As primary care providers, nurse practitioners (NPs) and physician assistants (PAs) play a critical role in the health care system. Although the two professions share commonalities, there are some important distinctions to keep in mind when deciding which role may be right for you. From education and certification requirements to job placement and level of care to average income, the career trajectory of an NP may look different from that of a PA. 

This page provides a general overview of both roles, highlighting differences such as approaches to patient care and more.

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As the population of primary care physicians struggles to support a strained health care system and the aging population [PDF, 3.8 MB], advanced practice registered nurses (APRNs) and physician assistants are expected to fill their shoes—providing advanced care to patients with a range of issues. Before we discuss the key differences between a PA and NP, here are a few factors the two positions have in common:

PAs and NPs have similar work environments and job functions. As a result, it may be difficult to distinguish the two professions. NPs and PAs do, however, differentiate themselves in a few ways. Below, we explain some of the main differences between a PA and an NP:

Education and Training 

As previously mentioned, both NPs and PAs require—at minimum—a master’s degree to obtain a license to practice. However, the specific type of nursing degree program and training necessary for each role, is usually different. For instance, NPs must earn a Master of Science in Nursing (MSN) from a program/school that has been accredited by the Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE). PAs on the other hand, are required to complete a master’s-level physician assistant degree program that has received accreditation from the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).

The curriculum for each degree program is also different due to varying on-the-job responsibilities. The coursework for NPs and PAs is tailored to the demands of each profession. For example, an NP program might focus on nursing-specific courses like Pharmacology for Nursing Care or Epidemiology and Population-Based Nursing. PA programs tend to offer more clinical, disease-centered coursework since the position primarily focuses on diagnosing and treating illnesses rather than the broader symptoms of patients. Topics you might cover in a PA program include Biochemistry, Clinical Anatomy, Clinical Laboratory Science, Medical Ethics and more.

Master’s programs and licensing bodies often require clinical training, as a way to help prepare NP and PA candidates for practice. Generally, NPs must complete a minimum of 500 supervised hours of clinical practice. PAs usually complete more–around 2,000 clinical practice hours in a range of health care settings. 

Specializations

If you’re interested in studying a specific area of medicine, there are a number of specializations for NPs and PAs to consider. NPs focus on patient-centered care. Therefore, nursing specializations are often grouped by patient type. A prospective NP might decide to specialize in one of the following areas:

• Family care
• Neonatal care
• Adult gerontology care
• Pediatric care
• Psychiatric care
• Women’s health

Since PAs—like physicians—typically have pathology-focused training rather than patient-focused training in addition to clinical practice, specializations are often more concerned with anatomy and disease than they are with patient classifications. Available PA specializations might include: 

• Anesthesia
• Cardiology
• Dermatology
• Emergency medicine
• ENT/otolaryngology
• General practice
• Internal medicine
• Neurology
• Obstetrics and gynecology (OB/GYN)
• Psychiatry
• Radiology
• Rheumatology
• Pediatrics
• Surgery
• Urology

Scope of Practice

Both NPs and PAs share the responsibility of diagnosing and treating patients, so it’s not surprising that there is some crossover in their day-to-day responsibilities. However, there are still a few differences between NPs and PAs when it comes to scope of practice.

In general, PAs are trained similarly to medical students and educated in general medicine with a disease-centered curriculum. This is often reflected in the clinical practice of physician assistants, which might include: 

• Examining patients
• Diagnosing illnesses
• Assisting in surgeries
• Interpreting lab results and X-rays
• Prescribing medication (prescriptive authority varies by state)
• Managing treatment plans
• Advising patients on preventive care

Nurse practitioners, on the other hand, are trained using a patient-centered model. A few tasks included in the scope of practice for NPs are: 

• Keeping patient records
• Identifying symptoms and diagnosing conditions
• Developing patient-centered treatment plans
• Educating patients 
• Performing minor patient intake duties
• Ordering diagnostic tests 
• Operating medical equipment
• Evaluating test results
• Conducting research
• Supervising/managing other nursing staff

Another important consideration is the level of authority each position carries. As of October 2020, in 22 states, NPs have full practice authority, which means they have the autonomy to evaluate and diagnose patients, order and interpret diagnostic tests and develop treatment plans without any physician supervision. According to a 2018 resource guide from the American Medical Association [PDF, 549 KB], PAs are supervised in 47 states. PA prescriptive authority varies by state—the same goes for NPs.

Certification and Licensing

NPs and PAs require specific licenses and certifications. However, the state and national boards that are responsible for issuing those licenses, are different. Before you decide if you want to pursue a career as an NP vs PA, understanding the licensing and certifications you might need—and your state’s specific requirements—can be helpful. 

To become a nurse, you’ll first need to complete an undergraduate, or associate’s degree program in nursing and get licensed as a registered nurse (RN) in the state you wish to practice. Then, you can go on to complete an on campus or online MSN program. From there, you’ll also need to earn national certification from a recognized NP certification board. The specific certification you pursue is usually determined by your specialization—and you’ll be responsible for keeping your certification current through a renewal process determined by the certification body. Finally, you’ll need to pass a state licensing exam.  Be sure to check your state board’s guidelines for renewing licenses. 

For physician assistants, the general requirements are slightly different. You’ll need to obtain national certification from the National Commission on Certification of Physician Assistants (NCCPA), which requires graduation from a physician assistant program. Additionally, state licensure is required. Professional organizations like the American Academy of Physician Assistants (AAPA) provide state-by-state PA licensing information.

