If you're thinking about a career in healthcare but don’t want to spend a decade in medical school, becoming a nurse practitioner (NP) or physician assistant (PA) could be the perfect path. These two roles are often compared because they have similar responsibilities—both diagnose patients, prescribe medication, and provide treatment. But despite the overlap, there are key differences between a nurse practitioner and a physician assistant, from how they’re trained to their level of independence on the job.
In this physician assistant vs nurse practitioner article, we'll break down the main differences between these two professionals, covering their education, job duties, salary comparisons, pros and cons, and how to decide which path is the best fit for you.
What is a nurse practitioner?
A nurse practitioner is an advanced practice registered nurse (APRN) with specialized training that allows them to diagnose illnesses, develop treatment plans, and prescribe medication. NPs work as independent healthcare providers, frequently taking on roles similar to doctors.
NPs commonly work in primary care settings, but they’re also found in hospitals, specialty clinics, urgent care centers, and even telehealth services. Some specialize in areas like family medicine, pediatrics, women’s health, oncology, cardiology, or psychiatry, allowing them to provide targeted care to specific patient populations.
One of the biggest advantages of being an NP is prescriptive authority—meaning they can write prescriptions, manage chronic conditions, and provide preventive care. In many states, nurse practitioners can practice independently without physician supervision, making them a key solution to the growing shortage of healthcare providers, especially in underserved areas.
What is a physician assistant?
A physician assistant is a highly trained medical professional who diagnoses illnesses, develops treatment plans, prescribes medication, and assists in surgeries—all under the supervision of a physician. While PAs have a wide scope of practice, their role is inherently collaborative, meaning they work closely with doctors rather than practicing independently.
In some cases, however, this supervision is minimal. Their role is designed to extend the capabilities of doctors, helping bridge gaps in patient care and improving access to medical services in underserved areas, like rural locations.
PAs can be found in hospitals, surgical teams, outpatient clinics, and specialty practices like dermatology, orthopedics, emergency medicine, and cardiology. Their flexibility allows them to shift between specialties without needing additional certification, making them incredibly valuable in fast-paced healthcare environments.
Nurse practitioner vs physician assistant: What’s the difference?
So, what's the difference between nurse practitioner and physician assistant? At first glance, these roles seem very similar, as both can diagnose, treat, and prescribe medication. However, their training, scope of practice, and approach to patient care set them apart.
Educational pathway
“PAs are trained in the medical model, while NPs are trained in the nursing model,” says physician assistant Diane Bruessow. “PA and NP practice is regulated at the state level. The difference is that PAs are regulated by medicine, while NPs are regulated by nursing.”
Nurse practitioner:
Becoming a nurse practitioner typically begins with earning a Bachelor’s in nursing (BSN), followed by obtaining a registered nurse (RN) license. After gaining experience as an RN, NPs pursue advanced degrees: either a Master of science in nursing (MSN) or a Doctor of nursing practice (DNP).
Once the educational requirements are complete, NPs must pass a certification exam in their chosen specialty. The timeframe for becoming an NP typically spans six to eight years.
Physician assistant:
The path to becoming a physician assistant starts with a Bachelor’s degree, usually in a science-related field, although other fields may be acceptable if prerequisites are met. Afterward, prospective PAs enter a PA program, which typically results in a Master's degree in physician assistant studies. These programs are highly competitive, involving coursework in medical science, clinical rotations, and a focus on disease diagnosis and treatment.
After completing the program, PAs must pass the PANCE (Physician Assistant National Certifying Exam). The overall time commitment to become a professional is typically six to seven years when including undergraduate studies and the PA program.
Scope of practice
The difference between a nurse practitioner and a physician assistant is most noticeable in how independently they can practice. While both NPs and PAs are trained to diagnose illnesses, develop treatment plans, and prescribe medication, their level of autonomy depends on state regulations.
Nurse practitioner:
States with full practice authority (more than half of the U.S. states, including Arizona, Massachusetts, New York, and Washington), allow NPs to open their own clinics and work as independent healthcare providers, particularly in primary care, family medicine, and women’s health, without a doctor overseeing their work.
Some states allow NPs to diagnose and treat patients independently but require a collaborative agreement with a physician for certain aspects of care, such as prescribing certain medications or performing advanced procedures. But, in states with the most restrictive laws, like California, Florida, and Texas, NPs must work under direct physician supervision for most or all aspects of patient care.
