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Physician Assistant vs. Nurse Practitioner: What’s the Right Move for Your Career?

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Looking for a new direction in your healthcare career? Working as a physician assistant (PA) or a nurse practitioner (NP) could be a great fit for you. Both careers are advanced practice medical professional roles in which you would see patients, diagnose and evaluate medical problems and concerns, treat conditions, and prescribe medication.

PA vs. NP: What’s the Difference?

Although patients are not always aware of the differences between PAs and NPs, these two distinct roles differ in their patient care approaches, educational requirements, and scopes of practice, among other aspects.

In this article, we answer the question posed above by discussing the most important differences between the PA and NP positions, touching on the following topics:

  • Educational Requirements
  • Patient Care Approach
  • Certification
  • Specialization
  • Job Duties & Responsibilities
  • Practice Authority
  • Work Environment
  • Salary
  • Job Outlook
  • Other FAQs

Educational Requirements

PAs and NPs both go through many years of classes and clinicals to become certified to treat their patients. However, the path to each profession differs slightly.

PA Educational Requirements

To become a PA, students must obtain their bachelor’s degrees and get hands - on healthcare experience. Then they can apply for a PA program. Once accepted, students spend approximately 27 months in PA school.

Even after graduates become licensed PAs, their education isn’t through. PAs have to log 100 continuing education hours every two years as well as take a recertification exam every ten years.

NP Educational Requirements

Most NPs start with a bachelor’s degree in nursing (BSN), take the National Council Licensure Examination (NCLEX), log clinical training hours, obtain a registered nurse license (RN), and work in the nursing field before eventually applying to NP school.

NP schools are graduate - level programs that award master’s degrees in a variety of NP specialties. NPs also need continuing education. While the exact requirements depend on their certifying board, NPs generally must log 1,000 clinical hours in their specialty every two years.

Patient Care Approach: Both Medical Models Explained

PAs and NPs are both trained to act as medical professionals who diagnose and treat patients, but they do have some differences because PAs operate under a medical model of care, while NPs work from a nursing model of care.

PAs: The Medical Model

As the American Academy of Physician Associates (AAPA) describes, PAs are medical professionals who diagnose, treat, and manage patient care. PAs operate under the medical model of patient care, which primarily looks at evaluating and treating the symptoms of a patient, and not treating the patient as a whole. Like doctors, they can serve as primary care providers in office settings or specialize and work in a variety of settings, such as hospitals or urgent care clinics. They have hundreds of hours of clinical training and experience and must earn a master’s degree as well as pass a certifying exam before being licensed.

Although the name implies that PAs are “assisting” doctors, that’s not the case; instead, PAs act as full partners in medical care teams. However, in almost all states they don’t have the same amount of authority as physicians do and must work in settings that are licensed through doctors. For this reason, PAs in most states (outside of North Dakota) can’t have their own practices.

NPs: The Nursing Model

NPs are first and foremost, nurses, which means they operate under the nursing model. As the Journal of Excellence in Nursing Leadership explains, the nursing model is based on treating the patient as a person, not just a collection of symptoms. The nursing model of care relies on building a relationship and rapport with the patient to establish trust, outline a plan of care, and educate the patient.

As both Registered Nurses and advanced practitioners, NPs will approach patient care in the same way, but are able to go beyond a nursing plan of care to develop a full care plan as well and diagnose and treat symptoms. The American Association of Nurse Practitioners (AANP) explains that NPs are nurse clinicians who can diagnose, treat, and manage patient care. NPs are classified as advanced practice registered nurses, which means that all NPs are first RNs who then complete additional training.

Like PAs, NPs must complete a master’s program and pass an NP certification exam to practice. NPs also have set clinical hours to complete through their education; they may have additional healthcare experience as nurses as well. NPs also have one advantage over PAs because, unlike PAs, they are recognized as independent practitioners in some states –– meaning they don’t need to work under doctors but can open and operate their own practices.

Because NPs are RNs trained in the nursing model, care under an NP heavily focuses on education, health management and disease prevention. And this approach results in positive outcomes for patients. Research summarized by the AANP shows that NPs consistently provide high - quality, safe, and effective care for patients.


No PA or NP can practice without being certified. Even after these medical professionals have passed their initial exams, they must still log continuing education hours and periodically pass certification exams to maintain their licenses.

PA Certification

PAs receive their initial certification by taking and passing the Physician Assistant National Certifying Examination (PANCE) after graduating from their PA program. PANCE is a timed exam of 300 multiple - choice questions that assess medical and surgical knowledge. Students who do not pass the first time can retake the exam as many as six times in six years. Once licensed, PAs maintain their license by logging 100 continuing education hours every two years and taking a recertification exam every ten years.

NP Certification

NPs receive their initial certification by taking and passing a National NP Certification Board Exam and then applying for their state NP licensure. They can be certified by any one of five national NP certifying organizations. To maintain their licenses, NPs have to log both continuing education hours and clinical practice hours; each certification board carries different requirements. Their RN licenses must be active as well.


