Should I Become A Physician Assistant Or A Nurse Practitioner?

"I was planning to apply for a nursing program, with the goal of becoming a nurse practitioner. The reason I wanted to do that and not just aim for LVP or whatever is because I want to be able to take on more responsibility. But then I found out about physician assistants, and they sound like almost the same thing as nurse practitioners. Which one should I do?"

asked by Duncan from Wichita, KS

A nurse practitioner is a registered nurse with a master’s degree (in most cases). Nurse practitioners often already have a lot of work experience, because they start out as regular nurses, and go on to get their advanced degrees at a later time. They may work without the direct supervision of a doctor, and may even own private practices. Most nurse practitioners focus on preventative care and provide general services to treat basic illnesses and injuries. Like doctors, they are able to write prescriptions.

Physician assistants, like nurse practitioners, can take on a fair amount of responsibility, but only under the direct supervision of an attending physician. That means that if you were to become a physician assistant, you would be unable to run your own practice.

You can however take on numerous different tasks, including a wide range of diagnostic testing duties and treatments. You also have the power to write prescriptions. If you are interested in specialized medicine, you may prefer this role, since physician assistants often have the opportunity to pursue highly specialized roles. They also do not need to get an advanced degree. A simple two-year degree may allow you to become a physician assistant.

So the fundamental differences between the two can be summarized like this: A nurse practitioner can work independently of a doctor, but a physician assistant cannot. A physician assistant may take on a very specialized role, while a nurse practitioner is less likely to do so, particularly if he or she works alone in an independent practice. Under a physician, a nurse practitioner is more likely to pursue specialized medicine.

A nurse practitioner requires a master’s degree and extensive work experience, whereas a physician assistant does not. A two-year degree will get you started.

So ask yourself how much responsibility you want. Is it important for you to be able to operate an independent practice? Or would you be okay working under a supervisor? How much money and time do you have to spend on your education? Would you rather get a two-year degree and start making a high salary straightaway, or spend some extra time working your way up so you can take on more responsibility?

Good luck making your decision! Whatever choice you make, you should find many opportunities waiting for you.

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Join The Discussion - 17 Comments

  1. Heather says:

    PA is a Master’s level degree that requires an undergraduate education in the sciences as well as medical experience. To my knowledge, only 2 or 3 of the 180 something PA programs are not Master’s level, and they are changing. Also- NP’s typically spend 500 hours in their clinical education and PAs spend 2000 or more. PAs generally have a more thorough medical knowledge and although they are required to work in partnership with a Physician they are very autonomous and can be found running their own clinics and departments.

    • Chris says:

      It sounds like your trying to diminish Nurse Practitioners and pump Physicians Assistants. PA programs are 1 year didactic classroom training and 1 year of clinicals, then your a Physicians Assistants. Yes, many programs require a bachelors degree to gain entry to PA school, but, that is not medical training. Also, the Physicians Assistants programs the require “medical experience” will accept medical experience as a CNA or EMT-Basic. Being a Nurse Practitioner requires much more education and experience. 4 years to become an bachelors prepared RN, bedside experience as an RN, and then a 2 year Masters program. No wonder why Nurse Practitioners are much more respected in the medical community. We have much more experience and education. Plus, we now have DNP programs to become clinical doctoral NP’s.

      • Diana says:

        I think that both the NP and PA professions provide quality healthcare to this country. However, I obtained my FNP and a colleague of mine is a PA-C. He was required to take pre-med courses (same as medical school applicants), have a bachelor’s degree, obtain 2000 paid healthcare hours, take the GRE, and have a sufficient amount of volunteer hours before being able to apply to PA school. Even though many NP programs require you to have your BSN before applying, there are many direct entry NP programs which do not. Many people can apply to NP programs without any healthcare experience.

        Additionally, many NP programs can be obtained online. If I could do it again, I’d probably do the PA route even though it’s more competitive initially.

      • Martin says:

        You offer valid points. To add more, 2 of the 4 BSN years are not medical training. I would like to add that Nurse Practitioners can have excellent bedside manner with moderate to vast experience as an RN, an understanding of interprofessional teams, and a holistic treatment approach.
        On a different topic, approximately 71 nurse practitioner schools have didactic work completed online. There are currently 0 physician assistant schools that do the same and there is only one bridge PA->DO program. However, completing medical school beginning as an MS-1 is possible.
        Flaming aside, NPs and PAs are incredibly important in today’s healthcare. Both are completely different routes, as highlighted by Diana below. As such, to compare the two is like trying to compare apples and oranges.
        A slight grammatical correction I would like to politely add is that PAs are Physician Assistants, not Physicians Assistants.

