NP vs Physician / Medical Doctor (MD)

America desperately needs more expertly-trained healthcare professionals. As the Baby Boomer generation advances into old age, medical schools cannot graduate enough physicians (MDs) fast enough to meet their complex medical needs. This necessity is part of the reason why the healthcare workforce has increasingly diversified and included a broader set of healthcare professionals, which are known collectively as the allied health professions. 

Nurse practitioners (NPs) are the most advanced and most educated of those allied health professions. Relatively young by medical standards—the profession is just over 50 years old—it’s undergone rapid growth in the last few decades, to the point that today’s NP is unrecognizable from the NP of the 20th century. In several states, NPs are operating independently and performing many (if not all) the same tasks a primary care physician would. In the next 50 years, NPs will make up an increasingly critical portion of America’s healthcare workforce. 

Several differences remain between NPs and MDs, but they’re not as obvious as they used to be, nor are they as numerous. To learn more about the similarities, differences, and overlap between NPs and MDs, read on.

Similarities, Differences, and Overlap Between Nurse Practitioners (NPs) and Physicians (MDs)

The NP role and the MD role are distinct from one another. However, the NP role—which is objectively much younger—has matured rapidly over the last two decades, resulting in more rigorous education, more specialized training, more formal fellowships, and more progressive legislation such that it’s not impossible for an NP to perform many of the same tasks as a physician in some states and in some specialties. 

In some states, NPs are allowed to practice independently, and in rural areas, in particular, they’re often the only primary care provider within reach. A fully-empowered NP can diagnose, treat, and manage common and chronic conditions; they can also prescribe a full suite of medications as needed. 

NPs also can specialize in a wide range of areas that, while not identical to the range of specialties physicians enjoy, is similar. And, as studies have shown, NPs provide high-quality, cost-effective care that is on par with that of physicians. 

However, NPs are not MDs, nor do they aspire to be. Physicians undergo a longer educational journey, and their specialty training is even more rigorous than that of an NP. Physicians can practice the same way in all 50 states, while legislation for NPs is still slowly moving through the nation, state-by-state, to authorize a single scope of practice. NPs value their nursing backgrounds, employing a patient-centered approach that is only possible with the longer appointment times enjoyed by NPs; MDs are the experts of their field, bar none, and as such, their time is in high demand. 

While NPs and MDs may perform many of the same roles in some geographies and specialties, they will perform drastically different roles in others. But the NP role is continuing to evolve rapidly, and the differences aren’t as drastic as they were 20 years ago. To get a more detailed comparison of NPs and physicians, read on.

Side-by-Side Comparison: Nurse Practitioner (NP) and Physician/Medical Doctor (MD)

Nurse Practitioner (NP)Medical Doctor (MD)
Number Practicing in the USAccording to 2022 data from the American Association of Nurse Practitioners (AANP), there are over 355,000 NPs currently licensed in the US.According to 2019 data from the Association of American Medical Colleges (AAMC), there are 620,520 active MDs in the US.
Average Pay

According to the Bureau of Labor Statistics (BLS May 2021), the median pay for NPs is $120,680 per year.

An NP’s wages will vary based on their location, experience, and specialty.

Percentile wage estimates break down as follows:

  • 10th percentile: $79,470 per year
  • 25th percentile: $99,540 per year
  • 75th percentile: $129,680 per year
  • 90th percentile: $163,350 per year

According to the BLS, the median pay for MDs is equal or greater to $208,000 per year.

A physician’s wages will vary based on their location, experience, and specialty.

As of May 2021, the mean annual wages for physicians by specialty, were:

  • Anesthesiologists: $331,190
  • Obstetricians and gynecologists: $296,210
  • Surgeons: $294,520
  • General practitioners: $235,930
  • Pediatricians: $198,420
Job Outlook

NPs are expected to be the fastest growing professional group in the nation over the next ten years.

The BLS (2022) projects overall employment for NPs to grow 46 percent between 2021 and 2031, a rate over nine times the national average for all professions, resulting in an additional 112,700 jobs.

Physicians are expected to be one of the slowest growing professional groups in the nation over the next ten years.

The BLS projects overall employment for MDs and surgeons to grow only 3 percent by 2031, a rate roughly half the national average for all professions, resulting in 21,400 added jobs.

Educational Requirements

NPs will need to be licensed as a registered nurse (RN).

Most NPs will first earn a bachelor of science in nursing (BSN) before earning a graduate degree.

