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Nurse Practitioner vs. Physician Assistant

Ujwal Deshmukh
Several NPs and PAs mention that on the job, their roles are very similar and do not have much of a difference except their titles. However, there is a minor difference that can be brought to the fore to help one decide which program to specialize in.
Nurse practitioners and physician assistants are primary healthcare providers and are vital in the medical field due to shortage of physicians.Their work is similar, except that nurse practitioners have some autonomy whereas a physician assistant works under a physician.
This does not mean that a physician must mandatorily be present to delegate work; however, the physician assistant must report to a physician at the end of the day.
It is believed that the two professions are distinguished mainly by their titles, at least in a hospital, as their scope of work remains largely the same. The marked difference is the fact that physician assistants may assist in surgeries, whereas instances of nurse practitioners assisting in surgeries is very rare. Here is an overview of both professions.

Nurse Practitioner

  • Definition: A registered nurse trained to be a primary healthcare provider.
  • License: Independent Nursing License
  • Scope of Practice: Ordering lab tests, evaluating medical history, diagnosing and treating medical conditions, prescribing medication as permitted by the law
  • Education: Based on nursing model and philosophy. Master's degree with relevant experience + Certification + License to practice

Physician Assistant

  • Definition: A healthcare provider practicing medicine under the supervision of a physician.
  • License: Practice under the license of a physician
  • Scope of Practice: Ordering lab tests, evaluating medical history, diagnosing and treating medical conditions, prescribing medication as permitted by the law, assisting in surgery
  • Education: Based on medical model. PA program + License to Practice
Nurse Practitioners and Physician Assistants are authorized to practice in all 50 states of the USA and Washington D.C. in accordance with state regulations. They have prescriptive rights in all states, which are also regulated and may differ from state to state.

Nurse Practitioners

Nurse practitioners are registered nurses with a master's degree in nursing or an associated field in healthcare.
Along with a graduate degree, an NP is expected to have some amount of clinical experience; while some say that they should have experience over ten years before they apply for an NP program, there are now graduate programs that accept applications even from less experienced registered nurses.
The autonomy for nurse practitioners is not applicable in every state of the United States of America. Some still have to work in collaboration with a physician. Only 17 states in the US permit nurse practitioners to practice nursing independently, i.e. diagnose and treat patients, and prescribe medication without the guidance of a physician.
However, this is mainly applicable to general conditions, while more complex conditions are taken care of by physicians. This has allowed them to set up their own nursing practice, particularly in rural areas where a physician's reach is fairly limited.
Some nurse practitioners may use their training, experience, and education to counsel and educate people about leading a healthy lifestyle and preventing diseases. They may also opt to enter administration as well as research instead of opting for patient care.

Job Description

  • Evaluating and assessing a patient's medical history
  • Performing physical examinations
  • Ordering laboratory tests and exams
  • Diagnosing medical conditions based on patient history and current symptoms
  • Case Management
  • Counseling about general healthcare and prescribing preventive therapies


  • Bachelor's of Science in Nursing (BSN)
  • National Council Licensure Examination for Registered Nurses (NCLEX-RN)
  • Master's of Science in Nursing (MSN)
  • Candidates without nursing experience may opt for direct entry NP Programs with a bachelor's degree from an accredited university. These programs provide fast-track training for students to become RNs while preparing to become NPs and take the NCLEX in the course of the program.
  • Doctor of Nurse Practice [Only DNP programs will be recognized by the accrediting body of the American Association of Colleges of Nursing (AACN) by 2015] with focus on one specialty.
  • Course curriculum includes physiology, pathophysiology, biostatics, pharmacology, and healthcare ethics.
  • Specialty areas include acute care, emergency medicine, family nursing, occupational health, neonatal care, pediatrics, psychiatry, oncology, occupational health, public health, women's health, adult health.
  • NPs complete anywhere between 500-800 hours of clinical training before being allowed to practice full-time.
  • Upon completion, NPs are required to be certified in a chosen specialty by the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners (AANP). These certifying bodies need them to hold a master's degree, post-master's certificate, or doctoral degree in nursing.
  • They may then obtain a license to practice by fulfilling the requirements of the state Board of Nursing.
  • They are required to engage in continuing education based on the state requirements.


The website PayScale reports that a nurse practitioner certified by the ANCC may earn anywhere between US $68,000 and US $110,000.

Physician Assistants

Physician assistants are trained under the medical model and thus have similar abilities to provide therapy and medication to patients. They are given duties by physicians which they are then expected to carry out independently.
Physician assistants may not practice independently. Even if they have set up practice in a rural area, they must telecommunicate with a physician in order to prescribe medication. According to the American Academy of Physician Assistants, physician assistants can provide high-quality care to patients and may be trusted by patients to treat them.
The responsibilities of a PA largely depend on the kind of setting he works in, the state law, and his relationship with the supervising physician. PAs are fairly autonomous in their decision-making, but must be answerable to the physician at all times.
They may also be required to consult the physician in situations where they lack the experience or in those that are out of their scope of practice.

Job Description

  • Understanding and assessing patient history
  • Performing physical exams
  • Ordering laboratory tests and interpreting them
  • Ordering medication and treatment procedures
  • Providing basic treatment, such as giving injections as necessary
  • Recording patient progress
  • Assisting in surgery


The average education time of a PA program is 27 months. It is based on the medical model of theoretical teaching as well as clinical instruction. It does not require an internship or residency. All PAs do not have prior medical training or professional certifications. PAs spend much lesser time in formal education than physicians.
  • PAs are required to enroll in a 2-year Physician Assistant Program after completing a bachelor's degree in any field of healthcare.
  • Some courses may demand a certain amount of work experience before they are eligible for the program.
  • Curriculum includes anatomy, biology, chemistry, pharmacology, and clinical skills.
  • Clinical rotations are a part of the curriculum and include family medicine, psychiatry, general surgery, emergency medicine, internal medicine, thoracic surgery, and obstetrics and gynecology.
  • They are required to complete 2,000 hours of supervised clinical training before graduating.
  • Upon completing the program, a PA is required to obtain a license by Passing the Physician Assistant National Certifying Exam (PANCE), administered by the National Commission on Certification of Physician Assistants (NCCPA).
  • After passing this exam, they may use the title "Physician Assistant - Certified".
  • PAs are expected to maintain national certification by completing 100 hours of clinical education every two years and renewing their certification every 6 years.


The website PayScale reports that a PA-C may earn around US $95,000 on an average. All in all, the role of NPs and PAs is fairly similar. The goal of both professions is to make primary care of a certain standard accessible to patients.