Physician Assistant vs. Nurse Practitioner: What Are the Differences?

Observing a physician assistant (PA) and a nurse practitioner (NP) in practice, you might not see the difference. They share many of the same duties and responsibilities: writing prescriptions, developing treatment plans, ordering tests. Both are trained clinical health providers with advanced degrees and clinical preparation, and they must be nationally certified in order to practice. 

But the two professions have key differences. A physician assistant receives a generalist education modeled after medical school. Upon graduation, they are prepared to treat the whole patient and develop areas of specialty through clinical practice. An NP, on the other hand, typically specializes in a patient population while in school, such as geriatric or women’s health. They build their expertise through clinical hours.

Learn more about the careers of PAs vs. NPs and find out which is the better fit for you.

PA vs. NP: Role and Scope of Practice

A nurse practitioner is a registered nurse (RN) with the advanced clinical expertise needed to prevent, diagnose, and treat health conditions, as defined by the American Association of Nurse Practitioners (AANP). They develop comprehensive treatment plans in collaboration with patients and integrate insights from the entire medical team, including physical therapists, speech language pathologists, registered dieticians and others as needed. Nurse practitioners (NPs) typically specialize in a particular patient population, such as families, neonatal infants or older adults.

In daily practice, nurse practitioners use a holistic approach. For primary care, this includes addressing social determinants of health, preventing disease and promoting health management. NPs support their patients in practicing healthy lifestyles — scheduling regular health screenings, getting physical activity, stopping unhealthy behaviors such as smoking — that can help prevent chronic diseases. This emphasis on preventative care can ultimately lead to lower health care costs, making NPs essential to creating a more efficient and effective health system.

Common responsibilities of a primary, acute or specialty care NP include:

  • Ordering and interpreting diagnostic tests (such as X-rays and lab results).
  • Diagnosing and treating acute and chronic conditions.
  • Prescribing treatments and medicines.
  • Managing patients’ overall care.
  • Providing education on disease prevention and healthy lifestyles.

A physician assistant is also a medical professional who works with the entire clinical team to manage a patient’s care, as described by the American Academy of Physician Assistants (AAPA). Training for PAs is modeled on medical school education. While NPs specialize in a patient population, PAs receive a generalist preparation with rotations in a variety of specialties and subspecialties. Through rotations, and later through practice and continuing education, PAs develop expertise in particular populations, conditions and bodily systems.

Physician assistants make diagnoses, create treatment plans and prescribe medications. Common responsibilities of a PA include:

  • Giving physical exams and recording medical histories.
  • Performing procedures and offering assistance in surgery.
  • Ordering and interpreting diagnostic tests.
  • Diagnosing and treating acute and chronic conditions.
  • Prescribing treatments and medicines.

PA vs. NP: Degree and Training Requirements

Physician assistants and nurse practitioners undergo rigorous training to prepare for medical practice. This training typically includes academic and hands-on work. Read further to explore options for PA vs. NP education.

PAs receive a master’s degree-level education. To become a PA, a student must:    

  • Hold a bachelor’s degree, with prerequisite coursework in basic and behavioral sciences.
  • Graduate from an accredited PA program.
  • Complete more than 2,000 hours of clinical rotations.
  • Pass the national certification exam.

After becoming licensed, physician assistants must maintain their licensure through continuing medical education and recertification exams every 10 years.

Registered nurses aspiring to become NPs may complete either a master’s or doctoral degree program. This could be a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP) degree.

To become an NP, a nurse must:

  • Hold an active, current RN license.
  • Graduate from a nursing master’s or doctoral degree program.
  • Complete clinical hours required by their program and specialty (often more than 500 hours).
  • Pass the national certification exam for the chosen specialty.
  • Meet state requirements to obtain licensure.

Similar to PAs, nurse practitioners must maintain their clinical competencies through continuing education.

PA vs. NP: Career Paths and Salary

The demand for health care services will increase as the U.S. population grows and ages, according to the Bureau of Labor Statistics (BLS). Physician assistants and nurse practitioners are positioned to provide essential care to patients. Learn more about the PA vs. NP salary below.

