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The Difference Between Nurse Practitioners (NPs) and Physician Assistants (PAs)

  • Article by:Health Career Center
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Nearly all American nurses contemplating their futures have heard the numbers by now:  a nearly 35% uptick in the need for nurse practitioners by 2024 and an almost 41% salary hike when an RN becomes an “NP.”  The same kinds of opportunities lure those considering a physician assistant’s position.

So what’s the difference between the two in education and experiential requirements, and how does it feel to walk a mile in their Crocs?

“The real difference between the two is… the framework by which they come to the work,” says Jackie Sommerville, former chief nursing officer and senior vice-president of patient care services at Brigham and Women’s Hospital in Boston.  “Nurses come to the work in more of a holistic focus on prevention, health maintenance and the whole person.   PAs are really trained in the medical model.  They come to cure, to diagnose and to treat.”  

Though nurse practitioners have much of the same medical training, Sommerville, who holds a PhD in nursing, says NPs gravitate toward primary care environments and in many states can practice without any supervision from physicians. Physician assistants usually work in more acute settings and with much less autonomy.  They practice entirely under the direction of a physician who typically delegates their scope of practice.        

The training of nurse practitioners, who now are increasingly referred to as Advanced Practice Registered Nurses (APRNs), and physician assistants reflect that dichotomy.   Nurse practitioners already must be RNs with a bachelor’s degree in nursing and up to five years of experience in the medical field to apply for APRN graduate programs.  During their training NPs specialize in any number of areas from cardiology to women’s health and emerge with a Doctor of Clinical Practice (DNP) degree.    Once they pass the certification exam in their specialty and meet state nursing board requirements they can practice in that specialty.

The training for physician assistants has much less specialization. PAs begin their training once they’ve earned a bachelor’s degree in any major as long as they have the pre-requisites to enter a PA educational program and about three years of direct healthcare experience.  A full-time student usually completes the required general medical coursework in three academic years, specializing when they enter their clinical rotations. They receive master’s degrees, and then must pass the national exam before practicing. Despite options for specializing after their coursework, PAs are trained as generalists who should need minimal additional instruction before shifting to another medical specialty.

With their degrees, certificates and licenses in hand, newly minted NPs and PAs start their job searches.   They’ll find that despite their different orientations and levels of training hospitals want the same basic characteristics in both.

“What we’re looking for,’ says Somerville, “is someone who can practice on a team -- someone with good communication skills, a good communicator and team-player, and someone who knows when to call in a social worker or a physician.”

She also stresses that prospective NPs and PAs need to be patient-centered and life-long learners.

As they make their way through the interview process, jobseekers should gauge the employer’s commitment to provide a robust orientation.   Somerville says that most hospitals haven’t developed strong orientation programs for APRNs and PAs.

“They come in and hit the ground running.” she says.  “A lot of work needs to be done with orienting NPs and PAs.  RNs have a formal orientation process and that’s needed for NPs and PAs too.”

On the job, NPs are overwhelmingly involved in primary care including examining patients for annual checkups, making diagnoses, taking patient's medical history, performing exams, ordering lab tests, prescribing medications, and treating and managing diseases and illnesses, often without approval from physicians.

PAs can perform the same tasks but usually in more acute environments and under the direct supervision of physicians.

According to Somerville, the level of job satisfaction and fulfillment in both these positions can differ wildly depending on the expectations within the medical team.

“I’ve found that NPs want a panel of patients of their own,” she says. “They don’t want to be given task after task without being able to take care of the whole patient.  I personally find that in doing discrete tasks nurse practitioners are not as satisfied and don’t stay as long.”

Studies show that in recent years annual turnover rates among nurse practitioners and physician assistants have reached over 11%.

Despite those concerns, Somerville sees a very bright future for both nurse practitioners and physician assistants.

“Both role groups are making major contributions to advancing the care of patients, “ she says.   “There’s more than enough work for both roles and they both fit beautifully into our healthcare system.”