A nurse practitioner, or NP, is a registered nurse who is trained to provide various health care services and, depending on state regulations, may be able to see patients and practice medicine in the same way that a doctor of medicine (MD) can. A physician assistant, or PA, is a health care professional who can practice medicine but only under the supervision of a physician. Their duties often vary slightly by state, especially when it comes to delivering babies and prescribing controlled pharmaceuticals.
Both NPs and PAs must have a bachelor's degree, followed by master's degree, in medical/nursing practice and medical/physician practice learning models, respectively. NPs must also have 500-700 hours of clinical experience, and PAs require 2,000 hours for certification. PAs may also have to complete a residency program. Both typically make between $90,000 and $100,000 a year and have to recertify periodically.
Education and Certification
Nurse practitioners must first become a registered nurse, after completion of a Bachelor of Science in Nursing (BSN) or a diploma program followed by adequate training. Most states require a master’s degree or a doctoral degree, followed by certification, before NPs are allowed to practice. The certification for an NP is awarded by the American Nurses Credentialing Center and the American Academy of Nurse Practitioners.
PA programs also offer a master's degree in Physician Assistant Studies (MPAS), Health Science (MHS), or Medical Science (MMSc). The requirement for enrolling into these programs is a bachelor’s degree along with MCAT or GRE scores. Although PAs are not required to complete a residency program, this training is available as an option after completion of the program. PAs are, however, required to clear the Physician Assistant National certifying Exam (PANCE) according to the regulations set down by the National Commission on Certification of Physician Assistants (NCCPA) before practicing, and have to register every 2 years.
NPs recertify every 5 years through the accumulation of 1,000 practice hours and either 15 continuing education (CE) credits or satisfactory completion of an oral exam. PAs must certify again by completing the Pathway II exam every 6 years and by completing 100 CE credits over each 2-year period. These requirements may vary somewhat from state to state.
Areas of Training and Specialization
Some of the areas of specialization for Nurse Practitioners are acute care NP (ACNP), emergency NP (ENP), family NP (FNP), occupational NP (OHNP), holistic NP (HNP), oncology NP (ONP), pediatric NP (PNP), and so on.
Essentially, both NPs and PAs, while limited in some practices in some states, perform all of the functions and duties of physicians. In some cases, NPs may even be able to practice independently. PAs are always supervised by a physician, however.
PAs are trained in the fields of anatomy, microbiology, pharmacology, hematology, pathology, and clinical medicine as part of their curriculum. Clinical rotations are done in areas of internal and family medicine, surgery, pediatrics, obstetrics and gynecology, oncology, and emergency medicine, among others.
Some of the post-nominal initials that NPs use are:
- NP-C (certified NP)
- ARNP (advanced registered NP)
- MSN (Master of Science in Nursing)
- MN (Master of Nursing)
The post nominal initials for PAs are:
- PA-C (PA – certified)
- RPA (registered PA)
Scope for Practice
As these professions are regulated by state governments, scope of practice varies in different states.
A nurse practitioner’s job profile may allow one to work independently or in collaboration with a physician. The duties include but may not be limited to conducting a physical examination, obtaining medical histories, physical therapy, performing diagnostic tests, prescribing drugs, and providing prenatal care, as well as counseling and educating patients.
The work of physician assistants is further determined by their agreements with supervising physicians. They mainly perform tasks such as collecting medical information from patients, performing examinations and tests, diagnosing illnesses, prescribing medications, referring patients to specialists, and assisting in surgery.
According to the U.S. Dept. of Labor Occupational Outlook Handbook, Nurse Practitioner demand has risen about 31% per year since 2012, creating demand for about 48,000 new NPs annually. The increase in demand for PAs is even higher at 38% per year increase, creating 34,000 new jobs each year.
The institutions that can employ NPs include community clinics and health centers, nursing homes, private and public schools, hospitals, physicians, and more.