What is the Difference between a Physician’s Assistant (PA) and a Nurse Practitioner (NP?)

PAs and NPs are often referred to collectively as “mid-level providers” by physicians who tend to see them as interchangeable. In fact, in many settings the job descriptions for PAs and the NPs are identical, as are the pay scales. So what are the differences? Since the laws regulating PAs and NPs vary tremendously from state to state, there will be some states where the difference is more pronounced than in others. But, in general, here are the basic differences:


PAs are trained either in a special Bachelor’s degree program or in a Master’s degree program following a Bachelor’s degree in one of the sciences.  All PAs are trained as generalists. Some specialize once they get out into the work world but their training is not specialized. PAs are trained under the medical model. Their training includes performing minor surgeries and assisting in major ones.

NPs all have Master’s degrees. They have to be registered nurses before going back to NP school and most have many years of experience in health care before they go to their Master’s training to become an NP. NPs are trained in the nursing model of care. All NPs have to choose a specialization: family practice, adult, pediatric, neonatal, gerontologic, women’s health, or acute/critical care. So, NPs come out of their training as specialists. NPs can also go on to earn a doctorate degree in their field – the DNP– whereas there is no doctoral degree for the PA at this time.

Scope of Practice

PAs must practice under the supervision of a physician. In fact in most states they practice under the MD’s license rather than being licensed themselves. They are authorized to prescribe medications in 48 states. They generally assist the physician by handling their less complicated patients. PAs are also trained as “first assists” in hospital surgery rooms.

NPs are licensed by their state Boards of Nursing and thus practice under their own licenses. In 23 states, NPs may practice completely autonomously without any MD involvement at all. In the other states, NPs must “collaborate” with an MD, meaning that the MD doesn’t have to be on site but must be ultimately responsible for the NP. Therefore, NPs can open independent practices, whereas this is not possible for PAs. NPs, however, are not trained to assist in surgery as PAs are.


Since PAs are trained under the medical model their focus is to diagnose and treat and  “fix things” (minor surgeries). As a general rule, NPs are more holistic in their approach and emphasize preventive health and health teaching. NPs are first and foremost nurses so they are usually more “touchy feely” than PAs, although this, of course, is a generalization and you may find a PA who is just as nurturing and holistic as an NP!