As many patients know, people rarely see a medical doctor for routine physical examinations anymore. They are far more likely to have an appointment with a Nurse Practitioner (NP) or Physician Assistant (PA) who works in the practice. Many people are unaware of what each title actually means. I’m embarrassed to admit that I didn’t know the difference for a very long time. What is the difference between a Nurse Practitioner and a Physician Assistant?
Nurse Practitioners
A Nurse Practitioner is a registered nurse (RN) who also has a Master’s degree and clinical experience. The NP may work independently or as a member of a health care team. He or she helps to educate patients, with a focus on health maintenance, counseling, and disease prevention. A nurse practitioner must choose a particular specialty during his or her training. This training allows him or her to empower patients and ensure better patient outcomes, and may involve the patient’s family in their treatment plan. A Nurse Practitioner has a collaborative relationship with physicians.
Nurse Practitioners have a median 36-hour work week, with a median salary of $73,000 annually. They may work in a variety of settings and specialties, including family medicine, neonatal, pediatrics, geriatrics, obstetrics and gynecology, acute care, occupational health, or as Certified Nurse Midwives and Certified Registered Nurse Anesthetists.
Physician Assistants
A Physician Assistant is a licensed health professional who has passed the national certificated exam that is administered by the National Commission on Certification of Physician Assistants. He or she does not choose a specialty, but must complete a clinical rotation through various specialties without regard to post-graduation career path. The PA works under the supervision of a physician to provide preventative, diagnostic, and therapeutic health care services. He or she helps take medical histories, examine patients, treat patients, order and interpret lab tests, order and interpret x-rays, make diagnoses, and provide treatment for minor injuries. In most states, a PA also has prescribing privileges. A Physician Assistant may also participate in managerial or supervisory duties.
Physician Assistants have a median 32-hour work week, with a median salary of $69,000. They may work in a variety of settings and specialties, including family medicine, pediatrics, obstetrics and gynecology, internal medicine, emergency medicine, orthopedics, general surgery, thoracic surgery, and geriatrics. Those who specialize in surgery are involved in preoperative and postoperative care; they may also work as assistants during major surgery.
Nurse Practitioner or Physician Assistant?
Both Nurse Practitioners and Physician Assistants can play important roles in health care practices. Patients are in good hands, whether they are treated by a PA or NP. Prospective students should consider becoming a Nurse Practitioner if they favor the nursing model or a Physician Assistant if they favor the medical model.
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You failed to point out that NPs are also licensed health care professionals that sit for National Boards as well depending on their speciality: Adult, Family, or Pediatrics.
In addition, NPs do focus on health promotion and disease prevention, but they are also vital to diagnosing, interpreting lab results, and some read x-rays as well depending on the practice. There is a lot of the “medical” side that NPs perform, but yes, they embrace the nursing model which is what makes nurses nurses.
also it was not brought up that Np’s have prescriptive authority as well and depending on the state, such as in Pennsylvania, we can prescribe schedule II-V narcotics with the appropriate DEA #.
Future NP and tmmcrnp,
Thanks to both of you for your insight and feedback.
PAs have a supervisory agreement with their supervisory physician. PAs have 100% of their patient charts reviewed within 24 hours. While NPs have a collaborative agreement with their physician practice which determines the percentage of their charts that must be reviewed. It is my understanding the percentages differ from practice to practice.
I have worked directly with a NP in an occupational medicine practice. Both of us performed the exact same tasks, ordering/interpreting labs, X-Rays, etc…
This pertains to M. Carson:
As of July 1, 2009, Florida legislation passed a law no longer requiring cosignatures on all charts in an outpatient setting for physician assistants.
Just for clarification.
I am trying to decide which school I should go to. P.A. or N.P. I have been a tech in the hospital for 8 years now. I love patient care I do believe I don’t want to be a bedside nurse. I am very interested in the sciences and how everything in the body syncronizes. I am also interested in knowing if there are travel assignment possibilities for either. Can anyone lend some advice please?
Thank you very much!
What exactly are the limitations for a NP vs a PA. NP can practice independant from a physician whereas a PA cannot. But what exactly are the advantages and disadvantages of each. I have my BSN and trying to decide which route to take?
Deciding factors as to whether one should pursue a degree as a Nurse Practitioner or a Physician Assistant is primarily dependent upon the State in which you will be working. In many cases, the pay is relatively equal, as are the duties and level of responsibility. Another question would be what the MDs in any given area prefer. For many, the preference is the NP because of the independence factor, while other Physicians have exactly the opposite opinion – they would rather employ a professional that extends their clinical reach, but within defined paramaters.
