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Nurse Practitioners versus Physician Associates

Similarities, Differences and More

Author:Ali Syed, PharmD

Editors:Alyssa Haag,Emily Miao, PharmD,Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Stacy M. Johnson, LMSW


What is a nurse practitioner (NP)?

A nurse practitioner (NP) is a licensed, advanced practice registered nurse that provides primary and specialized health care across specific populations, including children, adults, and the elderly. NPs may practice in rural, urban, and suburban communities in many settings, including clinics, hospitals, nursing homes, schools, and public health departments. NPs can provide patient care in various specialty areas, including primary care, cardiology, and oncology. NPs most commonly practice independently, where the supervision of a physician is not required.

To be a certified NP in the United States, a graduate from an accredited NP program must pass the National NP Certification Board Exam through a nursing organization specific to their specialization, such as the Pediatric Nursing Certification Board for those specialized in pediatric care. After passing, an individual would apply for NP licensure, for which the laws and requirements vary by state. To qualify for certification renewal and to maintain clinical competency, NPs undertake self-directed continued education and a specified number of clinical hours every five years. 

Male NP and female PA.

What is a physician associate (PA)?

A physician assistant (PA), also known as a physician associate (PA) as per the American Academy of Physician Assistants, is a licensed health care professional who practices medicine under a licensed physician's direction and supervision. PAs may practice different specialties, such as family medicine and surgery, across various settings, including clinics and hospitals.

To be a certified PA in the United States, a graduate from an accredited PA program must pass the National Commission on Certification of Physician Assistants administered Physician Assistant National Certifying Exam (PANCE). After passing, an individual would apply for PA licensure, for which the laws and requirements vary by state. To qualify for certification renewal and maintain clinical competency, PAs undertake self-directed continued education, a specific number of clinical hours, and complete the Physician Assistant National Recertifying Exam (PANRE) every six to ten years.

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What is the difference in education between nurse practitioners and physician associates?

Nurse practitioners and physician associates both require a graduate-level degree, clinical training, and specific certifications; however, there are important differences in the type of education NPs and PAs receive.  

NPs typically begin their education by completing a four-year Bachelor of Science in Nursing degree, then obtaining a registered nurse license by passing the National Council Licensure Examination (NCLEX-RN) licensing exam. NPs will then typically complete a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) program, which may vary from two to four years in length. NP programs follow a patient-focused nursing model of education, consisting of didactic courses and a minimum of 500 clinical rotation hours under the supervision of a preceptor. Once NP educational requirements have been satisfied, graduates may obtain their certified NP license and recertify as appropriate. 

PAs typically begin their education by obtaining a bachelor’s degree, followed by a two-to-three-year master’s degree from an accredited physician assistant program, commonly known as a Master of Science in Physician Assistant Studies. PA programs follow a disease-centered, medical model of education, consisting of didactic courses and a minimum of 2000 hours of supervised clinical practice across various medical and surgical settings. Once PA educational requirements have been satisfied, graduates may proceed to obtain their PANCE license and recertify as appropriate.

PA programs primarily focus on all foundational aspects of general medicine and are modeled after medical school curricula. In contrast, NP programs focus on a specific clinical population, such as pediatrics or obstetrics, and the advanced nursing practice.

What are the roles of nurse practitioners and physician associates?

Nurse practitioner and physician associate roles both intensely focus on providing direct patient care alongside physicians, with many similarities and a few key differences.

Nurse practitioners generally specialize and obtain licensure in providing care to a specific population, such as individuals of a particular age group or that fall under a clinical specialty, such as psychiatry. NP scope of practice commonly involves obtaining medical histories, performing physical examinations, diagnosing acute and chronic conditions, ordering laboratory tests and imaging, prescribing medications, performing procedures, monitoring results, and conducting research. In 26 American states, NPs have full practice authority and are not required to work under the supervision of a physician. If an NP switches specialties, additional training and licensure for the new specialty are required.

