Nurse Practitioner (NP) vs Physician Assistant or Associate (PA)

Pursuing a clinical healthcare career isn’t limited to becoming a physician. With a two-year master’s degree, one can become a nurse practitioner (NP) or a physician associate/assistant (PA) and provide primary or specialized care in clinical settings. 

Nurse practitioners, a type of advanced practice registered nurses (APRNs), have state-dependent levels of practice autonomy and can prescribe medications. Physician assistants, also known as physician associates or PAs, work alongside physicians and independent clinicians. 

Healthcare careers are one of the fastest-growing occupations in the United States. The U.S. Bureau of Labor Statistics (BLS) shows healthcare openings will grow by 16 percent between 2020 and 2030. This is twice as fast as the national average (8 percent) and will create 2.6 million new jobs. This includes nurse practitioners and physician assistants/associates, which are projected to grow by 52 percent and 31 percent in the same decade. 

Nurse practitioners (NPs) are registered nurses (RNs) with a master of science in nursing (MSN), a post-master’s NP certificate, or a doctorate of nursing practice (DNP). Most NP programs include 500 to 1,000 clinical hours as part of the curriculum. NPs see patients in clinical primary or specialized care settings, lead nursing teams, and may work in clinical research. They can seek specialty certification as a family nurse practitioner, adult-gerontology primary care, and emergency nurse practitioner from organizations such as the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners Certification Board (AANPCB).

Depending on the state where they practice, NPs have full, limited, or restricted practice authority. Full authority means practicing independently of a physician, while limited and restricted practice authority means practicing under the supervision of a physician, among other constraints. NPs can diagnose, treat, and prescribe medications to patients.  

Physician assistants (PA) are clinical healthcare professionals with a master’s degree from a physician assistant program. Applicants may have a pre-med or a non-medical bachelor’s degree. Still, most PA program admissions are highly competitive, so applicants are encouraged to demonstrate high grades in prerequisite coursework in chemistry, biology, human anatomy and physiology, and microbiology at the undergraduate level. 

It’s not unusual for PA applicants to have experience as registered nurses (RNs) or emergency medical technicians (EMTs). PAs complete more than 2,000 hours of clinical rotations in primary care, ambulatory clinics, and specialized care facilities during their graduate studies. 

Upon graduating from an accredited PA program, candidates are eligible to take the Physician Assistant National Certifying Exam (PANCE) offered by the National Commission on Certification of Physician Assistants (NCCPA). The PANCE exam is required for PAs in all states to work legally. 

State licensure laws also dictate that PAs must hold a collaborative agreement with a supervising physician. Like NPs, PAs are authorized to diagnose, treat, and prescribe medications to patients. 

While these healthcare professions are uniquely different, their scopes of practice are similar, as are their origin stories. Since the 1960s, NPs and PAs have filled in the gaps left by the national physician shortage and expanded patient access to healthcare in metropolitan and rural settings. 

Read on to learn more about the differences between nurse practitioners (NPs) and physician assistants (PA) (associates).

Nurse Practitioner vs Physician Assistant (Associate): Side-by-Side Comparison

Unless otherwise indicated, all occupational data for nurse practitioners and physician assistants/associates is sourced from the BLS.

Nurse Practitioners (NP)Physician Assistants (PA) (Associate)
DefinitionAdvanced practice registered nurses (APRNs) who provide primary and specialty patient care, with and without physician supervision. Licensed and nationally certified medical professionals who work alongside physicians to provide primary and specialty healthcare. 
Occupational Demand52 percent (much faster than average) from 2020-2030 (BLS 2021) 31 percent (much faster than average) from 2020-2030 (BLS 2021)
Number Employed234,690 (BLS May 2021)132,940 (BLS May 2021)
Education

Master of Science in Nursing (MSN)

Post-Master’s NP Certificates

Doctor of Nursing Practice (DNP)

Master of Science in Physician Assistant Studies 
Sample Degree Programs

Baylor University– Online BSN to DNP programs

Regis College – Online BSN to DNP, MSN, and Post-Master’s NP Certificate programs