  2. Marie says:

    “And finally, a nurse practitioner requires a master’s degree and extensive work experience, whereas a physician assistant does not. A two-year degree will get you started.”

    For the majority of PA programs, you must first have received a bachelor’s degree and have approximately 1,000-2,000 paid healthcare hours prior to applying to a PA program. PA programs are competitive and are becoming increasingly more so. For some of the top programs, there are around 1400 applicants for 54 available seats.

    The decision as to whether to become a PA or NP really falls on personal preference. Do you have all the pre-med prerequisites (PA programs require more chemistry than NP programs do)? Do you want to practice independently in certain states? NPs have to specialize in an area of medicine (geriatric, psychiatric, adult, etc.) where as PAs do not. PAs have the flexibility of moving from one specialty to another, since they are general practitioners. Just some thoughts to ponder. Best of luck!

  3. Randall Dickson says:

    Physicians Assistants on average make $10,000 – 20,000 more than NPs. Physicians Assistants have on average, 4 years of medical experience and a bachelor’s degree prior to attending Physicians Assistant school. Physicians Assistants are trained in the medical model, mostly by physicians and Physicians Assistants are trained in a nursing model, mostly by nurses. Physicians Assistants training requires 2000 hours of clinical rotations, Nurse Practitioners on average have only 400-600 hours of training and do not need any nursing experience prior to going to NP school. They only have to have to be a Registered Nurse. Some of their schools will give them a Registered Nurse license after 6 months of training. Also, Nurse Practitioners can only work independently in 16 of the 50 states and only less than 2% have their own business. Physicians Assistants can own their own clinic in almost all 50 states.

    • Eric RN says:

      Randall Dickson, you need much info about nursing education my friend. First of all, to become an NP one must be an RN with a bachelors. There are some nurses who transition from associstes degree RN to NP, but they have to complete all of the bachelors prerequisites. Also, there are family nurse practitioner programs that allow new RNs with a BSN, entry into their programs. However, most do require at least 1 year of experience. This is very different for acute care nurse practitioners or certified registered nurse anasthetist. They must have their RN with a bachelors, have a minimum 2 year experience in a critical care setting, and only then are they admitted to an ACNP or CRNA program. Most NPs have many years of experience as RNs, just FYI. You state on average PAs have upto 4 years of medical experince. Well being a CNA or EMT does not count my friend. In fact, counting that as medical experience is at best, rubbish. Neither does a degree in health care or any related studies. There’s is no other profession prior to advanced pracrice other than nursing where one critically thinks, has knowledge of medicine, and has thousands of hours of clinical bedside experience. Yes, in the PA curriculum the hours are greater than that of a NP program. However, the experience and education of an RN is considered part of that individual’s clinical hours. Also NPs can own their own practice in all 50 states and it is now 22 states where NPs can practice independently. There is a difference between owning practice and practicing independently. In the states where NPs can’t practice independently, just like a PA, they can still own their practice but will have an MD/DO on payrole to oversee the practice. Also,the differences in salary is not as great as you state. Please do some research before posting on a forum such as this.

      • Aneshia Rowland says:

        To state that working as a CNA is”rubbish ” as an example of medical experience is ignorant. Ive worked along side RNs for a short 2 years and already I’ve gained experience in various treatments, learned how the healthcare system works. I’ve learned so many medications, their side effects, their alternatives, and most importantly how to interact with patients. I am sure an EMT gains those experiences plus more. For you to say my experience doesn’t qualify to become a PA is a ridiculous.

        • Eric RN says:

          Aneshia, with all due respect you obviously don’t understand that there’s a vast difference between working as a CNA and as a nurse. Just like there is a big difference betweeen LVN and RNs. I can see in a clinic setting you can see yourself doing similar things as a nurse. However in an acute care setting where the RN is titrating multiple drips for a super septic patient who is on the vent. Or managing ventrics on neuro patients or recovering a heart patient who just had a valve repair or bypass or both. These are all things that I do. As a CNA it is ridiculous for you to think that your experience is comparable to that of a nurse. Even though I know how the cardiac procedures are done doesn’t mean I know how to do them. My point here was doing what a CNA does does not qualify you to be a PA or a NP. Going to school and taking the proper tests is what qualifies you. Your experience of being around patients my help you but without proper education you are not aware of what you don’t know.

  4. Pam says:

    I cannot speak for all schools, but the Master’s program I graduated from required 4,000 hours of critical care experience before I could enter the Acute Care Nurse Practitioner program. Because I am specialized in Acute Care, my degree allows me to work anywhere except pediatrics. My specialty is 14 years of age and older.

