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Difference Between NP and PA

stethoscopeNP vs PA

Even if you’re not part of the medical community, it still pays to learn about the basics of terms like PA, NP, RN and the like. This is especially true if you have a relative or friend or you yourself are in the hospital ‘“ because these are the professionals who will help you through your healing process. You may already be familiar with the role of an RN or a Registered Nurse but what about NPs and PAs? This is exactly what we will try to discover here.

First, what do the acronyms stand for? NP is what nurse practitioners are called while PAs are Physician Assistants. How exactly do their jobs differ from that of a typical nurse? Basically, all of them have the same goal of examining and treating patients while assisting doctors at the same time. Where they differ is the scope of service provided, as well as the educational requirements that each job has.

Duties of PA

  • Work under the supervision of a physician or surgeon
  • Review patients’ medical histories
  • Do physical exams to check patients’ health
  • Order and interpret diagnostic tests, such as x rays or blood tests
  • Make preliminary diagnoses concerning a patient’s injury or illness
  • Provide treatment, such as setting broken bones and giving immunizations
  • Counsel patients and their families; for example, answering questions about how to care for a child with asthma
  • Prescribe medicine, when needed
  • Record a patient’s progress
  • Complete insurance paperwork

    A PAs duties and the extent they must by supervised by the physicians varies from state to state.

Duties of NP

  • Record patients’ medical histories and symptoms
  • Give patients medicines and treatments
  • Set up plans for patients’ care or contribute to existing plans
  • Observe patients and record the observations
  • Consult with doctors and other healthcare professionals
  • Operate and monitor medical equipment
  • Help perform diagnostic tests and analyze results
  • Teach patients and their families how to manage their illnesses or injuries
  • Explain what to do at home after treatment

In 2010 median salary of PAs in the US is $86 410 while NPs earned a median salary of $64 690 [1].

Education.

PAs typically need a Master’s degree but it differs from state to state. An accredited educational program for PAs must be completed to become one. All states require PAs to be licensed.

NPs must also be licensed. NPs must have atleast a master’s degree.

Whether a patient is treated by a PA or an NP, patients will still have the same level of care  especially since both have the proper training and educational requirement to perform their duties in the health care industry.

[1] http://www.bls.gov/ooh/Healthcare/Physician-assistants.htm
[2] http://www.bls.gov/ooh/Healthcare/Registered-nurses.htm#tab-1


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18 Comments

  1. Unfortunately, this article is incorrect and/or misleading on a number of points, especially on the role and educational background of the Physician Assistant (PA). I hope that I can clarify a few points:

    PAs are licensed practice medicine, and like Nurse Practitioners, are able to diagnose and treat (including prescribing medication) medical and surgical illnesses. While all PAs have a “supervising physician”, that physician is generally not required to be physically present while the PA is practicing medicine.

    The majority of PA educational programs are Masters conferring programs. In contrast to NP programs (which are all specific to a field of medicine, such as “family nurse practitioner” or “acute care nurse practitioner), PA programs mirror medical school, offering basic science courses followed by clinical rotations in most fields of medicine/surgery. PAs also have the option (not mandatory) of completing a year long residency in their chosen field. This “generalist” education allows a PA to switch specialties, however they will always undergo training in that field (by their physician and other PAs) prior to practicing autonomously.

    The salaries of NPs and PAs are quite comparable, and an NP and PA practicing in the same setting will make the same salary. NPs do not have independent practice rights in all states, and therefore more likely than not will have a “collaborating physician”. The scope of practice of an NP is determined by their degree as well as the state nursing boards, so that an Adult Nurse Practitioner would be unable to care for pediatric patients (and would have to go back to school to do so). In contrast, a PA’s generalist education allows them to go into any field of medicine.

    So, in reference to the “Summary”:

    1) NP programs are all at the Masters level, moving towards the doctorate (though not increasing scope of practice). PA programs mostly confer the Masters degree, with a few Bachelors programs (though taught at the same graduate level). Both NPs and PAs must pass licensing exams. NP programs are specialized, restricting the scope of practice and fields of medicine available to that NP (the Adult NP would have to complete a Family/Pediatric NP program to treat children), while PA programs are generalist, allowing the PA to see patients of all ages and go into any field of medicine.

