care.
PA program courses cover a wide variety of areas, including anatomy, behavioral science, biochemistry, clinical laboratory science, physiology, pharmacology, physical diagnosis, pathophysiology, and medical ethics.
PA programs also include more than 2,000 hours of clinical rotations to gain experience in family medicine, emergency medicine, psychiatry, general surgery, pediatrics, and internal medicine.
After completing a PA program, the next step is to become certified. You can do so by passing the Physician Assistant National Certifying Examination (PANCE), which the National Commission on Certification of Physician Assistants (NCCPA) administers. After passing the PANCE exam, you’ll carry the designation of physician assistant-certified (PA-C).
The final step in your journey to becoming a PA is to obtain a state license. Your local licensing board will provide a list of statutory and regulatory requirements for your initial licensure. After that, it becomes a matter of maintaining your certification; this requires completing 100 hours of continuing education every two years and taking the Physician Assistant National Recertifying Examination (PANRE) every 10 years.
How to become a nurse practitioner
The path to becoming an NP greatly differs from that of a PA, something to consider when weighing your options between a physician assistant vs. a nurse practitioner. Applying for the NP program involves meeting certain educational requirements: The first is to earn a Bachelor of Science in Nursing (BSN). The standard BSN program takes four years; however, some accelerated BSN programs and RN to BSN programs operate on shorter timelines.
The BSN program delivers the education and hands-on nursing experience required to prepare you to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN), which is a national board certification exam that tests your knowledge and critical thinking skills that pertain to nursing. Passing this exam is required to obtain state licensure; all states require working RNs to be licensed.
NPs are required to earn a Master of Science in Nursing, which offers several areas of specialization. When pursuing an MS in Nursing, you can either select a generalist degree or concentration, such as FNP (specializing in family care) or an PMHNP (specializing in psychiatric mental health).
After completing a graduate education, you’ll need to take a national board certification exam specific to your area of focus. Several NP certification boards administer exams, including the following:
- American Academy of Nurse Practitioners Certification Board (AANPCB)
- American Nurses Credentialing Center (ANCC)
- American Association of Critical-Care Nurses (AACN) Certification Corporation
- Pediatric Nursing Certification Board (PNCB)
- National Certification Corporation (NCC)
After passing the exam that applies to your specialty, you’ll need to apply for NP licensure in your state (consult your state’s NP requirements). From that point forward, you’ll need to meet your renewal requirements and continuing education requirements to maintain a valid credential. Continuing education requirements and length of certification can vary by state and specialty.
Physician assistant salary and job outlook
When comparing physician assistant vs. nurse practitioner, it’s worth considering salary ranges and job outlook. However, this is a case in which the two careers are relatively even on both fronts.
According to the U.S. Bureau of Labor Statistics (BLS), the median annual physician assistant salary was $115,390 in 2020. The BLS projects that positions will grow by 31% between 2020 and 2030, much faster than the projected national average.
Nurse practitioner salary and job outlook
The BLS reports that nurse anesthetists, nurse-midwives, and nurse practitioners made a median annual salary of $117,670 in 2020 and projects the roles to grow by an estimated 45% between 2020 and 2030.
Education, experience, region, hiring facility, and other factors, including demand, can affect salaries. A hospital with no resident FNP on staff may be willing to pay more than one with several.
FNP vs. PA
FNP is one of the most popular NP specialties. FNP vs. PA comparisons are regularly made, as they both are health care providers who require licensure, work alongside physicians, diagnose and treat illnesses, and are able to prescribe medication. Additionally, they both require board certification to practice. What then are the key differences between the two?
FNP vs. PA key differences
The first key difference between an FNP and a PA is that PAs are required to work under the supervision of a collaborative physician, although some states allow supervision to be conducted remotely. FNPs have more autonomy, but it’s not absolute throughout the country. FNPs have full practice authority in 24 states; this means that they have the authority to evaluate, diagnose, and treat patients without supervision, including prescribing medication. In the remaining states, either reduced practice or restricted practice authority limit their patient care abilities. PAs don’t have different practice authority levels based on location.
Another key difference is the matter of work environment and specialization. PAs can switch work environments or specialties, for example, transitioning from emergency care to family care, without having to go back to school or get new certification. In contrast, FNPs who decide to switch specialties have to complete the required education and licensure. For example, an FNP interested in becoming a CRNA would need to complete a CRNA program.
A final difference between FNPs and PAs is their approach. FNPs follow the nursing model, whereas PAs follow the medical model. The nursing model is a holistic approach that considers the entirety of the patient — both physical and emotional needs — beyond the symptoms the patient exhibits. The medical model is predominantly based on cause and effect and focuses on treating symptoms.
For example, a patient diagnosed with psoriasis will likely be treated with a steroid-based medication such as prednisone or betamethasone dispropionate by a PA, whose goal is to treat symptoms. An FNP may dig deeper, potentially revealing that the patient eats a lot of red meat and dairy products, foods that can cause psoriasis inflammation. The FNP in this case will prescribe the necessary medication, of course; however, the FNP will also recommend a change in diet to avoid future inflammation. When considering FNP vs. PA methods of treatment, FNPs tend to think more holistically.
Choose the perfect path to your health care profession
If you want to make a difference in the field of health care, becoming an NP or PA is a rewarding career path with strong job security and generous compensation. Although some distinct differences exist between the two, both are centered on helping people.
At Northeastern University, we offer an online MS in Nursing program with three concentration options: adult-gerontology primary care nurse practitioner (AGPCNP), family nurse practitioners (FNP), and psychiatric mental health nurse practitioner (PMHNP). Learn more about the program and concentrations, required coursework, and pre-qualify online.
Sources:
AAPA, Become a PA
AAPA, PA Prescribing (PDF)
Accreditation Review Commission on Education for the Physician Assistant, Accredited Programs
American Association of Nurse Practitioners, NP Fact Sheet
American Association of Nurse Practitioners, Nurse Practitioner (NP) Certification
American Association of Nurse Practitioners, Nurse Practitioners (PDF)
American Association of Nurse Practitioners, State Practice Environment
American Association of Nurse Practitioners, The Path to Becoming a Nurse Practitioner (NP)
American Association of Nurse Practitioners, What’s a Nurse Practitioner (NP)?
American Nurse Journal, “The Role of Adult Gerontology Acute Care Nurse Practitioners”
CareerBuilder, 3 Differences Between a Nurse Practitioner and a Physician Assistant
Indeed, 17 Nurse Practitioner Specialties for 2021
Indeed, Nursing Model vs. Medical Model: Benefits and Key Differences
LinkPAs, Nursing Model vs. Medical Model (Similarities & Differences)
National Council of State Boards of Nursing, Taking the NCLEX
NCCPA, About PANCE
PayScale, Average Family Nurse Practitioner (NP) Salary
PayScale, Salary for Certification: Acute Care Nurse Practitioner (ACNP)
The Balance Careers, “What Is a Physician Assistant?”
U.S. Bureau of Labor Statistics, Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners
U.S. Bureau of Labor Statistics, Physician Assistants