  5. Brad Burkhart PA says:

    This is a misinforming article. PA school itself is at minimum 24 months and sometimes even 36 months based on the program. That does not include your undergraduate degree which is another 4. This degree in undegrad is the same degree you would get to apply to medical school. I work as a PA and think both PAs and NPs are great. To say you can become a PA in 2 years is insulting. If that was the case you would see 20 year old PAs working in the hospital.

  6. Brian says:

    I’m both. You want to learn to write papers then go nursing route. You want to learn to practice medicine then go to a physician assistant program. Bottom line and end of story

    • Barbara Munafo says:

      Thank you for that short but informative reply

  7. Erica says:

    I personally would like to know what states you guys are in! NORTH CAROLINA requires all NPs to be a Registered nurse that has at least a year of full time nursing experience. That’s anywhere above 1700-2200 hours. Plus before you can become an RN you have to have your CNA (that’s more hours). And Psyhciatric NPs can gross a good bit more than a PA; with that said I think it depends on State & Speciality…let’s face it you can still challenge boards in Califronia from what I hear! WHO DOES THAT?

  8. Dave says:

    I have been a nurse for 15 years, 10 of which have been in Critical care. I am finally completing my BSN online. I have looked into both the NP and the PA programs. Their is no comparrison the PA program is much more intense. NP programs are now requiring you to have a doctorate to practice. But lets not avoid the fact that the content of the programs are clearly different. as has been said in earlier posts, the PA program uses a Medicine model while the NP program uses a nursing model. That difference means that PA’s are focusing on hard sciences like chemistry an biology while NP’s are focusing on nurse theory. The reason it has taken me so long to get my BSN is due to my total lack of interest in taking the “fluff” courses(theory based, subjective data) that are required for this degree. I have a number of friends that are currently in NP programs. They have said that there are no shortage of “fluff” classes in their program as well.
    The bottom line is NP school:
    1) based on a nursing model
    2) you can get your degree online
    3) prereqs have less science requirements
    4) Yo can still work while in the program

    PA program:

    1) based on a medical model
    2) not an online program
    3) more science courses required.
    4) cannot work while in the program

  9. Lee says:

    It is impossible to obtain a PA degree in two years as the original article in this article states. All PA programs with the exception of about two currently require a bachelor’s degree prior to entry that includes many heavy medical prerequisite courses. The vast majority of PA programs require the same prerequisites for entry that Medical schools do. All PA programs require medical experience prior to entry. The average NP program is 600-750 hours of didactic training, whereas the average PA is 2000 to 2500 hours of didactic training. The average NP training requires 675 hours of clinical training whereas the average PA program requires a minimum of 2000 hours of clinical training. All PA clinical rotations must meet very strict specifications and are set up by the PA program. NP clinical rotations are set up by the student himself and do not have to meet a list of requirements. Most PA programs have a cadaver dissection component as well as heavy components in pathophysiology, immunology and the more advanced aspects of medicine. It is largely unheard of for a NP program to have any of these dimensions. In addition to this, many NP programs are online whereas PA programs are not. PA coursework is extremely demanding and is too extensive to be committed to an online program. Most PA’s with a master’s degree have more didactic training and more clinical training than a NP with a DNP degree if you take the time to carefully examine the programs and lay them side by side. On top of that if you lay the training programs side by side the story is told immediately. Much of NP and especially DNP programs are nursing philosophy. PA training is entirely clinical training. There definitely are NP programs that will take nurses straight out of nursing school, without any nursing experience. I highly respect both professions, but please do not insinuate that PA’s obtain their degree in two years. That is extremely uninformed. PA’s are highly trained medical professionals. By the way, if you examine most state laws, there is very little difference between PA and NP autonomy. PAs do not practice with a physician looking over their shoulder. Many NPs will tell you they practice autonomously when in reality they do not. Many states require a collaborative written agreement with a physician. In the end this is little different than PA practice since all but four states have removed the countersignature requirements for PA’s.

    • Eric RN says:

      More than half of the states allow NPs to practice independently. That means many NPS are running their own clinics. Not just owning but running. To my knowledge PAs are not allowed to practice independently. Of course I understand the importance of the “harder sciences”, they are ultimately pointless when taking care of a patient. Ask any physician or PA if they remember the chemical compounds of nor-epi or dobutamine. Also see how many first year Residents and first year PAs can manage a critical care patient, where’s as an ACNP would have no problem because of their at minimum 2 year or more experience as an ICU nurse.

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