    2) NPs are not able to work independently in all states. PAs do not have to work in the physical presence of the physician. Both NPs and PAs can autonomously diagnose and treat patients. Many if not most NPs also have a “collaborating physician”. PAs are licensed health care professionals, licensed to practice medicine.

    3) NPs and PAs earn virtually the same salaries, with PAs perhaps earning more, since more PAs practice in the surgical subspecialties than NPs (again due to the generalist education of the PA, which includes education and training in surgery, allowing them to be first assistants in surgery).

    • It is quite disturbing to think that someone who has no experience with critically ill patients, who may have a business degree may enter into a medical specialty as a physician assistant. I have worked with many np and pa’s working in a level one trauma center, and it is quite shocking to see the difference in the two specialties. Many pa’s I have worked with are quite ignorant regarding the basics of the abc’s that are the building blocks of anyone with any medical sense. I believe that I have nursing technicians that are more knowledgeable that most pa’s I have unfortunately had to deal with. It is all in experience. A nurse that has worked in an ICU for 4 years is much more qualified to perform most duties than anyone who merely wears a white coat as a pa graduate without the “title”. In my opinion comparing pa’s and np’s is extremely insulting. Most pa’s are people that cannot get into medical school, and are too lazy to actually get a nursing degree (medical experience) and complete the program.

      • Typical nurse mentality.

      • Typical nurse mentality indeed. Most nurses lack the deductive reasoning and critical thinking ability required to be a successful provider. They are mostly trained to follow orders and double check physicians.

        • Marie & Jay,
          I find this an odd remark because I have been certified in both NP and PA fields, in which, all of these “lacking” qualities that you speak about are shown in both professions. It is not the initals behind your name but the intelligence and ability to apply it that makes a truly great healthcare provider. As usual, THIS unprofessional egocentric need to determine who is superior will continue to undermind our professions thus detering us from our true purpose. “nurse mentality” as a slur … “pa stupidity” as a slur … give it a break!!! Remember their are people in both professions that could have been MD’s ,however, their situations in life or CHOICE made them the other. Honestly, I would go to either for excellent medical care. As for the practice of medicine vs practice of nursing is concerned, the subject is irrelevent because all of us provide care to our patients by taking an H&P, preforming a physical assessment and evaluation, forming a diff. diagnosis, made a treatment plan to include test,meds,referrals, dictate,etc…
          NONE OF US ARE MD’s so why the hatred???????????
          Do you honestly believe an MD finds either professional his/her equal?? Let me answer that”NO!!!”

        • I was lonoikg everywhere and this popped up like nothing!

      • To all, and mainly Lee-

        PA’s cannot enter a PA program with only a business degree, you have to have courses in biology or typical “pre-med” courses. The program I went to I actually had multiple classes with the med students. I did training in critical care, emergency medicine, and trauma services. Therefore, some PA’s are trained to practice critical care.

        Furthermore, most PA’s chose to go into the PA profession based on their mission and type of care they wish to give, which is why anyone chooses to be a RN, NP, DO, MD, etc. It is not that I could not get into medical school but because my personality fit a PA’s mindset. Many preceptors have told me that I have the drive and abilities to go on to medical school if I wished, it is not that I could not get it. Many states have lower regard for PA’s. If you come to NY, you might see something a little different than if you live in TX, FL, etc which do not embrace PA’s as well.

        To say a PA is too lazy to go to be an RN is ABSURD. The training is far more complex than an RN program. There is a reason why a PA can diagnose and treat and an RN can’t. Lastly, to become a PA you also need medical experience. I had to have over 1,500 hours of patient contact which I worked in hospitals and nursing homes for to even be able to go to PA school.

        I believe your vision of PA’s in general is very jaded. We are not all idiots and lazy. All areas of medicine have good/bad Docs, good/bad midlevels, and good/bad nurses.

