Nurse Practitioner vs. Physician Assistant: What’s the Difference?

Both nurse practitioners (NP) and physician assistants (PA) perform critical functions in the U.S. healthcare system. In a world of persistent healthcare provider shortages, both professions are in high demand and can earn strong salaries for their expertise.

While these two healthcare roles are similar, NPs and PAs differ in education and certification requirements, professional independence, and specialization pathways.

Before you choose between a nurse practitioner and a physician assistant role, find out how these careers differ and which path matches your goals.

NPs and PAs provide licensed direct patient care, but their education and scope of practice set them apart. While NPs follow a more patient-centered or holistic model of care, PA training focuses more on medicine and medical treatment.

Still, these two roles overlap in their duties, including:

Additionally, both professions require each candidate to complete an accredited program, pass a board exam, and apply for state licensure.

Regardless, these two healthcare roles have some key differences.

An NP is a type of advanced practice registered nurse (APRN) who provides primary and specialty care.

NP duties often include:

According to the Bureau of Labor Statistics (BLS), approximately 47% of NPs work in physician offices, 23% find employment in general medical and surgical hospitals, and 10% work in outpatient care centers.

A physician assistant provides primary and specialty care under the direct supervision of a medical doctor.

PA duties can include:

According to the BLS, 54% of PAs work in physician offices, 25% work in hospitals, and 9% work in outpatient care centers.

Both careers report higher average salaries than the national figures for all occupations. These roles also received higher job growth projections for 2023-2033 than estimates for all job growth in the nation.

Nurse practitioners and physician assistants take different pathways into their profession, but their roles and responsibilities often look similar. NPs and PAs work closely with patients, diagnosing and treating their illnesses, ordering and analyzing tests, and assisting in surgical procedures.

They differ, however, in where they work and their ability to practice independently. For example, according to the Health Resources and Services Administration (HRSA), more than 90% of NPs work in primary care as of 2023. In comparison, only about 22% of PAs work in primary care, according to a 2023 report from the National Commission on Certification of Physician Assistants (NCCPA).

An NP’s scope of practice refers to the responsibilities and services they can legally provide, which varies by state. According to the American Association of Nurse Practitioners (AANP), NPs can practice independently in 28 states but require collaboration with physicians in 12 states.

In the remaining 11 states — California, Georgia, Florida, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Virginia — NPs require supervision from a medical doctor.

Some states also limit an NP’s prescriptive authority, such as Oklahoma and Missouri, which restrict their ability to prescribe Schedule II controlled substances.

Similar to an NP, a PA’s scope of practice depends on the state.

According to the American Medical Association, most PAs work under medical doctor supervision. A few states allow PAs to treat patients without a medical doctor on-site if they have an established collaborative relationship with a physician.

Depending on state laws, experienced PAs can expand their scope of practice after meeting clinical hour requirements. For example, Arizona allows PAs with more than 8,000 clinical hours to move from a physician supervision requirement to collaboration.

State laws also determine prescriptive authority for PAs. For example, PAs cannot prescribe Schedule II medication in Alabama, Arkansas, Georgia, Hawaii, Iowa, Kentucky, and West Virginia.

NPs and PAs must earn master’s degrees in their respective disciplines for certification. NP programs typically explore advanced nursing courses in a chosen specialty, such as family care or pediatrics. PA programs are modeled after a medical school curriculum, focusing more on general medicine and offering clinical training in various settings.

However, NP and PA programs feature similar courses like advanced pharmacology, anatomy and pathophysiology, and microbiology.

NPs must first become licensed RNs before moving to advanced practice roles. There are several pathways to becoming a nurse, such as starting with a licensed practical nurse (LPN) credential and then taking an LPN-to-RN bridge program while working as an LPN.

Another way to become a registered nurse is to complete an associate degree in nursing (ADN), which can take about two years. Completing a bachelor’s degree in nursing (BSN) also works — typically a four-year commitment.

ADN and BSN-prepared nurses must then pass the National Council Licensure Examination (NCLEX-RN) to qualify for RN licensure in their state.

Once licensed, an RN must earn an MSN to become an NP. Other common pathways to this degree include RN-to-MSN bridge programs. Some NPs even earn DNP degrees.