As nurse practitioners must renew their certifications, so do physician assistants. PAs will renew their PA certification with the NCCPA. A recertification exam must be taken every 10 years, in addition to successful completion of 100 Continuing Medical Education (CME) credits every two years and a biennial certification maintenance fee. PA license validity varies from state to state. In certain states, renewal is required every year and in others, like California, it is required every two years.

As advanced practice registered nurses, nurse practitioners oversee a wide variety of clinical responsibilities, from diagnosing illnesses to providing comprehensive treatment plans. NPs often conduct their work independent of physician oversight and may even run their own practice in some states.¹

As the number of licensed physicians per capita in the U.S. continues to decline and the population ages, experts project that the critical support NPs offer the health care industry will continue to expand in the coming years. 

If you’re interested in becoming a nurse practitioner, you can explore a variety of degree options including online NP programs, to learn more about what your path into the industry may look like. 

What is a Nurse Practitioner (NP)?

Nurse practitioners have a broad scope of practice and are primarily responsible for diagnosing, treating and prescribing medication for patients with different illnesses. In addition to operating as a general health care provider, NPs will often administer preventive care to their patients as well. 

There are many different specializations for nurse practitioner careers. For instance, nurse practitioners may practice in:

• Women’s Health: Women’s health NPs are responsible for treating female patients at all stages of life. If you’re interested in the specialization or simply want to learn more about what aspiring WHNPs might study, you can explore online women’s health nurse practitioner programs. 
• Psychiatric and Mental Care: NPs who specialize in psychiatric care also work with patients across the lifespan. Commonly known as PMHNPs, these health care professionals may be found in correctional facilities, mental health centers and other settings, putting together and implementing treatment plans for individuals with mental health disorders.
• Family Care: Family nurse practitioners (FNPs) conduct a general practice, providing treatment, education and preventive care to patients with a wide variety of conditions. Interested in this career path? There are a number of degree programs that can help to prepare you for an FNP position. Online FNP master’s programs in particular, may allow you to balance your work schedule and other personal commitments with your studies. 

Choosing a career in health care might be challenging for some people, especially when they’re not sure what to expect. As APRNs, nurse practitioners may prepare to assume managerial roles. Depending on where they work, some NPs may be responsible for conducting research and teaching staff new policies and procedures. 

The salaries of NPs and PAs are relatively comparable. However, according to recent data from the U.S. Bureau of Labor Statistics (BLS), NPs hold a slight edge over their PA counterparts. As of May 2019, NPs earned a median annual salary of $115,800, according to the BLS. Check out our nursing salary comparison chart to see how nurse practitioners stack up against other nursing positions. 

Both fields are expected to grow considerably within the next 10 years. According to the BLS, overall employment for NPs is projected to increase 52% by 2029.  

Physician assistants or PAs are highly trained health care professionals whose day-to-day responsibilities generally look similar to that of a physician. The scope of practice varies by state and clinical environment, but PAs may serve as a patient’s primary health care provider, with some oversight from a licensed physician.  

Since PAs interface with people on a daily basis and typically end up making decisions that are critical to the well-being of patients, employers may look out for candidates who demonstrate strong communication skills, a sense of compassion and problem-solving skills. Learn more about what a career as a PA might look like. 

What is a Physician Assistant (PA)?

A physician assistant, like an NP, examines, diagnoses and treats patients, working closely with teams of physicians and surgeons to help conduct a disease-centered practice. Both NPs and PAs offer support in a variety of health care environments, but PAs—as suggested by their title—are generally considered as more of a direct stand-in for physicians than NPs are.

If you’re interested in pursuing a career as a physician assistant, you might want to know more about what to expect on the job. PAs typically work full time and may be on-call during nights, weekends and holidays, depending on their specialization or clinical environment. The position may also be physically demanding. PAs may be on their feet for most of their shift, walking from room to room to see patients or standing in operating rooms during surgical procedures. 

The salary difference between PAs and NPs is fairly minimal. PAs make a median salary of $112,260 a year, according to 2019 BLS data. Salaries may vary depending on the clinical environment in which you work. For instance, PAs in outpatient care centers earned a median annual wage of $119,090 in 2019. Meanwhile, PAs who work in the office of a physician earned a median annual wage of $110,670.

The job market for physician assistants is projected to grow 31% between 2019 and 2029, according to the BLS. By comparison, the average growth rate for all occupations during the same time is 4%. BLS research reveals that a growing number of elderly patients will increase the demand for health care services and may also result in higher salaries for PAs. 

If you’re still having trouble deciding which career is right for you, it’s important to consider what you’re looking for in a job before making a choice. What are your priorities? Perhaps you want a higher-paying position or you prefer patient-centered care over disease-centered care. Or, maybe you’re interested in treating a specific segment of the population, like neonatal or geriatric patients. Overall, consider your goals, educational background, program requirements and possible career paths to help you make the right decision. 

There are many vocations within the medical field—all with varying responsibilities and training requirements. In addition to PAs and NPs, here are a few related nursing specialties and health care career paths that you may be interested in pursuing: 

Sifting through the wall of information that greets anyone who decides to enter the medical field isn’t always easy. Here are a few frequently asked questions (and answers) that may help you start your educational journey and career on the right foot. 

_{¹ “State Practice Environment.” American Association of Nurse Practitioners, www.aanp.org/advocacy/state/state-practice-environment.} 

Information on this page was last retrieved in November 2020.