University of Wisconsin-Madison – On-Campus Physician Assistant Program

Yale University – Online Physician Assistant program

Work Environments
  • Physicians offices 47 percent
  • Hospitals: 26 percent
  • Outpatient care centers: 8 percent
  • Educational services: 4 percent
  • Offices of health practitioners: 3 percent
  • Offices of physicians: 53 percent
  • Hospitals: 26 percent
  • Outpatient care centers: 8 percent
  • Educational services: 5 percent
  • Government: 2 percent
Typical Responsibilities Care for patients, with or without physician supervision (depending on the state-level scope of practice laws); provide primary or specialized healthcare; order tests; prescribe medication; lead teams of nurses; teach nursing education; and conduct research.  Provide patient care on teams of physicians and surgeons; order diagnostic tests and interpret results; counsel patients on recovery and preventative care; conduct patient care research, and teach public health seminars to the public. 
Major Specializations
  • Adult-Gerontology NPs, Primary or Acute Care
  • Pediatric NPs, Primary or Acute Care
  • Family NPs
  • Neonatal NPs
  • Women’s Health and Gender-Related NPs
  • Psychiatric-Mental Health NPs
  • Anesthesia
  • Cardiology
  • Dermatology
  • Emergency medicine
  • Nephrology
  • Neurology
  • OB/GYN
  • Oncology
  • Pediatrics
  • Radiology
Licensure

NCLEX-RN Exam (required)

National certification exam(s)

State-specific requirements

Physician Assistant National Certifying Exam (PANCE)

State-specific requirements

Certification Examples

American Nurses Credentialing Center (ANCC)

  • Adult-Gerontology Acute Care Nurse Practitioner (AGACNP)
  • Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP)
  • Family Nurse Practitioner (FNP)
  • Psychiatric-Mental Health Nurse Practitioner (PMHNP)

American Academy of Nurse Practitioners Certification Board (AANP)

  • Family Nurse Practitioner (FNP)
  • Adult-Gerontology Primary Care (A-GNP)
  • Emergency Nurse Practitioner (ENP)

National Commission on Certification of Physician Assistants (NCCPA)

Certificates of Added Qualification (CAQ):

  • Cardiovascular and Thoracic Surgery (CVTS)
  • Dermatology
  • Emergency Medicine
  • Hospital Medicine
  • Nephrology
  • Orthopaedic Surgery
  • Pediatrics
  • Palliative Medicine and Hospice Care
  • Psychiatry
Average Annual Salary$118,040 (BLS May 2021)$119,460 (BLS May 2021)
Scope of Practice 

From the American Association of Nurse Practitioners (AANP):

Full practice authority: Without physician supervision, NPs can evaluate, order tests, diagnose, prescribe, and manage patient treatments (27 states)

Reduced practice authority: At least one element of practice requires NPs to collaborate with a physician (15 states and territories)

Restricted practice authority: NPs must be supervised by a physician to provide patient care (11 states)

From the American Academy of Physician Assistants (AAPA):

PAs are independent clinicians who work in collaborative agreements with physicians. The physician need not be on site for the PA to see and treat patients.

From the American Medical Association (AMA):

47 states require PAs to be supervised by physicians. Some states limit the prescription of certain classes of medications.

Resources

American Nurses Credentialing Center (ANCC)

American Association of Nurse Practitioners (AANP)

Academy of Physician Assistants (AAPA)

National Commission on Certification of Physician Assistants (NCCPA)

The Bottom Line Nurse practitioners (NPs) are APRNs with a graduate (MSN) or doctoral (DNP) degree. NPs provide patient care, clinical leadership, and can be active in teaching and research. State-level scope of practice laws determine whether NPs have full, reduced, or restricted practice authority and can practice independently or under the supervision of a physician. NPs prescribe medications. Physician assistants/associates (PAs) are licensed clinicians with a master’s degree (MPA). PAs work in patient care, diagnosis, and treatment alongside or via supervisory agreements with physicians (depending on state laws). PAs work in various clinical, educational, government, and workplace settings. PAs can prescribe medications. 
Rachel Drummond

Rachel Drummond

Writer

Rachel Drummond is a freelance writer, educator, and yogini from Oregon. She’s taught English to international university students in the United States and Japan for more than a decade and has a master’s degree in education from the University of Oregon. A dedicated Ashtanga yoga practitioner, Rachel is interested in exploring the nuanced philosophical aspects of contemplative physical practices and how they apply in daily life. She writes about this topic among others on her blog (Instagram: @racheldrummondyoga).