This table contains information regarding projected job growth for physician assistants and nurse practitioners in the United States. According to 2018 BLS data, employment of physician assistants are projected to grow 31% through 2028 while nurse practitioners are projected to grow 26% through 2028. The median salary for physician assistants is $108,610 while the median salary for nurse practitioners is 107,030, according to the same 2018 BLS data.
BLS Data Physician Assistant Nurse Practitioner
Projected Growth, 2018–2028 +31% +26%
Median Salary $108,610* $107,030*

*as of May 2018

Outcomes and Job Outlook of Physician Assistants

BLS data indicates that employment of PAs is projected to increase 31% between 2018 and 2028.

Physician assistants may practice in a variety of settings. The most popular settings as per a 2019 AAPA Salary Survey of clinically practicing PAs in the United States include:

  • Outpatient office or clinic (53.3%)
  • Hospital (36.5%)
  • Urgent care center (5.9%)
  • Other (e.g., nursing homes, schools and universities, rehabilitation centers, correctional facilities, 4.3%)

PAs also work in all medical specialties. The same survey shows that the most common specialties include:

  • Other (e.g., psychiatry, hospice and palliative care, obstetrics and gynecology, 28.8%)
  • Surgical subspecialties (27.4%)
  • Primary care (20.8%)
  • Internal medicine subspecialties (12.2%)
  • Emergency medicine (9.4%)
  • Pediatric subspecialties (1.4%)

Most physician assistants work full time and often earn a salary higher than $100,000 each year. The 2018 median pay of PAs was $108,610 per year, but it can vary based on the setting. As of May 2018, the BLS reports the following physician assistant salaries in various work environments:

  • Outpatient care centers ($115,560)
  • Hospitals; state, local and private ($111,540)
  • Employment services ($109,890)
  • Offices of physicians ($107,230)
  • Educational services; state, local and private ($102,870)

Outcomes and Job Outlook of Nurse Practitioners

Similar to PAs, nurse practitioners work in a variety of settings. The BLS shows the following breakdown of work environments for nurse practitioners, nurse anesthetists and nurse-midwives:

  • Physicians’ offices (47%)
  • Hospitals; state, local and private (27%)
  • Outpatient care centers (9%)
  • Educational services; state, local and private (4%)
  • Offices of other types of health practitioners (3%)

The BLS predicts NP employment will increase 26% between 2018 and 2026. The 2018 median salary for NPs was $107,030. However, salary varies by clinical specialty and work setting. As of May 2018, the BLS reports the following salaries for NPs, nurse anesthetists and nurse midwives in various work environments:

  • Hospitals; state, local and private: $120,540
  • Outpatient care centers: $115,720
  • Offices of other health practitioners: $112,740
  • Physicians’ offices: $111,440
  • Educational services; state, local and private: $104,310

Find out what salaries nurse practitioners earn in your state.

PA vs. NP: Certifications and Licensure

After completing their degree programs and clinical hours, physician assistants and nurse practitioners must obtain specific certifications and licensure to provide care to patients. 

Becoming a Physician Assistant

The AAPA outlines the steps to becoming a practicing PA:

  1. Graduate from an accredited PA program.
  2. Pass the Physician Assistant National Certifying Exam (PANCE), administered by the National Commission on Certification of Physician Assistants.
  3. Secure state licensure as a physician assistant. 

Those who pass the PANCE exam receive the title of physician assistant-certified (PA-C).

Becoming a Nurse Practitioner

The steps to becoming a nurse practitioner are similar, as indicated by the AANP:

  1. Graduate from an accredited program (MSN, DNP or another higher degree). For MSN programs, the Commission on Collegiate Nursing Education (CCNE) is the national accrediting agency.
  2. Pass the national certification exam, which is specific to the nurse’s chosen population focus.
  3. Secure state licensure.

Nurses who complete the degree program and receive certification become an advanced practice registered nurse (APRN). This includes certified nurse-midwives (CNM) and family nurse practitioners (FNPs).