PA vs. NP: A Simple Explanation of the Fundamental Differences

“What is the difference between a PA and an NP?”


This question comes up for most pre-PA students at one of two distinct times. The first is when you are initially considering a career in medicine, and you start looking into possible roles. The second is long after you decided to become a PA, and you are wondering how to field this (or a similar) question during a PA school interview.


Whichever one of these points you find yourself at, this post will help you distinguish the main practical differences between a physician assistant and a nurse practitioner to either help you make or explain your career choice.



1. Differences in training of PAs and NPs

If you've looked into the PA/NP question before, you've undoubtedly found information about the medical model vs. the nursing model.


Great. So what does it mean?


In essence, physicians and PAs train on the medical model and focus on the diagnosis, testing, and treatment while NPs train on the nursing model and concentrate on the impact of the diagnosis, testing, and treatment on the patient.


In practice, the difference in training models may cause a slight variation in approach among the different types of providers. However, if a patient comes in with two broken arms, a PA is unlikely to ignore the fact that the patient will have trouble caring for herself and may need assistance with home care and the NP is equally as unlikely to ignore the importance of casting and proper bone healing.


Most important differences between PA and NP lBe a Physician Assistant

Despite similar outcomes of the training models, you may still find one preferable to the other based on your learning style and goals as a provider. 


Nurse practitioner programs are either master's or doctorate level, and typically require several years of nursing experience before admittance.


[Expedited NP programs now exist which grant a BSN along with a higher level degree. However, the majority of NP programs continue to follow the more traditional model of nursing experience first.]


PA programs are primarily master's degree level (95.4%), but some programs have not yet made the shift (all accredited PA programs are obligated to be master's level by 2020). Many require or prefer prior experience in healthcare, and a variety of roles qualify for this experience.


The average program length of an NP program is 15-24 months, while PA programs average 27 months. PA students obtain at least 2,000 hours of clinical contact during training. NP students average 720 clinical hours during training (remember that most have patient care experience as a nurse before entering an NP program).



2. Areas of practice

Often, PAs and NPs can be found in the same hospitals or practices, filling similar roles. It can be hard to distinguish between the professions when viewed from this perspective, but despite the similarities, some fundamental differences remain with how these two types of providers may practice. 


PAs train as generalists and can practice in nearly any field with a collaborating physician. PAs can switch specialties without the need for new certification or education other than on the job training, and nearly 50% of them do so during their careers.  


NPs train in either primary care or acute care, which is then further focused based on population: family/individual across the lifespan, adult-gerontology, neonatal, pediatrics, women's health, or mental health. Nurse practitioners are licensed specifically based on their training, including primary vs. acute care and population.


NPs also have the flexibility to work in a variety of specialties, as long as the specialty falls within the area (primary or acute) and population for which they trained. If an NP wishes to switch roles or patient populations, additional formal education is required along with licensure for the new role or population.



3. Level of autonomy

Most PAs and NPs practice reasonably autonomously, but there are definite legal distinctions and differing regulations between the two roles.


State medical boards are responsible for licensing PAs within their state. Licensure is built upon the concept of a physician-PA team, with each state outlining the requirements of "collaborative" or "supervisory" relationship.


Conversely, NPs are considered independent practitioners. The NP scope of practice varies widely based on each state's regulations, but some states allow for independent practice with full practice authority under the state board of nursing. PAs have no such autonomous state PA boards in any state.


There is currently a push for full practice authority for PAs, supported by AAPA. It emphasizes maintaining close physician-PA team relationships while removing the requirement to have a defined reporting relationship with a physician as a condition for a PA to practice (more in line with the current requirements for NPs).


The other proposals of the task force behind the movement include establishing independent state boards for PAs comprised of a PA majority and ensuring PAs are eligible for direct reimbursement from both private and public insurers.


The question of full practice does not affect autonomy for PAs now, nor does it guarantee more independence in the future. However, it is a hot topic in the PA world right now of which you should be aware whether you are considering a career as a PA or just want to be better informed for your PA school interview.


If you saw a PA or an NP as a patient, you probably would not notice a difference. However, if you were that PA or NP, your training, flexibility in practice, and autonomy would all be impacted by your career choice.


While PAs and NPs often fill similar roles, understanding the differences between the two roles can help you make the best career choice for you and also help you better explain that decision, perhaps to a PA school interviewer.  


Accreditation Standards for Physician Assistant Education, Fourth Edition. Updated March 2016.

Hass V. Physician assistants and nurse practitioners are not interchangeable. Journal of the American Academy of Physician Assistants. 2016;29(4):9-12. doi:10.1097/01.jaa.0000481408.81044.4e.

Issue Brief: Scope of Practice. American Academy of Physician Assistants. January 2017.

Physician Assistant Education Association, By the Numbers: Program Report 31, Washington, DC: PAEA, 2016. doi: 10.17538/PS31.2016