  2. Lee,

    You must have had a rare occurrence to run across a PA that were “…ignorant regarding the basics of the abc’s that are the building blocks of anyone with any medical sense.”, considering that all PA’s must pass board certifications every 6 years and graduate from a licensed PA program under the supervision of the AMA. I just don’t see how a PA could “fake” their way through a rigorous training program and then at the same time somehow fool the certification system (a test which is scheduled to take 6 hrs to complete). There are rules regarding the amount of CME (continued medical education), which consists of at least a documented 200 hours in a 2 year span. To suggest that PA’s are “are people that cannot get into medical school, and are too lazy to actually get a nursing degree” is again a very ignorant statement on your part. As a current PA student, I can assure you that I nor any of my classmates considered applying to medical school. It is a different rout and a completely different calling. Any one of the students in my class could have been accepted to a medical school program had we chosen that rout. We are shown everything a medical student will see in their 4 years of training, in our 1.25 years of didactic (classroom) education. It is usually in a broader perspective, but that is generally what a PA is. The medical community realizes that with a basic medical education, hands on training counts for much, much more. At the same time, I do not mean to belittle NP training either. As Jason wrote also, they are just different. Nurses are taught more about educating the patient, reading medical data, and performing clinical actions (such as injections, IV’s, etc.). NP’s are shown, in a specific area, some of the medical concepts that a PA is also shown as well. I personally take offense at your accusations, and would urge you to reconsider your position. If you do, in fact, think a PA is ill equipped to perform in a clinical setting, then it is your duty as a health professional, and for patient safety to report it. To go online and spread rumors not only paints a false portrait of the medical community, it does nothing to fix your ultimate gripe of these PA’s you have encountered not knowing medicine. It is simply ridiculous to make such a blanket statement. And to counter your statement that someone with a business degree will be practicing medicine with no experience is very off base. You state it as if anyone can get into a PA program somewhere. It is quite the opposite. I was one of 24 chosen of over 200 applicants at just my school. It is very competitive, and experience does count. There are also prerequisites classes for admission to PA programs which are weighted toward their final acceptance or denial. I worked extremely hard to get to the point that I am, and I still am working extremely hard. PA’s have had to fight this kind of stereotype for 50 years now, and I think we have proven ourselves for 2 generations of patients now. I think it is evident that PA’s can provide the same kind of medical expertise an MD can, in general medicine. Of course MD’s have training which allows them to tell the minor differences that PAs and NPs may not be able to discern in special cases, but the mid level provider does provide the primary care to patients that they were first brought into existence for in the first place.

  3. I am a NP with eleven years of experience. I have worked with both NPs and PAs and do not see much of a difference in how they work while diagnosing medical conditions and treating patients, as both professions are taught to administer care within the medical model. The salaries are the same, as are the benefits. We have both NPs and PAs who work in the surgical subspecialties, such as orthopedic surgery, neurosurgery, and cardiovascular surgery, and I often don’t know if one of my peers is a PA or NP. We all get along fine, and I have yet to have anyone comment on “us vs. them”. Unfortunately, there are NPs out there who cannot get past their basic training as nurses, and are not as independent as others are, and it is sometimes extremely frustrating when they won’t treat a complicated but stable medical patient without conferring with a physician. The physicians with whom I work will not tolerate this, and those NPs are often allowed to resign.

    Family practice nurse practitioners can work anywhere they want, doing any type of specialty they want. Most adult nurse practitioners do not want to work with children, so whether they need to be “generalists” is a moot point. The nurse practice act in my state is extremely general, stating that NPs can do anything they are trained to do. Some of them are now doing simple lap surgeries, such as choles, appendectomies, and hysterectomies, all under the eye of the surgeons. And there are post-master programs in anesthesia for both NPs and PAs. As far I am concerned, we all do the same job, and, in most cases, do it well.

    One of the physicians in my office told us that although they are 100% responsible for a PA’s decisions, they are only 30% responsible for the care provided by the NP, so his insurance cost to supervise the PA was more than the cost to collaborate with the NP. In my state, PAs are technically not allowed to work independently, whereas NPs can be considered independent contractors. However, most choose to be employees of a medical practice, and job openings usually ask for NPs or PAs. Yes, in almost all states, NPs must have a collaboration agreement with a physician or dentist, but it is just an agreement that they will see a complicated case if the decision making and follow-up care is considered to be beyond the scope of an NP, which is a decision made by the NP. I am confident enough with my skills that I usually just refer a patient to a specialty practice if needed instead of asking one of the physicians in my practice to see them. The PAs in my office practice the same way. All of us have a lot of experience and rarely need supervision. However, we often “curbside’ with whomever is available if we want help deciding on a particular treatment or referral. Once referred, the patient may even be evaluated by a PA or NP in that specialist’s office. After several years in a specialty, most NPs and PAs are highly qualified, regardless of their initial training.