Physician assistant:
Unlike NPs, PAs are required to work with a certain level of supervision. Some states allow PAs to practice with minimal oversight, (Iowa and Utah, for example) where they work collaboratively with a physician rather than needing direct supervision at all times. In more restrictive states, a physician must approve certain treatment decisions or prescriptions, and PAs may need on-site physician presence in specific settings, such as hospitals or surgical teams.
Specialization
This difference in specialization comes from their training models—NPs are educated within a specific patient population focus, such as adult-gerontology, neonatal care, or psychiatric-mental health, which shapes their career paths early on.
Nurse practitioner:
Once an NP is certified in a specialty, switching to another area often requires additional education and certification.
Here are some common NP specialties:
- Family Nurse Practitioner (FNP)
- Pediatric Nurse Practitioner (PNP)
- Adult-Gerontology Nurse Practitioner (AGNP)
- Neonatal Nurse Practitioner (NNP)
- Psychiatric-Mental Health Nurse Practitioner (PMHNP)
- Women’s Health Nurse Practitioner (WHNP)
- Acute Care Nurse Practitioner (ACNP)
Physician assistant:
PAs, on the other hand, are trained as generalists in medicine, giving them the flexibility to transition between specialties throughout their careers without needing to obtain new credentials. This adaptability allows PAs to explore different fields, respond to workforce demands, and take on roles in high-need areas like surgery and emergency care, where their broad medical training is particularly valuable.
Some of the common specialties PAs pursue include:
- Emergency Medicine
- Surgery
- Orthopedic Surgery
- Dermatology
- Cardiology
- Gastroenterology
- Family Medicine
- Oncology
Approach to patient care
NPs and PAs also have distinct approaches to patient care. While both professionals diagnose and treat illnesses, their training models shape how they interact with patients and develop treatment plans.
Nurse practitioner:
NPs follow a nursing model, which emphasizes holistic, patient-centered care, considering a person’s physical, emotional, and social well-being. NPs often prioritize long-term patient relationships, preventive care, and patient education, aiming to treat the whole person rather than just the symptoms of an illness.
Physician assistant:
PAs, on the other hand, are trained in a medical model, using a disease-centered model that emphasizes diagnosing conditions, formulating treatment plans, and coordinating care with other healthcare professionals.
Work environment and work-life balance
The work settings and schedules of NPs and PAs can differ significantly based on their specialties and practice locations.
Nurse practitioner:
Nurse practitioners often work in settings that emphasize continuity of care, such as primary care clinics, family practices, and community health centers, where they develop long-term relationships with patients. This can lead to more predictable schedules, especially for those in outpatient settings.
Physician assistant:
In contrast, PAs frequently work in acute care environments, such as emergency rooms, surgical teams, and trauma units, where patient needs are unpredictable. This can mean longer shifts, irregular hours, and on-call responsibilities, particularly in hospital-based roles.
Nurse practitioners and physician assistants often work together
While nurse practitioners and physician assistants have their differences, they frequently collaborate closely in patient care. “Healthcare is a team sport,” Bruessow says. In most settings, NPs and PAs work alongside physicians and other medical professionals to provide comprehensive care.
This collaboration extends across specialties. “I recently had a patient who an NP managed in primary care and was referred to sleep medicine, where a PA evaluated and managed the patient for their related issue,” she says. “[In that case], a PA, a physician, or an NP could have held either of these roles.”
More often than not, a provider’s profession matters less than their expertise and availability. Whether a patient needs a specialist or emergency care, referrals are based on what’s best for the patient rather than rigid job titles. “When we come across a patient whose need exceeds the resources in our environment, that patient is going to be referred to the correct resource based on the expertise that the patient needs,” Bruessow says.
Collaboration is also strengthened by shared clinical experience. As the only PA in a practice with highly experienced NPs, Bruessow notes, “At this point in our careers, I can't differentiate between us in any meaningful way. We follow the same guidelines and have spent many years in an apprentice-style model where we learn from more experienced clinicians, regardless of their academic degrees.”
Salary and job outlook: Which pays more?
Both professions offer competitive salaries, but there are some differences, particularly when factoring in specialization, location, and industry.
Physician assistants
The mean annual wage for PAs is $130,490, according to the latest data from the U.S. Bureau of Labor Statistics (BLS).
Top-paying employers for PAs include:
- Outpatient care centers: $144,160
- General medical and surgical hospitals: $132,580
- Offices of physicians: $127,910
- Colleges, universities, and professional schools: $116,420
- Offices of other health practitioners: $125,840
Top-paying metropolitan areas for PAs are predominantly in California, with the San Jose-Sunnyvale-Santa Clara area leading the pack with an annual mean wage exceeding $160,000. Other cities in California, like San Francisco-Oakland-Hayward and Napa, also boast high salaries, often above $160,000.