Both PAs and NPs can choose to focus on a specific subset of medicine. While this choice often requires an investment of more time and sometimes extra certification, it allows practitioners to provide more specialized patient care, as well as to follow their own interests and passions.

PA Specializations

Some of the most common PA specializations include:

  • Anesthesia
  • Cardiology
  • Dermatology
  • Emergency medicine
  • ENT/Otolaryngology
  • Family medicine
  • General practice
  • Hospital medicine
  • Internal medicine
  • Neurology
  • Obstetrics and gynecology
  • Pediatrics
  • Radiology
  • Surgical subspecialties

NP Specializations

Some of the most common NP specializations include:

  • Acute care
  • Cardiology
  • Family practice
  • Gerontology, including acute care or primary care
  • Neonatal
  • Oncology
  • Orthopedics
  • Pediatrics, including acute care
  • Psychiatry and mental health
  • Women’s health

Job Duties & Responsibilities

PAs and NPs work alongside doctors, playing their own vital parts of healthcare teams, from primary care to preventive care to emergency care.

PA Duties & Responsibilities

Some of the most common duties and responsibilities for PAs include:

  • Reviewing patients’ medical histories
  • Maintaining patient records for insurance companies
  • Examining patients
  • Ordering and interpreting lab work or other diagnostic tests
  • Diagnosing patients
  • Developing and managing treatment plans
  • Prescribing medication
  • Giving shots or stitches
  • Educating patients on preventative care
  • Making rounds
  • Assisting in surgery
  • Researching the latest treatments

NP Duties & Responsibilities

Some of the most common duties and responsibilities for NPs include:

  • Ordering, performing, and interpreting lab work or other diagnostic tests
  • Diagnosing patients
  • Monitoring and operating medical equipment
  • Managing patient care
  • Prescribing medications
  • Educating patients on preventative care
  • Assessing and recording medical histories
  • Examining patients

Practice Authority

State law defines what PAs and NPs can and can’t do while practicing. In almost all states, for example, PAs must practice under the legal authority of a licensed physician. NPs face different regulatory rules that also dictate their levels of authority.

PA Practice Authority

As mentioned, most PAs require supervision by a physician, and their scope of practice is determined with the supervising physician at the site. In 2019, however, North Dakota became the first state to pass legislation allowing Optimal Team Practice (OTP). The new law removes all references to PAs being “supervised” by physicians and makes PAs the ultimate authority for the care they provide.

The steps taken by North Dakota appear to be catching on in other states. Also in 2019, West Virginia enacted OTP for PAs who practice strictly in hospitals, allowing these practitioners to act as full independent clinicians. Overall, there is legislation and advocacy in the works in many states to shift from the practice of PAs as being under the supervision of doctors to being in collaboration with a medical team instead.

State law dictates PAs’ prescriptive authority as well. In 44 states plus the District of Columbia, PAs can prescribe any medication. The remaining 6 states, however, limit what medications PAs can prescribe, for example, by barring them from prescribing Schedule II medications.

States also regulate under what conditions, if any, PAs may own medical practices. Some states require physicians to be co-workers, some require specific business structures in place, and some don’t allow it at all. Additionally, owning a practice may differ significantly from operating the practice.

NP Practice Authority

Twenty - five states give NPs full practice authority, meaning they are not required to be supervised by a doctor to diagnose or treat patients. This type of authority allows NPs to open and own independent practices, as well as to prescribe all medications.

Fourteen states give NPs reduced practice authority, which restricts some of their rights to practice independently. The laws in reduced practice authority states might require that the NP have a legal agreement with another healthcare provider or limit what treatments they can offer.

Finally, eleven states give NPs restricted practice authority, mandating that they must be supervised by a physician throughout their careers.

All 50 states allow NPs to prescribe medications, although some states have additional specific requirements, such as Alabama, which requires that NPs have a full 12 months of demonstrated “safe” practice before being allowed to prescribe controlled substances.

Work Environment

When it comes to work environments, both PAs and NPs have a wide variety of choices. They can work everywhere from private practices to hospitals to remote environments.

Where Do PAs Tend to Work?

PAs might work in any of the following environments:

  • Physician offices
  • Hospitals
  • Employment service office
  • Outpatient care centers
  • Urgent care centers
  • Surgery centers
  • Government and community health agencies
  • Universities and research agencies
  • Healthcare or health industry businesses
  • Phone triage centers
  • Rural healthcare facilities
  • Nurse - managed medical centers

Where Do NPs Tend to Work?

NPs might work in any of the following environments:

  • Physician offices
  • Hospitals, acute care, or ambulatory care settings
  • Outpatient settings
  • Long - term care facilities and nursing homes
  • Private homes
  • Hospice and palliative care services
  • Government and community health agencies
  • Universities and research agencies
  • Healthcare or health industry businesses
  • Private practice
  • Phone triage centers
  • Rural healthcare facilities
  • Nurse - managed medical centers


While the average NP salary is a little less than what PAs get paid, PAs and NPs both tend to make an average of six figures per year, according to the Bureau of Labor Statistics (BLS).

PA Salary

PAs earn an average of $55.81 per hour and $116,080 per year, according to the BLS May 2020 report.