    There will always be a few who somehow are credentialed but are unsafe practitioners in both professions, just as there are unsafe physicians. In my state, both professions face significant barriers to practice, as this state is one of the last that will not let NPs or PAs WRITE a script for controlled substances….we can call them in, so it doesn’t make any sense. Both professions are working together to allow us to practice medicine without the constraints placed on us by a handful of physicians who feel threatened, especially with the change in primary care looming on the horizon. In many cases, the patients ask to see the NPs or PAs in the office because they find we listen better than the physicians do. I personally think NPs and PAs are much better at primary care than physicians are, and feel that, somewhere in the future, NPs and PAs will be the primary care providers and physicians will become the specialists.

  4. Excuse the spelling errors. I wrote quickly. Feel free to be demeaning because then you can justify to yourself your unwelcome comments

  5. Hello all. I have enjoyed reading these posts. I am co-authoring an article on a similar topic and would relish your critique. If you are interested, send me an email so that I might have you review it for accuracy. Thank you! butterworthpa@gmail.com

  6. Wow! This was a wake-up call to how NOT to trust the info you find on any website. I am horrified by this article and its false comparison of these 2 fields. I am currently in PA school right now which is a MASTER’S PROGRAM. I have a BS in medical technology and had work hard to get accepted into the PA program. I had to have a bachelors, a great GRE score, preferable healthcare experience, recommendation letters from at least 2 doctors, an essay, prerequisitie biology,chemistry, anatomy & physiology classes, etc. You get the point. NP’s and PA’s are quite similar! We both go through a master’s program and we both are healthcare providers who have to pass our accredited programs and pass a national board exam. Also, in the definition of PA’s there is the word supervision. We are not supervised like children. We work in collaboration or in conjunction with the physician. He/she is not looking over our shoulder every 2 minutes. Our attending physician doesn’t even have to be in the same building or even in the same state! He/she is there IF we need them.
    As for specialties, PA’s are taught the broad medical model and can go into a specialty if they like. Also, unlike doctors or NP’s, we can change our specialty without going back to school because we were taught most subjects from peds to women’s health to ER. NP’s have to specialize in school what they want to do such as women’s health. Anyways, NP’s and PA’s are about equal but we are held to the same standard as a physician.

  7. I haven’t looked at this website since I posted my note some time ago, and can still sense tension about this subject. While in school, we were told how “different” we future NPs would be when compared to PAs. However, in the real world, we are all doing the same job, and if one allows those small differences to matter while working along side each other, then there is no knowledge sharing, no respect for the other’s point of view, and the patient will suffer. I would also like to address a few other points.

    I do disagree with Shastina that only PAs are generalists, but she may not be aware that NPs also get a generalized medical education at first, with everyone having to take a basic core of subjects. I am a FNP, but have worked neurology, internal medicine, family practice (including women’s health and pediatrics), and in the ED. I work with both adult and acute care NPs in the hospital, with the acute care NPs outshining us all at first because they underwent more hours of acute care than most of the PAs, FNPs, and ANPs. Nevertheless, after the first year, I think we were all working on the same level, as we all knew that the learning did not stop when we graduated. I think Shastina will realize that when she gets out of school. (You sound like you have both feet on the ground and I hope you do well). An NP can change from one specialty to another as they choose.

    In my state, the physician does have to be in the same facility as the PA, but this is not always observed. I do know of one physician who went on a cruise and left his PA and NP to run the practice. Everything went fine until the PA tried to get a patient admitted to the hospital and the on-call physician demanded to speak directly to the office physician. There was a complaint filed with the Board of Medicine and both the PA and MD were reprimanded. The PA was reprimanded because he was not under the “direct supervision of the physician”. Seems silly, but again, one more barrier to practice. I know the physician in the hospital, and he would have also complained about the NP but there would not have been the hassle of a board investigation since the NP operates under his own license.