States with the highest concentration of PA jobs include New York, Connecticut, North Carolina, Alaska, and Pennsylvania, with New York, in particular, showing the highest demand.
The job outlook for PAs is bright, with employment expected to grow 28% from 2023 to 2033—a rate much faster than the average for all occupations.
Nurse practitioners
Nurse practitioners are also well-compensated, with a mean annual wage of $128,490.
Top-paying employers for NPs are almost identical to those for PAs, with differences in the mean annual wage. They include:
- Outpatient care centers: $139,860
- General medical and surgical hospitals: $135,610
- Home health care services: $146,850
- Offices of physicians: $122,780
- Offices of other health practitioners: $121,250
Like PAs, California leads in NP salaries as well. The San Jose-Sunnyvale-Santa Clara area tops the list, with a mean annual wage exceeding $191,000. The top 10 also includes Los Angeles, Sacramento, and San Francisco—all boasting salaries above $157,000.
States with the highest concentration of NP jobs include Tennessee, Mississippi, New Hampshire, West Virginia, and Arkansas, offering a higher concentration of positions in these areas.
The job outlook for NPs is even more promising, with a projected growth rate of 40% from 2023 to 2033, according to the BLS. This growth rate is particularly driven by an increased demand for healthcare services, especially in primary care, and the expansion of roles for NPs in various healthcare settings.
Which career is right for you?
Now that you know the difference between a physician assistant and a nurse practitioner, choosing which career to follow will depend on your career goals, work preferences, and the kind of patient care you want to deliver.
Do you prefer the nursing or medical model?
NPs follow a nursing model, which focuses on holistic, patient-centered care, addressing not only the physical health but also the emotional, social, and psychological needs of patients.
PAs are trained in the medical model, which is more disease-focused and emphasizes diagnostic skills, problem-solving, and treatment based on the medical and scientific understanding of illnesses.
Do you want full autonomy or physician collaboration?
If autonomy is important to you, becoming an NP might be a better fit, as many states allow NPs to practice independently, especially in primary care settings.
If you prefer a collaborative approach where you work closely with physicians, a career as a PA may suit you better. PAs are trained to work under physician supervision or in a collaborative team setting.
What are your long-term career goals?
Do you see yourself specializing in primary care and having an ongoing relationship with your patients? NPs often work in family medicine, pediatric, or geriatric care, where you can develop long-term relationships with patients.
Or do you prefer to have the flexibility to move between specialties, like surgery, dermatology, or emergency care? PAs have greater versatility in transitioning between different specialties without the need for additional certifications.
Making the decision
Ultimately, the choice between becoming an NP or PA depends on your values and career aspirations. Consider where you want to work, the patient population you'd like to serve, and the level of autonomy you're seeking in your role. Each career has its own set of rewards, so it’s important to weigh these factors carefully when making your decision.
FAQs
Is a physician assistant above a nurse practitioner?
Not necessarily. Both physician assistants and nurse practitioners are advanced healthcare professionals, but their roles are distinct, with different training models and areas of focus. Neither is inherently “above” the other in a workplace hierarchy; they simply have different areas of expertise and work in different settings based on state regulations and individual preferences. Their level of responsibility may vary depending on the specific role they hold, but both are highly respected in healthcare.
What can a PA do that a NP cannot?
While there is some overlap in the duties that PAs and NPs can perform, there are differences based on their training, specialty, and state regulations. Generally, PAs have more flexibility to switch specialties without needing additional certifications. They also work closely with physicians, often in collaborative environments. NPs, however, can sometimes have more autonomy, especially in primary care settings, where they may have the ability to practice independently in some states.
Which is harder: nurse practitioner or physician assistant?
Both career paths are challenging, but the difficulty depends on individual preferences, strengths, and learning styles. However, PA education can be particularly demanding due to the speed at which students must learn various medical subjects in a relatively short amount of time.
What are the biggest differences in daily responsibilities?
NPs tend to focus more on primary care and patient education, usually managing long-term relationships with patients and following a holistic approach, emphasizing prevention, health promotion, and managing chronic conditions. In contrast, PAs typically work in more specialized settings and can easily transition between different areas of medicine. Their focus is more on diagnosis and treatment using a medical model, often in collaboration with physicians.
Which career offers better job security?
Both careers have strong job security, but the demand for nurse practitioners is expected to be particularly high, with a projected job growth of 40% from 2023 to 2033—much faster than the average for other professions. Similarly, physician assistants are in high demand as well, with a projected job growth rate of 28% from 2023 to 2033.