Actually, Physician Assistants can choose specialties.
The concept on the “independent” NP is fairly misunderstood. NP’s are “independent” in that their nursing license is issued by the sate nursing board…however the “collaborative practice” arrangement that permits these RN’s to perform medical acts as NPs is a defacto supervisory arrangement with a physician or physician practice. Only in rare circumstances would one find an NP practicing medicine (often referred to as advanced practice nursing) without some definite connection to a physician’s license. Similarly, PA’s funstion under a supervisory or practice agreement. It is common for PA’s to practice under the “general” supervision of a physician…that is without the physician present…also there are many instances where PA’s are not required to have co-signatures for charts, and in my own state the only requirement is that the PA must meet with the supervising physician once every 6 months. NPs in my state are required to have “written protocols” whereas PA’s are not.
PAs do specialize and in fact, about 50% do. They also have the flexibility to cross over into various specialties because their medical education is broader than that of the NP. According to salary surveys I have read for both disciplines, PAs earn a higher median salary than NPs (from their own organizations). Also, PA’s have prescriptive ability in all, rather than “most” states. The real point to the layperson should simply be that both providers are well-educated, properly licensed, and in the same clinical setting perform essentially the same job with an equal degree of capability.
I am not demeaning the article, which did present good information, but it does seem a bit slanted towards an NP view of NPs vs. PAs and not a true comparison of the two different disciplines.
I’m curious about the pay rate / work hours info.
The information (and sequence and phrasing) appear very similar to that from a Berkeley article of a couple of years ago.
Assuming (without judging) that this was the primary source, I’m wondering if PAs in fact tend to work less hours than NPs. The exact phrasing in the Berkeley article is:
“Median Salary of Sample of 23,850 NPs Nationwide (2004):
$73,620 annually, working 36+ hours a week”
and
“Median [PA] National Salary (2006):
$69,517 annually, working 32 hours a week”
So is the median work week info cross-verified, or is this just general rate/hour info without claim of actual median weekly work hours?
Yes, NP’s are highly educated medical practitioners who can diagnose, treat, read labs and initiate treatment. NP’s also at the same time do disease prevention and management. The education of an NP starts from being an RN to BSN and then to master’s level. And it’s true, NP’s collaborate but for special situations that we acnnot handle. NP’s can run their own clinic and offers high qaulity care to sick patients. NP’s can write prescritions without a physician, they have their own DEA number and furnishing number. PA’s cannot practice without a doctor. If I were to choose. NP had extensive training both in nuring and medicine.
I just wanted to clarify a few points from Scott Best’s comment. The majority of states do require a collaborative agreement with a physician, but this is usually a few charts reviewed quarterly. There are many states where NPs can practice independently without any physician involvement (although there are states–usually in the South–where NPs are supervised just like PAs). Often times in rural areas NPs are the only health care providers around, and they frequently have their own clinics. I don’t know what the “written protocols” he is talking about. NPs use evidence based medicine just like physicians to make medical decisions (including diagnosis, prescriptions, and any other diagnostic tests). NPs all have nursing background, and therefore usually have years of nursing experience (I worked 8 years in an ICU) as well as a better understanding of the patient experience. As only 2% of graduating MDs are going into primary care, NPs are estimated to be the majority of primary care providers in the near future.
Hope this will give you some additional information on your decision.
I am a senior in college majoring in Nutritional Science and trying to decide whether to go onto become a PA or NP. I can’t decide and am going nuts! I am a people person, a leader, and agree more with the nursing model as I enjoy work more directly with the actually person as a whole, however, PA seems quite appealing too! HELP!
Hi Alisa –
You don’t mention what state you are in, so I will address your question in general. (Different states have different criteria.) The main difference is the level of autonomy (and your relationship with the physician with whom you choose to collaborate). NPs are, in general, more autonomous than PAs. PAs work more directly, on a daily basis, with the physician. The actual day to day care is usually the same, with the exception of prescribing privileges…which is different for every state. They both diagnose and treat medical conditions. Just coming out of college, the quickest way to go would be Physician Assistant, since you don’t have (or at least didn’t mention) any previous Nursing experience and there are two-year (approx) programs out there that are quite good. Make sure to choose one that is accredited. The AAPA website (www.aapa.org) can direct you to one in your area. Be aware, too, that many programs will require some previous healthcare experience (i.e. EMT, Medical Assistant, etc.). Good luck with your decision! You sound like a wonderful candidate… no matter which path you choose!
