Exploring the Distinctions Between Nurse Practitioners and Physician Assistants

The mounting concern of physician shortages in the United States is placing new and increased demands on the healthcare system. In an effort to combat this issue, states have lessened the requirements for physician oversight in regard to nurse practitioners and physician assistants.1,2These health professionals have thus taken on more responsibility serving the primary and preventative care needs of the population.1Despite their increased prevalence many people still do not understand what differentiates these two professions. This blog post will highlight the specific aspects that help to distinguish nurse practitioners from physician assistants. and Wendy’s article



        Nurse practitioners are registered nurses (RNs) with advanced degrees and training. Becoming a registered nurse requires an undergraduate degree in nursing, as well as a passing score on the National Council Licensure Examination. Additionally, in order to be designated as a nurse practitioner a person must also attend a nurse practitioner program. Nurse practitioner programs typically award a master’s in nursing and last 2-4 years, but some programs are now offering doctorate-level degrees.3

Physician assistant’s must have an undergraduate degree and complete the pre-requisite courses required at their corresponding physician assistant program. The majority of physician assistant’s programs require chemistry, physiology, anatomy, and biology courses for acceptance. Most accredited physician assistant’s programs are approximately 3 years and award a master’s degree upon graduation. Passing the Physician Assistant National Certifying Exam and obtaining a state license is a requirement prior to practicing at a clinic.4

Many hours of clinic experience in various healthcare setting are obtained by each of these professions prior to receiving their respective degrees. Physician assistant programs have students spend on average 2,000 or more hours in a clinical setting, and programs for nurse practitioners include 500-700 clinical hours into their curriculum.1However, it is important to note that the majority of nurses who are in nurse practitioner programs have received additional hours working in a clinical setting as a RN prior to starting their nurse practitioner program.3


Approach to Patient Care

The training that is received during education for each of these professions differs in the model that is taught. Nurse practitioners are instructed based on a patient-centered model, whereas physician assistants follow a disease-centered model.  The patient model encourages active collaboration and shared decision-making between patients and their providers. Based on this model the provider treats patients not only from a clinical/physical perspective, but also in terms of the patient’s overall well-being.1,5The disease-centered model taught in most physician assistant programs emphasizes clinical diagnosis and medical intervention in the treatment of a disease or its symptoms based on the anatomy and physiology of the human body.1,6


Roles & Physician Oversight

        Both nurse practitioners and physician assistants diagnose illnesses and injury, perform examinations, and implement treatment plans within the scope of their training and legal authority.1Depending on the state in which the person is practicing the laws regarding the degree of required physician oversight can vary.

In about half of the states, nurse practitioners are allowed to work independently without having a collaborative agreement with a physician. In states where collaborative agreements are required, nurse practitioners may perform their routine job duties without direct supervision. Most nurse practitioners work in hospitals as members of healthcare teams, but they can also form private practices in accordance with the state’s laws regarding physician collaborative agreement requirements.1

Most physician assistants are required by law to work in collaborative agreements with a designated physician. However, they may rarely operate under direct supervision depending on the setting they are practicing in. In acute care hospitals they often work as part of a team alongside physicians and other health professionals, whereas at a standalone outpatient clinic they may operate the clinic independently or even manage it.1



        At the time nurse practitioners enter into their graduate program, they are required to select a specific patient population to focus on as their primary specialty. Nurse practitioners may further specialize by practice setting and disease type.1It is not a requirement for physician assistants to determine an area of specialty, but many will ultimately decide to specialize in a particular area of medicine (ex: surgery, family medicine, emergency medicine).7


Medical Malpractice Lawsuits

As you can see, although many similarities exist between nurse practitioners and physician assistants, there are still plenty of differences that set these two professions apart. Since laws between these professions and across state lines vary in relation to the degree of physician oversight required, it is important to become familiar with the laws specific within each state and profession. Whether or not an overseeing doctor is liable in a medical malpractice lawsuit against a nurse practitioner or physician assistant could ultimately be decided by these state laws.



  1. Nurse Practitioner Vs. Physician Assistant. Nursejournal.org. https://nursejournal.org/nurse-practitioner/np-vs-physician-assistants/. Updated 2018. Accessed October 30, 2018.


  1. New Research Shows Increasing Physician Shortages in Both Primary and Specialty Care. News.aamc.org. https://news.aamc.org/press-releases/article/workforce_report_shortage_04112018/. Published April 11, 2018. Accessed October 30, 2018.


3.How Do I Become a Nurse Practitioner? Nursepractitionerschools.com. https://www.nursepractitionerschools.com/faq/how-to-become-np. Accessed October 30, 2018.


  1. Become a PA. aapa.org. https://www.aapa.org/career-central/become-a-pa/. Accessed October 30, 2018.


  1. What Is Patient-Centered Care? Catalyst.nejm.org. https://catalyst.nejm.org/what-is-patient-centered-care/. Published January 1, 2017. Accessed October 30, 2018.


  1. Foundation of US Health Care Delivery. Jblearning.com. http://www.jblearning.com/samples/0763763802/63800_CH02_Final.pdf. Accessed October 30, 2018.


  1. What is a PA? aapa.org. https://www.aapa.org/what-is-a-pa/. Accessed October 30, 2018.