While master of science in nursing (MSN) programs such as the family nurse practitioner (FNP) and pediatric nurse practitioner (PNP) programs are still the most common form of graduate degree for NPs, the doctor of nursing practice (DNP) is quickly becoming the industry standard. Both AANP and the American Association of Colleges of Nursing (AACN) support a move to the DNP as the baseline requirement for NPs.

Physicians will need a bachelor’s degree in an area like biology, chemistry, math, or physics.

They’ll also need to earn their medical doctor (MD) degree from a medical school.

Depending on their specialty, physicians will need another three to nine years in internships and residency programs.

Fellowships for further subspecialization can take an additional one to three years.

Degree Program DetailsThe DNP is a practice-focused degree. These programs are broken up into didactic coursework and clinical rotations. The didactic portion typically focuses on advanced pharmacology, physiology, pathophysiology, and patient assessment. Clinical rotations will provide hands-on experiences across a wide range of specialties. Medical schools awarding MDs are extremely competitive. These programs are broken up into didactic coursework and clinical rotations. The didactic portion covers the full spectrum of medicine: from anatomy and physiology, to brain and behavior, to microbiology and biostatistics. In the third and fourth years, clinical rotations will provide hands-on experiences in different specialties.
AccreditationThe two major accrediting bodies for DNP programs are the Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN).The Liaison Committee on Medical Education (LCME) is the main accrediting body for medical schools, sponsored by AAMC and the American Medical Association (AMA).
Example In-Person Programs

The following three schools offer in-person DNP programs:

The following three schools offer in-person MD programs:

Example Online Programs

The following three schools offer online DNP programs:

While there are no online MD programs, the following three schools offer online options at the undergraduate, graduate, and certificate level that help one prepare for medical school:

Certification and Licensure

All practicing NPs will need to pass a national certification exam and hold an NP license. Specific details will vary by state, and be determined by a state’s board of nursing. Most states require national certification.

NPs can be nationally certified through either the AANP Certification Board, the American Nurses Credentialing Center (ANCC), or the Pediatric Nursing Certification Board (PNCB).

Additional specialty certifications are also available through professional associations associated with those specialties.

All practicing MDs will need to be licensed by the state where they practice, and specific requirements vary from state to state. In each state, those requirements include passing the US Medical Licensing Examination (USMLE).

Board certification in a specialty is not required, but it may lead to increased employment opportunities. Board certification generally requires completing residency training and passing a specialty certification exam. Certifying boards include entities such as the American Board of Medical Specialties (ABMS) and the American Board of Physician Specialties (ABPS).

Common Practice Settings

NPs can work in a wide variety of clinical and non-clinical settings; their precise work environment will depend upon their specialty and their geography.

Most NPs typically work in physician offices, though in states with full practice authority they may operate their own clinic independently. The second most common practice setting for NPs is hospitals, followed by outpatient care centers.

MDs can work in a wide variety of clinical and non-clinical settings; their precise work environment will depend upon their specialty.

Clinical settings for MDs can include private clinics, group practices, hospitals, and other healthcare organizations. Some MDs, depending on their specialty and location, may choose to own their own practices, while others will work as part of a larger health system.

SpecialtiesThe AANP currently lists 24 specialty practice groups (SPGs) for NPs.The AAMC lists 47 specialties for MDs.
Regulatory Status / Scope of Practice

NP scope of practice varies from state to state. According to the AANP, 27 states have full practice authority, which means NPs are able to practice to the full scope of their training and education.

The remaining 23 states either restrict or reduce one or more elements of an NP’s practice, often requiring physician supervision or limiting prescriptive authority.

Physicians are able to prescribe medications in all 50 states; their scope of practice does not vary.
Key Skills

As primary care providers and specialty care providers, NPs need to have expert medical knowledge.

As nurses, NPs utilize a holistic, patient-centered approach. A good NP harnesses detail-orientation, empathetic communication, and interprofessional collaboration to best serve patients.

As primary care providers and specialty care providers, MDs need to have expert medical knowledge.

As physicians, MDs utilize a scientific, analytical approach. A good MD harnesses detail-orientation, leadership ability, problem-solving skills, and critical thinking to best serve patients.

Matt Zbrog

Matt Zbrog

Writer

Matt Zbrog is a writer and researcher from Southern California, and he believes a strong society demands a stronger healthcare system. Since early 2018, he’s written extensively about emerging topics in healthcare administration, healthcare research, and healthcare education. Drawing upon interviews with hospital CEOs, nurse practitioners, nursing professors, and advocacy groups, his writing and research are focused on learning from those who know the subject best.