Advanced Practice Providers (APPs) are an integral part of the healthcare team. They both perform very similar jobs, oftentimes the same one! But what exactly is the difference between them? In this article, I am going to walk you through and compare the education and training, job role, physician collaboration, as well as the salary of both NPs and PAs.
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Education and Training
Both Nurse practitioners (NPs) and Physician Assistants (PAs) are considered Advanced Practice Providers or APPs, and they both often work alongside physicians in many facilities and practice settings. This tends to lead to some confusion over what the difference actually is.
Please note that there are various alternative methods of obtaining your NP including direct-entry programs and RN-MSN bridge programs, but I will not be going over these within this article. Additionally, this article compares master’s prepared NPs vs master’s prepared PAs. Of course, there are many NPs who obtain their Doctorate of Nursing Practice (DNP), but that will not be talked about in this article.
Related content: “NP vs MD: Which one is better?”
PAs will first obtain an undergraduate bachelor’s degree in a whichever degree they desire, but they must complete their prerequisites for PA school. At the same time, a future NP will typically obtain their Bachelor’s of Science in Nursing (BSN). Both of these undergraduate degrees typically take about 4 years to complete, although some direct-entry PA programs complete the Bachelor’s degree portion in closer to 3 years.
During this part of their education, PA students won’t typically perform any formal clinical, but will often have to complete between 1000-4000 hours of direct patient healthcare experience which is required for PA school. This is usually experience being an EMT or paramedic, a patient care technician or Certified Nurses Assistant (CNA), or a medical scribe. BSN students, on the other hand, will complete between 800-1000 clinical hours on average within the hospital learning how to be a bedside nurse.
Upon graduation, PAs should have already applied and been admitted to a PA program to obtain their Master’s degree, and they will immediately move on to their graduate education. The NP, however, will pass their board certification once they graduate, the NCLEX-RN. They then begin working as a bedside nurse. There are some RNs who immediately go right into their NP studies, but most will work for as little as a year to as long as 20+ years before pursuing their master’s degree.
The PA/NP Programs
PAs will complete a Master’s degree in any of the following, depending on their program:
- Master of Physician Assistant Studies
- Master of Health Science
- Master of Medical Science (MMSc)
NPs will complete a Master of Science in Nursing (MSN). During their program, PAs are trained as generalists, so they can essentially work in any clinical setting so long as they have appropriate physician supervision. Instead, NPs must choose a specific patient population to focus on. When entering the program of their choice, the NP will have to choose one of the following patient populations:
- Family (across the life-span)
- Adults and Geriatrics (ages 13 and up)
- Primary Care
- Acute Care
- Behavioral/Mental Health
- Pediatrics (ages 0-18)
Most PA programs last about 2 full-time years of study (24-26 months). The first half they’ll go through didactic material learning in-depth medical sciences. Think of this as the first half a medical school but compressed into only 1 year. In the last half, they’ll complete clinical clerkships in pediatrics, OBGYN, family practice, general surgery, and emergency medicine, totaling about 2,000 hours of clinical experience.
NP programs are structured differently and usually have Full-Time, Part-time, and online options. Most programs will start out with solely didactic material including advanced pathophysiology, advanced pharmacology, and advanced health assessment. You’ll then start clinicals but at the same time continue didactic material simultaneously. It’s common to have to complete 16 hours per week fo the semester in clinical, so two 8-hour days each week.
Where you do your clinicals is going to depend on the program specialty, so FNPs will do rotations in primary care clinics, women’s health clinics, and pediatric clinics, whereas Acute care NPs would do most of their rotations within the hospital in the ICU. Some programs offer optional specialty rotations, where you can get experience in something other than your “typical” locations (like the ER for FNPs). NPs will complete an estimated 600-800 hours of clinical by graduation.
Once they graduate from their APP programs, PAs must pass the PANCE (Physician Assistant National Certifying Examination) in order to become a certified PA. NPs will have to pass their board certification exam in their specific specialty (either through the AANP or the ANCC). They both then apply for state licensure and can start practicing as APPs once credentialed
Related content: “Nurse Practitioner: Steps after graduation”
The actual job role of an NP and a PA regarding what they actually do is VERY similar if not the same at almost any location and specialty.
Both PAs and NPs:
- Obtain health histories from patients
- Perform a physical assessment
- Order diagnostic tests and interpret them
- Prescribe treatments such as medications and therapies
- Perform bedside procedures
- Consult appropriate specialists
They both work in pretty much every specialty including:
- Outpatient primary care
- Outpatient and inpatient specialty offices
- Inpatient hospitalists or ICU
- Emergency Department or Urgent Care Clinics
- Home Health / Hospice
Regarding surgery, NPs can become a first-assist with a surgeon but its much less common – usually they’ll do admissions and discharges for the surgical team instead of actually scrubbing in. PAs are more likely to scrub in and assist with surgery. NPs generally do not receive any surgical rotations throughout their program, so this just makes sense.
APPs often work in close collaboration with physicians – but this is where the main difference lies between the two.
NPs have full practice authority (FPA) in 23 states and counting. What this means is that State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing.
This means there is no required supervision or collaboration with a supervising physician. They practice medicine under their own license without any oversight. However, just because an NP might practice in an FPA state, this does not mean that they do not consult or collaborate with other experienced NPs and physicians when appropriate – it just means they have the legal authority not to.
NPs who do not live in an FPA state will require varying degrees of physician collaboration depending on their state and practice setting. This degree of physician collaboration is explicitly stated in a collaborative agreement, which outlines joint practice protocols, documentation review/oversight, and prescriptive authority. In practice, this often just involves occasional chart reviews and availability for consultation via electronic consultation via text or phone call. This doesn’t require an on-site physician.
Alternatively, PAs are always required to work under the direction and supervision of a physician or a group of Physicians. However, State-level laws influence more specific aspects of supervision including prescriptive authority, prescription co-signatures, collaborative agreements, and other various aspects of scope of practice.
So what does this mean?
Basically, PAs have more required oversight by physicians, but this does not mean that the physician is looking over their shoulder. Typically, this may involve the PA consulting the doctor with medical management of a complicated case, and the physician co-signing their charts and prescriptions for controlled substances. But this will look different in every State and practice setting, and the physician often won’t be required to even be on-site – just usually needs to be reachable.
All states will vary for both NPs and PAs in terms of who is legally able to sign death certificates, POLST forms, and/or order physical therapy.
As a general rule, the NP career offers more opportunity for autonomy. This is especially useful if you plan on opening your own practice or clinic, especially in an FPA state. PAs, at this time, are more limited in their ability to perform medicine autonomously.
Both NPs and PAs are a great part of the healthcare team, and both are very competent and able to take care of their patients within their respective scope of practices.
When looking at salary – both NPs and PAs make similar salaries and many locations and facilities will pay their counterparts the same. However, when looking at national data – NPs make on average $117,292, and PAs make $107,179 (Glassdoor). Keep in mind that this is national data. The fact that some NPs have the autonomy to open up their own practices typically means higher revenue, which will skew the national NP salary upwards.
And that is basically the difference between PAs and NPs. They are both very different paths, but essentially perform the same job role and have similar career outlooks. Some physicians and hospitals will prefer one type of APP over the other, and I’ve seen this go both ways. However, most places of employment will recognize the value of both an NP and a PA as integral members of the healthcare team.