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What is the difference between a Nurse Practitioner and a Physician Assistant?

Professionals who seek challenging and well-paying healthcare careers may find themselves torn between two comparable disciplines: nurse practitioner and physician assistant. Both nurse practitioners and physician assistants are mid-level practitioners. They are not doctors, but they take on some roles traditionally taken on by doctors, including making diagnoses and prescribing medication. They are valuable partly because of their role within an increasingly expensive medical system; their services are more cost-effective than those of physicians.

NPs and PAs sometimes compete for the same positions. Some specialized positions, though, go to one or the other. Even when they perform similar functions, nurse practitioners and physician assistants draw from different traditions; they are educated in separate schools or departments. Students may make their program choices based on their healthcare philosophy, their interest in particular specialized roles, and their previous healthcare experience.

The PA tradition draws more from a medical model. The NP model of course draws from the nursing tradition, one that has traditionally included a whole person and wellness approach. A students’ choice of disciplines will depend partly on his or her philosophies, but it is important to realize that there is also a school-specific component. There is a lot that an individual school can choose to offer. A course in homelessness, open to physician assistant students? In Washington State, it’s been done.

Another factor to take into account? Where one lives! It is more likely that a nurse practitioner will be allowed a greater level of autonomy in his other practice. The scope of practice, though, varies by state. Prospective students may want to consider practice perimeters in their own state before making a decision.

Differences in Role and Scope

People who are interested in certain specialized practice areas are more likely to find their niche as physician assistants. More than 25% of physician assistants have a surgical specialty. There are many duties from the pre-operative to post-operative stage. Actually carrying out surgery would be rare, though American Association of Surgical Physician Assistants lists some very minor outpatient procedures as possibly within the realm of the physician assistant.

Practitioners interested in fields such as maternal or neonatal care may be interested in becoming advanced practitioner registered nurses. Nurse midwives are not typically classified as nurse practitioners but practice at a similar level; some APRNs seek dual credentialing in nurse midwifery and women’s health nurse practitioner roles. (A critical role like neonatal nurse practitioner, though, would require previous related experience.)

It is actually the physician assistant not the advanced practice registered nurse who has the more generalist advanced education. Nurse practitioners are educated to serve specific populations, though the population can be as broad as family primary care. Nurse practitioner certification examinations reflect a particular population. Physician assistants get a somewhat broader education in their graduate programs. They take a generalist examination for licensing purpose.

Differences in Breadth and Depth of Clinical Training

A person training as a physician assistant can expect 2,000 hours of clinical training as part of his or her educational program. Rotations will take place in a number of very varied units – clinical training turns out well-rounded practitioners.

A person on the path to becoming a nurse practitioner can expect to do university-supervised clinical work at different stages: when training for initial RN licensing and when pursuing advanced licensing. In many cases, a licensed RN who is training for advanced practice will complete only 600 hours of additional clinical experiences. Clinical experiences will need to be sufficiently varied to prepare the person for his or her chose population focus, whether it is as broad as family practice (the most common) or as narrow as neonatal.

A nurse practitioner who seeks to change specialties can expect additional formal training requirements and an additional certification exam. This is not the case with physician assistants. The PA discipline has traditionally been thought of as one where a person can change specialties relatively easy. However, in a world of increasing healthcare knowledge and complexity, doctors often do want PAs who have already proven themselves within a particular specialty.

NP education, on the other hand, often takes place at the doctoral level. It’s not yet universal.

First Steps: Program Acceptance

Would-be physician assistants and nurse practitioners complete many of the same prerequisites (Nurse Practitioner prerequisites). Both need a sound foundation in natural sciences. Some schools have identical prerequisites for the two tracks. There can, however, be significant differences. PA programs may be more science-heavy. Some are very specific about the expected chemistry coursework; expectations are not identical from program to program. PA programs sometimes place less emphasis on other related coursework. Some require coursework in nutrition, but this is not the norm. A PA program may or may not have a psychology requirement.

A majority of physician assistant programs require previous healthcare experience. Physician assistant students typically enter school with three or four years of experience, though the formal requirement will likely be lower. Experience can take different forms: EMT or CNA as well as nursing.

Nurse practitioner offers a relatively straightforward career path for professional nurses. Many programs want experience and licensure while some will admit bachelor's level non-RNs and allow them to earn their professional nursing credential en route to advanced coursework. NPs have, on average, more healthcare experience at the time they begin practice than PAs do – but this isn’t a mandate.

Further Reading:

Professional Issues

Both disciplines have professional organizations that are working for policy that allows practitioners to practice to the full extent of their training. In the case of nurse practitioners, this typically means independent practice. The American Association of Physician Assistants (AAPA ), on the other hand, is working toward optimal team practice.

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