Nurse Practitioner and Physician Assistant - What's the Difference?

Both Nurse Practitioner and Physician Assistant are viable alternatives to medical school and both are important occupations when it comes to delivering quality healthcare. Learn more about each, including facts about salaries and specialties.

Overview of the Occupation, Salaries, and Specialties

Nurse Practitioner (NP)

A Nurse Practitioner (NP) is a registered nurse with advanced academic (having a masters degree) and clinical experience, which enables him or her to diagnose and manage most common illness, including chronic ones, either independently or as part of a health care team. NPs largely focus on health maintenance, disease prevention, counseling and patient education in a wide variety of settings.

Median Salary of Sample of 23,850 NPs Nationwide (2004):
$73,620 annually, working 36+ hours a week
(Taken from American Academy of Nurse Practitioners 2004 National NP Sample Survey)

Specialty Areas: Family NPs, Pediatric NPs, Adult NPs, Geriatric NPs, Women's Health Care NPs, Neonatal NPs, Acute Care NPs, Occupational Health NPs, Certified Nurse Midwives, and Certified Registered Nurse Anesthetists.

Physician Assistant (PA)

A Physician Assistant (PA) is formally trained to provide diagnostic, therapeutic, and preventive health care services, as delegated by a physician. Working as members of the health care team, they take medical histories, examine and treat patients, order and interpret laboratory tests and X rays, make diagnoses and treat minor injuries. PAs record progress notes, instruct and counsel patients, and order or carry out therapy. PAs also may have managerial duties and some supervise technicians and assistants.

Median National Salary (2006):
$69,517 annually, working 32 hours a week
(Taken from American Academy of Physician’s Assistants 2006 Census Highlights)

Specialty Areas: General internal medicine, pediatrics, family medicine, general and thoracic surgery, emergency medicine, orthopedics, and geriatrics. PAs specializing in surgery provide preoperative and postoperative care, and may work as first or second assistants during major surgery.


Personal Experiences Q&A

Manuel Hipol-Aldrich (MHA) who works at the University’s Tang Center as a Physician Assistant and Rebecca Riseman (RR) who works as a Family Nurse Practitioner at the East Bay Family Practice Medical Group relate their personal experiences describing how they prepared to enter the profession, and the ins and outs of their job.

Career Center (CC): What school did you go to for your undergraduate and graduate education?

Manuel Hipol-Aldrich (MHA): I went to Humboldt State University for my undergraduate degree. I then went to Stanford University for my Physician Assistant education.

Rebecca Riseman (RR): I went to University of Michigan for my undergraduate degree in English and education. I then got a dual Masters in Public Health and Social Work also at the University of Michigan. My graduate nursing degree is from UCSF. I was in the Master’s Entry Program in Nursing (MEPN), which is a one-year fast track program to obtain an RN and then two years for the Master’s degree.

CC: What education did you have to pursue to become a Physician Assistant? What were some of the tests that you had to take, for example, for certification and entry into the program?

MHA: I was an exercise physiologist before I pursued medicine. Most of my interactions with people were in the preventative lifestyle area. Once you commit to applying to a PA school, you will need to have some core prerequisites such as: Microbiology, Chemistry, Human Physiology, Human Anatomy, and Social Studies. Most PA programs have lists of all their prerequisites on their websites. There are no tests one really needs to take to apply to a PA school, but the application letter and interview process are what you really must prepare for. The application letter is your one chance to get noticed and get an interview. I studied the program I wanted to get into, what they wanted, who they wanted, and why I wanted to become a PA.

RR: As a NP, there are state boards, licensing exams, and accreditation exams. These have to be renewed every couple of years. Once you get your Masters degree in your specialty area, you must take the required examinations in order to start practicing in most workplaces.

CC: What extracurricular activities did you engage in while an undergraduate that helped you learn about the field?

MHA: I was mostly involved with under-served populations such as migrant farm workers, Native Americans, and low income families. The PA profession was originally created for these populations. The health system needed more providers -- most physicians did not want to work in these areas.

RR: I volunteered in a hospital as an undergraduate student, but I didn't become interested in becoming an NP until I was in graduate school. I worked as a safer sex educator in graduate school, which made me very interested in health in general. Then volunteering abroad as a teacher with the Peace Corps played a huge role in shaping my interest. I also volunteered at Glide Health Clinic and a homeless shelter in San Francisco, but that was when I was already an NP student at UCSF.

CC: What advice would you give to students hoping to pursue one of these occupations?

MHA: My advice would be to work in some aspect of the healthcare system. This will give you a stronger sense of whether you really want to pursue medicine. It also looks good on your application and fulfills the required hours of experience for application to some schools (e.g.,. Stanford). I would also advise trying to increase your work with underserved populations - it shows commitment to these areas and again looks good on your application. Don’t even step foot in the door of any school if you don't have your prerequisites done. Study up on the schools you want to apply to, and make sure to write a good application letter to help you get an interview. Nothing else really matters if you cannot get an interview.

RR: Try to shadow a Nurse Practitioner to see what her/his workday looks like. Also, it's important to volunteer in healthcare settings prior to applying to any program, specifically with underserved populations. Make sure you really understand the different areas in medicine (NP, PA, MD) before deciding which area you wish to pursue.

CC: What promising opportunities do you feel the profession has to offer for a new generation of students thinking of entering the profession?

