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So what is the difference between a physician assistant and nurse practitioner? 

By Alyson Rockhold PA-C, MPH

There are 5 nurse practitioners (NPs) and 2 physician assistants (PAs) that work at my office. Recently, a drug rep asked us, “So, what’s the difference between NPs and PAs anyways?” My co-workers and I looked at each other in uncertainty.

One NP muttered, “Well, um, NPs are trained in the nursing model, and PAs are trained in the medical model?”


Everyone shrugged at each other, and the conversation flowed in a new direction. But I couldn’t stop thinking about it. What do these different training models mean in the real world? In my particular office, PAs and NPs do the same work and get the same pay. Are we any different after all?

With a little digging, I discovered a few key distinctions between PAs and NPs, especially in their training, certification, and autonomy:


As my co-worker pointed out, the classic explanation is that PAs are trained in the medical model, and NPs are trained in the nursing model. In my experience, this doesn’t change very much about how PAs and NPs act in a clinical setting. Most patients won’t even realize they’re being treated by different medical professionals. Even though I was trained as a PA to focus on the disease state, I also care enough about my patients to make sure they’re comfortable and to explain everything thoroughly to them.

There are a few other differences in our training. The average PA program is 27 months and includes 2,000 clinical hours. On the other hand, NP programs run 15-24 months with 720 hours of clinical contact. The main reason for this disparity is that most NPs start grad school after a few years working as a nurse, while many PA students go straight from undergrad into their master’s program.

So, I started PA school having never given a shot or drawn blood while my NP friends had a lot of hands-on healthcare experience before starting their master’s programs. Most PA schools have a required number of shadowing and patient contact hours needed to apply, but these pale in comparison to the nursing experience seen in most NP programs. For example, my “patient contact hours” came from counting pills in a pharmacy. I learned a lot of drug names, but was still terrified when I had to insert my first foley catheter!


Most PAs receive a general license that allows them to work in any field of medicine. This gives a lot of career flexibility. In fact, about 50% of PAs switch specialties during their career. (There is a trend towards more specialized PA training and even residency programs). Our NP counterparts choose either primary or acute care and then further focus on a specific population, such as pediatrics, adults, or geriatrics.

Being a PA has allowed me to work in an out-of-hospital birthing clinic, family practice, child psychiatry, HIV/AIDS clinic, and ICU over the last 10 years. I’ve loved the flexibility of my career! NPs would not be able to move that fluidly in and out of the hospital and between pediatrics and adult medicine.


PAs are licensed by the medical board and must have a collaborating physician in order to practice. NPs are licensed through the state board of nursing. They are considered independent practitioners. Their scope of practice changes from state to state. Some states even allow NPs full practice authority!

Alright, I’ll admit it, I’m a bit jealous of my NP friends’ autonomy. There are some moves towards getting PAs more freedom, but right now we must always work in tandem with a physician.

And if you’re a numbers person, here’s how it breaks down for PAs vs NPs: **

Physician AssistantNurse Practitioner
Number practicing in the U.S. in 2019118,800 189,100
Median Pay$112,260$109,820
Expected job growth31%26%

So, while the PAs and NPs in my office are indistinguishable from each other, we were trained and certified a bit differently. My NP friends could launch out and open their own clinic (in some states) while I could switch to an entirely new field of medicine. 

If you’re deciding between becoming a PA or NP, it’s important to consider how these small differences could have big effects across an entire career. However, in the end, they are both growing, well-paid, well-respected health professions. You can’t go wrong either way!

** Data taken from the Bureau of Labor Statistics