Physician Assistant VS Nurse Practitioner

This is one hot topic!

Whether you are a confused patient, curious friend or considering the medical field, let me sweep aside the mystery surrounding the differences between Nurse Practitioners (NP) and Physician Assistants (PA).

As a practicing PA, I get asked quite frequently: “What is the difference between a NP and PA?” It is a fair question. I can fully appreciate how this topic is hard to sort out. We walk around in our lab coats and can be seen in office settings and hospitals alike. We evaluate patients, collaborate with team members, make assessments and plans. We order labs and imaging. We write prescriptions and make follow up phone calls. So……. what IS the difference?

Truthfully, our scope of practice in every day patient care is nearly identical. The story doesn’t end there though. The differences are partly historical, partly training, partly specialty and partly legislation. Taking it back to the 1960s, both nurses and physicians simultaneously recognized the need for a practitioner that fulfilled an intermediary role. Both professions set out to create a training program which would produce providers to fill this void. NPs were and are trained from the nursing model and are often registered nurses first. PA programs were first established by physicians causing a difference in the training model simply by virtue of which medical professionals were directing the learning. As a fun fact, the very first class of PA students were military men who had gained exceptional medical knowledge and experience in the military but did not have a platform in civilian life with which to utilize their skills.

One important distinction worth mentioning is that all PA programs train their students for general practice. Meaning their courses, clinical rotations and certifying exam cover a whole range of specialties from pediatrics, to surgery, to family medicine. NP students while also trained to excel in different specialties, also have the option of applying directly to a specialized program such as a Pediatric Nurse Practitioner Program.

More practically speaking in my state of practice I tend (strong emphasis on the “tend”) to see NPs more in office based practice and PAs more in hospital based practice. It wouldn’t take you long though to round the hospital corridor corner to find an NP with the in patient surgery service or a PA with a full panel of internal medicine patients to see in the office. In fact, most job postings will list open positions as “NP/PA”, thereby accepting both NP and PA applicants. Employers like to leave their options open and base their ultimate selection more on the individual and their work experience rather than their credentials. Less frequently, but still in existence are job postings that will specify one or the other.

Finally, legislation. This will be brief but can be an interesting component to the puzzle when explored in more detail. No matter what state you are in, PAs must always have on their official licensing record the name of a supervising physician. They may never practice completely independently. Meaning, they must always have a physician they can access for consultation. In fact there are many times when PAs are practicing medicine with a physician available only by phone. NPs on the other hand, depending on the state in which they practice, may choose to open their own practice and function entirely independently. In fact, roughly half of the United States currently permits this.

Just to highlight how interchangeable the two profession can be, I have both medical personnel and patients refer to me on any given day as a PA or NP. Sometimes I correct them, sometimes not. It offends me not at all to be called one over the other. Being a PA myself I tend to be tuned in more acutely to whether a provider is a NP or PA but honestly, there are so many of both running around the hospital that I too lose track of whom is which.

For some this may be too much information, for others a blasphemous oversimplification. My hope is that some clarification was provided, and you have a better working understanding of the providers you may be seeing or profession you may want to pursue.