The top percentile of salaried PAs in 2020 earned $162,470 per year, while the lowest percentile earned $76,700, according to the BLS. The most profitable industry for PAs is in the personal care industry, where they earn an average of $144,260 per year. If you’re wondering what falls under the personal care industry, it encompasses a lot of different jobs, including skin care specialists, fitness workers, and beauty services.

After that category, PAs tend to make the most in outpatient centers (an average of $128,820 annually), followed by general and surgical hospitals ($117,320), physician offices ($115,120), and specialty hospitals ($114,600).

NP Salary

Nurse practitioners earn an average of $55.05 per hour and $114,510 per year, according to the BLS May 2020 report.

The top percentile of salaried NPs in 2020 earned $156,160 annually, while the lowest earned $82,960. The highest - earning industry for NPs is in community, food, and relief services, where NPs earn an average of $143,480 annually. They also earn high wages in religious organizations ($131,710 annually), residential substance abuse and mental health facilities ($130,830 annually), and social advocacy organizations ($127,970).

In more traditional settings, NPs also earn high salaries: in outpatient centers, an average of $123,850 per year; in specialty hospitals, $123,550 per year; and in general and surgical hospitals, $118,210 per year.

Job Outlook

Curious about what PAs and NPs can expect down the road? Good news: Current demand is high for both jobs, and the same is expected in the future.

What’s the Job Outlook for a PA?

For PAs, job growth is projected at 31% from 2020 to 2030. This translates to about 40,100 new job openings for PAs over this ten - year period.

What’s the Job Outlook for a NP?

The employment of nurse practitioners is projected to grow 52% from 2020 to 2030, with 114,900 new job openings expected over this ten - year period.

Other FAQs on PA and NP Career Paths

Next we answer some of the most popular questions asked about these two professions.

Is a PA a higher position than an NP?

A PA is not in a higher position than an NP. Both NPs and PAs can serve as primary and specialty care providers. In general, NPs do have more full practice authority than PAs. Each state sets its own rules about what a PA or an NP is allowed to do in their practice, but in all states, PAs and NPs are important medical professionals who deliver healthcare in collaboration with other providers.

Can PAs and NPs prescribe medications?

Yes. Both PAs and NPs can prescribe medication in all 50 states. Some states have additional restrictions on prescription authority, however. See info above on Practice Authority to learn more on state requirements for each profession.

What GPA do you need for PA school? How about NP school?

For most PA programs, students need a minimum GPA between 2.75 and 3.2. Most NP schools require a minimum GPA of 3.0.

What can a doctor do that a PA or NP can’t?

A physician has more extensive education and clinical training (at least 12 years of school and several years of residency), as well as the ability to diagnose, treat, prescribe, and care for patients in all 50 states without restrictions.

Physicians also tend to have much more specialized experience for complex medical care. Unlike PAs and NPs, doctors may also practice surgeries and perform other advanced medical interventions. Physicians do not have restrictions on owning medical practices and are also reimbursed by insurance companies at the full rate. Medicare, for example, pays physicians higher reimbursement rates than they do PAs and NPs.

PA vs. NP: How to Choose the Right Path for Your Career

Both PAs and NPs work directly with patients, diagnose and treat medical conditions, prescribe medicine, and specialize in areas that interest them. Both sets of practitioners can choose from a wide range of clinical settings as well, which means they can tailor their careers to their interests and passions.

Whether you decide to become a PA or an NP depends on your current education and experience, as well as your future goals. If you are already a nurse, are in nursing school, or want to open your own independent practice someday, an NP might be the best route for you. You can even enter into an accelerated NP program if you have a master’s degree in another field and want to become an NP.

However, if you have a bachelor’s degree in another field and don’t have an interest in becoming a nurse or specializing as an NP, a PA might perfectly suit your needs. Becoming a PA can have some advantages over becoming an NP: for instance, you don’t have to go to nursing school or pass the NCLEX.

You will train under other PAs or physicians and not from nurses, so you’ll get a different approach to your education. Additionally, you can go directly from your undergraduate training to PA school if you choose without any extra licensure requirements.

Becoming a PA could also be a successful later - in - life choice because it does not require a nursing degree as a prerequisite. As with medical school, there isn’t one certain bachelor’s degree you have to earn to get accepted into PA school, but you should expect some heavy requirements in the science, chemistry, and math departments. If you haven’t been in school for a while, you’ll probably have to catch up on some prerequisites and demonstrate around three years of healthcare experience.

Choosing a career as a PA or an NP lays the groundwork for a rewarding career that allows for a lot of growth, opportunity, and specializations for your own passions in healthcare.

And no matter which route you choose, one thing is clear: you can feel confident you’re going to be making a positive difference in your patients’ lives.

How does this compare to a Nurse? > > Read NP vs Nurse: What’s the Difference?

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Last updated on Mar 10, 2023.

Originally published on Mar 24, 2022.


The views expressed in this article are those of the author and do not necessarily reflect those of Berxi™ or Berkshire Hathaway Specialty Insurance Company. This article (subject to change without notice) is for informational purposes only, and does not constitute professional advice.

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