    As far as someone being too lazy to become a nurse, I find that absurd. Most nurses do not go into the field to become NPs. Most nurses go into nursing to practice the art and science of the profession of nursing, and want to remain at the bedside. Thank goodness, because it is a difficult job with few rewards from the medical team or hospital administration. However, there are quite a few nursing assistants, pharmacy techs, lab techs, etc. who have a degree in other fields, and start to talk about going back to get their BSN so they can apply for NP programs. I have suggested that they look into PA programs since they already have a degree. The expense to double back for another degree, as well as the time they will spend just trying to get into nursing programs could be a waste (at my alma mater, UF, it takes a 4.0 to get into the nursing program, but only a 3.4 to get into medical school!!). One of the nursing assistants took my advice and is now working with the cardiac group in one of our facilities as a newly board certified PA. It took him only two and a half years instead of four or five years. I hope that this subject is resolved as more and more NPs and PAs work side by side.

    I am concerned that the push for the DNP degree as the entry level for NPs will be one more hassle for all of us. Even though the NPs in these programs are told differently, there will be no increase in responsibility or any lessening of barriers to practice. Is it just one more way the nursing hierarchy in academia is trying to separate the jobs of PA and NP? I am not sure, but I have a PhD and my job description hasn’t changed one bit. I am an independent contractor as are the two PAs with whom I work. We are paid the same and we work the same schedule. The only “perk” is that I HAVE to be the chief investigator when we are involved in research studies that are not pharmacy driven, and I am reimbursed for that. This allows me to participate at a level the PA currently cannot, but I have also encouraged my peer to continue her education. She is hoping to be entering a doctoral program in the spring. At the time of her graduation, we are hoping to engage in many new research projects, and we will all bring something to the table. We will also all be named as researchers when we publish. The PAs were not involved or recognized in the previous three studies or on any published work, which I though was unfair, but the grant was for doctoral degrees only. In a practice that is not heavily involved with research projects (not including clinical trials), these differences would be moot, and there should be no performance issues or differences between NPs and PAs. For those of you who are experiencing strife between the professions, perhaps having dual NP and PA monthly meetings would be beneficial. Central Florida has been doing that for some time, and there is a definite camaraderie and solidarity between the two professions..

  8. My PA has answered 4 questions differently than my doctor. I have no confidence. But now my doctor won’t see me, it is always the PA. How can I ask to see the doctor directly? I don’t want to offend. Also the PA yells while the doctor is patient.

  9. All of the above posts are incorrect, misleading, and incomplete. I advise more factual based evidence based research before posting such fallacies. It is dangerous to post things that you know nothing about obviously.
    With my experience, I have found that Advanced Registered Nurse Practitioners off more holistic, comprehensive patient care and do not offer prescriptions for every imaginable diagnosis. I will continue to see my Advanced Registered Nurse Practitioner because she provides awesome evidence based care.

  10. Hello All,

    I know this thread is a bit old now but I found it incredibly informative because it is nothing you will read in a textbook or pamphlet. The truth really comes from people with hands on experience in the field, and the truth is exactly what future students like me need to hear before completely changing careers. I am applying to accelerated nursing BS programs as I already have a bachelor degree in Accounting, I am a CPA. I however have taken several pre-med classes and my heart has always been in science and health care.

    A friend of mine who is in their third year of residency (MD) had suggested I look into PA school instead of nursing because of the increased level of respect they receive from doctors. He stated that NP’s and MD’s have an adversarial relationship whereas PA’s are treated more like peers by MD’s – this is in NYC. I told him that frankly, I don’t care. I am not changing my career to kiss the butt of an MD but to help patients and use my brain in a challenging and dynamic environment every day.

    With that being said, I want to make sure that I choose a path that provides me with the most open doors or options. I am not certain that I want to commit to a specialty right away (most accelerated BS programs offer a bridge right into a Masters program at which point I would have to declare a specialty with little to no actual work experience). I love variety and a change of pace to ensure that I am constantly challenged and engaged. Based on those desires it sounds like PA school may be more appropriate? I would love to hear your thoughts and any words of encouragement other than the fact that business majors can’t do medicine. Thank you!

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