MHA: To be honest, for any motivated individual, the opportunities are very promising. It really comes down to personal preference. If you want to work a lot, there are many jobs out there to be had. If you want to work less (like me), you can arrange your schedule so as to leave time for your family, friends, and recreation. You can work in any field of medicine if you have a good preceptor who is willing to train you. Check out the American Academy of Physician Assistants website to learn more about the profession.

RR: Increasingly, NPs have more autonomy such as the ability to write prescriptions for controlled medications that once was not possible.  There are jobs all over the country and in so many different areas, which makes it a very exciting field.

CC: What prompted you to become a Physician Assistant/Nurse Practitioner? What qualities in an individual does the profession require?

MHA: I managed three clinics in San Francisco and worked with 14 different MDs in varying fields. A few of those physicians recommended I pursue medical school to become an MD or PA. I didn't have the time for medical school. I had never heard of a PA, but it seemed to fit all the things I was looking for so I decided to investigate. It wasn't a huge educational time commitment, it was a viable career choice, and my background/education fit with the type of people they look for. I think the main quality a person needs in any health profession is the desire to help others.

RR: My decision to become an NP involved a few different career turns. I started as an English major with a teaching certificate and taught for a couple years in Kenya as a Peace Corps volunteer.  While in the Peace Corps, I realized how critical good health was to the well-being of my students, and I decided to go into health education and counseling. After I earned a dual degree in Public Health and Social Work, I worked for a couple of years at a school-based clinic in Detroit that had an on-site Nurse Practitioner. I realized I wanted to do work as tangible and directly involved with patients as she was doing. So I decided to go back to school to become a Family Nurse Practitioner. I also wanted a career that would allow me to balance work and family life, and I felt that an NP degree would allow me to have the desired flexibility.

I think an NP needs to have empathy, good listening skills, be non-judgmental, possess critical thinking ability, and be able to see the patient as a whole person, not just a diagnosis.

CC: What is a typical day like at work? What duties occupy your time the most?

MHA: My goal in my work life was to work smart, not hard. I currently work only three days per week. I begin my day at 8:00 a.m. and end at 5:00. I work in Occupational Health, so my main duties are to examine and treat injured workers. I also do medical surveillance for UC Berkeley police officers, animal handlers, custodians, and most any position that needs some sort of OSHA-required examination.

RR: I see both well and sick patients of all ages, including pregnant women. A typical day consists of a mix of urgent, add-on visits with others who have scheduled physicals or prenatal visits. My duties are mostly with the patients, plus charting and returning phone calls after seeing the patients. It's a busy schedule and my days are very full.

CC: Do you yourself work with a specific population (i.e., clients with specific needs, cultural, etc.)? Is working with specific populations typical of Physician Assistants/Nurse Practitioners?

MHA: My population tends to be Workers Compensation/Occupational Health. This is typical of Physician Assistants. One is able to work in different aspects of medicine ranging from primary care to emergency medicine, dermatology, surgery, or any other specialty. It really depends on what area you feel you are good at and whether physicians take the time to help train you in their specific area of expertise.

RR: The nice thing about my work is that it ranges across all different ages--from newborns to geriatric patients--and our patients are from all different ethnicities, religions, and socioeconomic groups.  I have patients who are homeless and others who live in the Berkeley hills.  It really is a wide range, which I love. There are many NPs who work with specific populations, like cardiac patients, pediatrics, women's health, patients with genetic disorders, student health services, homeless populations, etc. Patients come to me with all types of issues - respiratory complaints, bladder infections, gynecological concerns, migraines, birth control, back pain, abdominal pain, depression, insomnia, thyroid disorders, chest pain, rashes, STD questions - the list is long!.

CC: What are some of the challenges of your job? What are some things about your job that you enjoy? What are some things that you don't like?

MHA: Besides practicing medicine, I think the biggest challenge is adapting to your role as the "provider." You are responsible for all decisions, tests, and care regarding the patient. It really takes a mental shift.

I would have to say the aspect I enjoy the most about my job is having the opportunity to meet so many different people and help them in some way. As providers, we do what we can to help an injured or sick person and make them comfortable. Much of our job is really preparing, explaining, and walking people through an injury or illness. This gives people comfort at its most basic level. The thing I don’t like: paperwork! 

RR: I enjoy the diversity of the patient population and also the constant learning that is part of my job.  I have access to seven other medical practitioners, including MDs and PAs, and can consult regularly with them which is a great perk. The challenges are trying to fit everything into the 15 minutes we are given for patient urgent visits or follow-ups. It's difficult in the current healthcare system for a clinic to survive without maximizing the number of patients they see. As a result, we only have brief slots in which to see them. 

CC: Why would people see you as opposed to a regular physician/doctor?

MHA: PAs have more technical expertise, like suturing, wound care, etc. I think originally they worked closely with physicians and helped with procedures and so forth before becoming more autonomous practitioners.  

RR: I think people like NPs because they see them as more empathetic and able to explain health information in a way that is understood by the patient. I think this is mostly because the training involves first becoming a nurse which is focused on patient care and caring. Nurses have more one-on-one time with patients while doctors have to make rounds to see multiple patients a day and have much less time with them. Our knowledge base is similar to that of a Family Physician, although our training is not as extensive and is more focused on common illnesses and complaints. When a patient's health issues become more complex, we are able to refer the patient to the appropriate specialist.

CC: What would you say are the main similarities and differences between being an NP and a PA?  

RR: I work with a PA and we largely do the same things in practice. It varies from state to state, but the training is more technically-focused for PAs as far as procedures and so forth. I really don't see any difference when we are actually working day to day, but I think it depends on the clinic.

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