-Sherry Crews
Sherry-
I go to school in Minnesota , but am from Wisconsin and am willing to practice anywhere afterwards. I have always had a passion to work with kids, am very hands on, and thoroughly enjoy the nursing model, however, I am starting to be pushed towards becoming a PA rather than an NP. I plan to get my CNA soon as well as other healthcare experience, but as of now I am at a stand still. I appreciate any advice!
Thank you!
Alisa
Alisa
If you are currently in school for your CNA training and wish to work as a CNA for awhile (to get the coveted healthcare experience), then you do have a bit of time to continue your research. It is possible to go through a PA program within two years or so. Going in that direction would allow you to work sooner than attacking a lengthy nursing program. So, if that’s important to you, the PA route would be the best bet. If you have plenty of time (and earning money is not an immediate issue), I suggest the nursing path. However, there is no rule that says you can’t do both!
As noted above, I think it is important to point out that NP’s have all of the same medical privileges as you pointed out for the PA. We diagnose, treat, and have prescriptive authority. In fact, in NYS a nurse practitioner is an independent provider, where a PA must work under the direct supervision of a physician. Somehow the term “nurse” in the title of the practitioner seems to allow for the belief that we do not perform these services, when in fact, we not only perform them, but are able to legally and professional perform them without a supervising doctor. We do require a collaborative agreement with a physician, and rightfully so. Isn’t collaboration what medicine is all about anyway? So please be sure gentle reader that a you understand: a NP likely has had multiple years of clinical experience prior to entering into an accreditation program, providing him/her with an outstanding knowledge base clinically. We are INDEPENDENT providers. This needs to be pointed out as a distinct difference between an NP and a PA.
Every PA I know has an excellent ability to diagnose and treat. I am blessed to work with several that are outstanding, so there should be no concern that the care provided by a PA is less than that of a NP; they simply are required to have supervision and more oversight in their daily delivery of care.
Take this with a grain of salt, because I am neither a PA nor an NP yet, but I have seen both in action as a paramedic and nurse, and offer the following comments. Civilian PAs and NPs are quite similar in many states, in their scope of practice, duties, privileges and responsbilities. Individuals interested in military medicine/healthcare (as I am) should be aware that PAs and NPs are currently assigned quite different missions within the armed forces, owing to the historical nature of nursing and PA. The first PAs came from returning Vietnam-veteran corpsman and medics, whose considerable experience found no exact civilian counterpart. These were trained under the hurry-up medicial training model used in WWII, and PAs were the result. To this day, many medics and corpsmen become PAs. Nurse-practitioners come mostly from nursing, which is historically a female-dominated profession. Fair or not, the army, navy, etc. use PAs very differently than NPs. The former in more-stereotypically male roles nearer to the front, NPs in missions the nurse corps has always received. The services are beginning to change in how they use PAs and NPs, but the old ways do persist. For anyone interested in military medicine, as I am, weigh this factor in your decision-making.
No one is mentioning CRNA much in discussing APNs. Nurse-anesthetists do many of the same cases as anesthesia MDs, and at considerably less cost. CRNAs can practice independently in many states, and are very widely used in the military, where many are men. CRNAs are very well-compensated, making well into the six figures, some as high as 170K/year. It is a pre-requisite to have done 2+ years in ICU/ER nursing, before admission to a masters program. Training takes two years. My brother is an MD in anesthesia, and recommended CRNA to me. My interests lie elsewhere, but someone reading this may want to explore this crucial specialty.
My investigations show that PAs get a generalist education, and specialize later; APNs are forced to choose a specialty earlier in their training, while still in school. Both approaches have their merits; choose according to your learning style and tastes. Similarly, a semantic point is that PAs are “medical” practioners, while NPs are “nursing” practitioners. Strep throat is strep throat, a fractured femur a fractured femur, no matter what your license says on it, but be aware that these terms and distinctions will follow you around in your professional life.
I’ve seen more PAs assisting in surgery than NPs, but the latter are becoming more common. Some hospitals and docs use PAs only, others NPs only. Both are heavily-used in under-served areas, such as inner-cities and rural areas.
Anyone know of a source for comparing PA and NP side-by-side, in terms of duties, scope of practice, income, hours, state regs, etc.? I’m still making up my mind. Also, is there a clear advantage in terms of cost and length of training for one or the other, or financial aid avalable?
I’m probably leaning toward the PA route, but not yet decided for certain; there are pros-and-cons to both.