Most NP programs include core coursework in:

They also include courses in specialty areas, such as family care, acute care, pediatrics, and psychiatry.

NP programs incorporate supervised clinical practicums for students to gain experience with treating patients. Board certification for NPs requires at least 500 clinical hours, and some NP programs add additional clinical hours. Certification is a requirement for NP employment. Earning an MSN generally takes 2-3 years, while a DNP takes 3-5 years.

With an MSN or DNP, NPs must then complete a national board certification exam in their specialty area with an organization like the American Academy of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC). After passing an approved certification exam, newly eligible NPs can apply for APRN licensure through their state’s board of nursing.

Licensed NPs must renew their certifications every five years by completing 1,000 practice hours and 75 hours of continuing education. Each state has its own licensure renewal requirements as well.

Earning a bachelor’s degree, preferably in a science-based field, is a typical first step in preparing for a master’s program and becoming a PA.

While prospective PA students can pursue bachelor’s degrees in various disciplines, they need to complete prerequisites like anatomy, physiology, biology, and biochemistry. Applicants also need healthcare experience from volunteering or hands-on patient experience as a medical assistant, paramedic, or registered nurse.

With the bachelor’s degree and prerequisites completed, aspiring PAs can pursue master’s programs in physician assistant studies. To ensure the program leads to PA licensure, students should only attend master’s programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).

PA master’s degrees take about three years to complete and feature broad coursework and clinical work in different specialties. Potential clinical rotations include:

After completing a program accredited by ARC-PA, graduates qualify for the Physician Assistant National Certifying Exam (PANCE) from the NCCPA. A passing PANCE score qualifies them for the PA-C credential, which is required by state licensing boards.

To maintain PA-C credentials, licensed PAs must complete at least 100 hours of continuing medical education every two years and pass the Physician Assistant National Recertifying Exam every ten years. Each state also has specific PA licensure renewal requirements.

Each NP chooses a specialization before applying to a graduate nursing program. They also sit for a board certification exam in that specialty. After choosing an initial specialization, NPs can switch specialties or obtain subspecialty certifications to advance their careers.

Most NPs become family nurse practitioners to care for patients across the lifespan with various healthcare needs. Other NPs pursue specialties in acute care and mental health or work with specific patient populations, such as pediatrics or adults.

Rather than focusing on one specialty area, PAs receive training as medical generalists, gaining skills in all areas of medicine. They complete clinical rotations in multiple specialties so they can adapt to different care areas and change specialties without additional training.

According to AAPA, more than 50% of PAs practice in an outpatient office or clinic, 37% work in hospitals, and 5% work in urgent care centers.

NPs and PAs earn above-average salaries and receive strong employment growth projections. Learn more about the salary and career outlook for nurse practitioners vs. physician assistants below.

The average nurse practitioner salary was $128,490 as of May 2023, according to BLS data. Business support services, mental health and substance abuse facilities, and home healthcare services pay some of the highest NP wages. Salary data by state indicates California, Nevada, Washington, and New Jersey pay the highest salaries in the profession.

The BLS also projects 46% job growth for nurse practitioners from 2023-2033, over 11 times faster than the projected growth for all occupations.

According to BLS data, the average PA salary was $130,490 as of May 2023. Employment services, outpatient care centers, and ambulatory healthcare services reported the highest salaries in the field. Nevada, California, Washington, and Connecticut are the top-paying states for physician assistants.

Physician assistants also benefit from much faster-than-average job growth projections, with the BLS reporting a 28% employment increase from 2023-2033.

Nurse practitioners and physician assistants are important and in high demand in the healthcare system. Both careers receive strong projected growth rates and earn six-figure median salaries. They also share similar work settings and education requirements.

When choosing between these similar professions, consider your interests and situation. Which profession is in greater demand in your area? Which discipline has the best master’s program near you?

While both career paths can take the same amount of time, NPs need RN licensure and nursing experience, which takes additional effort but can open the door to nursing jobs while in school. You’ll have more independence as an NP, but you also need to choose a specialization earlier in your nursing journey.

Whether you prefer an NP’s patient-centered care education or the disease-centered training of PAs, the best option for you depends on your unique interests and goals.