Physician associates generally train and obtain licensure to provide direct patient care in general medicine, such as emergency medicine or surgical specialties. PA scope of practice is analogous to that of an NP; however, PAs are required to work under the supervision of a physician or surgeon. Physician associates generally train and obtain licensure to provide direct patient care in general medicine, such as emergency medicine or surgical specialties. Physician associates generally train and obtain licensure to provide direct patient care in general medicine, such as emergency medicine or surgical specialties. If a PA switches specialties, additional training and licensure for the new specialty are not required.

What is the difference in salary between nurse practitioners and physician associates?

NPs and PAs earn competitive salaries and benefits, which vary based on certain factors such as geography, certification, specialty, years of experience, practice setting, and education level.

According to the United States Bureau of Labor Statistics, NPs earned an annual median salary of $123,780, whereas PAs earned an annual median salary of $121,530.

What are the most important facts to know about the differences between nurse practitioners and physician associates?

A nurse practitioner (NP) is a licensed, advanced practice registered nurse that provides health care across specific populations in many different settings. NPs typically complete a four-year-long Bachelor of Science in Nursing degree, followed by passing the National NP Certification Board Exam through a nursing organization specific to their specialization. NP scope of practice generally includes but is not limited to taking medical histories, diagnosing conditions, ordering investigations, prescribing medications, performing procedures, monitoring results, and conducting research. On the other hand, a physician assistant (PA), or as they are now known, physician associate, is a licensed health care professional that practices medicine under the direction and supervision of a licensed physician across various settings. PAs typically begin their education by obtaining a bachelor’s degree, followed by a two-to-three-year master’s degree from an accredited physician assistant program, commonly known as a Master of Science in Physician Assistant Studies. PA scope of practice is relatively analogous to that of an NP; however, PAs are required to work under the supervision of a physician or surgeon. 

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Related links

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Resources for research and reference

American Association of Nurse Practitioners. (n.d.). What's a Nurse Practitioner (NP)? Retrieved August 2nd, 2022, from https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner

American Association of Physician Assistants. (n.d.). What is a PA?. Retrieved August 2nd, 2022, fromhttps://www.aapa.org/what-is-a-pa/?__cf_chl_tk=BU9qujZMvmXn.9kjUDlVymbVjyjoDEb62nbJfoTLU6A-1662148356-0-gaNycGzNCmU

Massachusetts College of Pharmacy and Health Sciences. (n.d.). PA vs. NP: What's the Difference? Retrieved August 2nd, 2022, from https://www.mcphs.edu/about-mcphs/news/difference-between-physician-assistant-and-nurse-practitioner

Oppenheimer, T. (2022). How to Become a Nurse Practitioner (NP). In nurse.org. Retrieved August 2nd, 2022, fromhttps://nurse.org/resources/nurse-practitioner/

Regis College. (n.d.). What’s the Difference Between a Nurse Practitioner and Physician Assistant? Retrieved August 2nd, 2022, from https://www.regiscollege.edu/blog/nursing/nurse-practitioner-vs-physician-assistant

Tufts University School of Medicine. (2022). What Is a Physician Assistant? Retrieved August 2nd, 2022, fromhttps://medicine.tufts.edu/academics/physician-assistant/pa-program-overview/what-physician-assistant

University of St. Augustine for Health Sciences. (2021). Nurse Practitioner vs. Physician Assistant: Key Differences. Retrieved August 2nd, 2022, from     https://www.usa.edu/blog/np-vs-pa/

U.S. Bureau of Labor Statistics (n.d.). Physician Assistants. In U.S. Department of Labor, Occupational Outlook Handbook. Retrieved August 2nd, 2022, from https://www.bls.gov/ooh/healthcare/physician-assistants.htm 

U.S. Bureau of Labor Statistics (n.d.). Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners. In U.S. Department of Labor, Occupational Outlook Handbook. Retrieved August 2nd, 2022, from https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm

U.S. National Library of Medicine. (2020). Nurse practitioner (NP). In MedlinePlus. Retrieved August 2nd, 2022, from https://medlineplus.gov/ency/article/001934.htm