PA vs NP, what really is the difference?

  1. Hello,

    I've been asking about the difference between Physician's Assistants and Nurse Practitioners and I've never gotten a real answer, not even from the schools that offer these programs here. It seems to me that PAs and NPs do pretty much the same things and in many instances they make about the same amount of money. That being the case, why is it that all NP programs are graduate degree programs though many PA programs are associate degree programs.

    If anyone can help me out with this I'd appreciate it.

    Thanks.
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  2. 15 Comments

  3. by   mitchsmom
    I've heard it said that PA's are "mini-doctors" and NP's are "super nurses". It's just a saying but there is an element of truth. If I'm correct, PA's are trained by doctors and are not nurses, and NP's are trained at nursing schools for advanced practice. Because of this, most PA's are more oriented to the medical model than the nursing model of care. I think PA's make slightly more money on average (but as you said, close to the same). They are both considered mid-level practitioners and really they are similar in the grand scheme. Someone can correct me if I'm wrong.
    Last edit by mitchsmom on May 3, '04
  4. by   Traveler
    That's a pretty accurate response I think. NP's are geared toward more the holistic nursing model. Also I believe NP's (in many states) have more autonomy than PA's who have to work under a doctor. NP's collaberate with a doctor. I don't know about prescriptive priv. for PA's but NP's can write rxs. Depending on where you live it seems one is more utilized than the other. In my area the doctors use more NPs and an hour away from here there are more PAs. Usually a NP will have an MSN. Not sure about the educational requirements for the PA. I am a little biased since I am an RN and am returning to school for my NP. For me I prefer the holistic approach of nursing.

    Ann
  5. by   Sheri257
    Check out this thread in the NP section:

    http://allnurses.com/forums/showthread.php?t=59658

  6. by   smk1
    just dropping in to say that most PA programs are bachelor or masters level. I don't think there are too many if any left that are associate degree. from what i understand the differences are that PA's are trained in the medical model and are certified not licensed and work under or in collaboration with a doctor whereas NP's are advanced practice nurses with at least a masters degree that work under their own license and though they may work in a similar capacity or role as a PA they do not legally require "supervision" as the PA will. both are midlevel practitioners and are used interchangeably in many places. NP's have the benefit of being able to work on their own and open their own clinic if they want whereas PA's can't at this time.
  7. by   psychomachia
    Quote from smkoepke
    NP's have the benefit of being able to work on their own and open their own clinic if they want whereas PA's can't at this time.
    From http://www.geocities.com/byupaclub/QA.html

    As of March 2002, Medicare has stated that PA owned clinics are appropriate entities to bill the Medicare program. The PA may own up to 99% of the professional corporation (or limited liability company or limited liability partnership) while the other 1% must be owned by another entity that is able to bill the Medicare program separately, such as a physician.
    Federally certified rural health clinics may be solely owned by the PA. Your state laws may also determine whether a PA is able to own a medical practice/corporation. Payment is made to the corporation, not the PA.

    From http://www.aapa.org/gandp/3rdparty.html

    Effective April 1, 2002, the Centers for Medicare and Medicaid Services issued new Medicare Carriers Manual instructions that expand employment and practice ownership opportunities for PAs. The new policy removes a restriction on PA ownership by allowing a PA to have up to a 99 percent ownership interest in an approved corporate entity (e.g., a professional medical corporation) that bills the Medicare program. Previously, CMS prevented payment to corporate entities in which a PA had any ownership interest. Medicare requires that at least one percent of the corporation be owned by someone other than the PA (e.g., the PAs spouse). There is no requirement for any degree of physician ownership of the corporation. The new policy also removes a provision that prohibited Ambulatory Surgical Centers from employing PAs.
  8. by   smk1
    i stand partially corrected! PA's can own a practice or at least be a majority holder in it. Practically speaking the obvious answer to the OP's question is that PA's are physician assistants trained in the medical model and practicing off of their license and NP's are advanced practice nurses trained in the nursing model and practicing on their own license. both are used in similar roles or capacities.
  9. by   marilynmom
    It just depends on if you are more interested in Nursing or Medicine....neither are the same. PA's most certainly hold a masters degree as do NP's. NP/RNs are not more holistic than PA's or MD/DO's for that matter, that depends on the individual practitioner. PA's of course have rx privileges and do not have to work under a Physicain, most assist in surgery as well depending on what field you go into. A lot have their own practices as well. Less than 1% of NP are in their own practice, I don't know the stats on PA's off hand.

    It just boils down to do you want to practice and be trained in the medical model or the nursing model? I myself, prefer the medical model.....but that is just an individual choice and depends on your interests, etc

    You need to think about what you want to practice and go from there, like if you are interested in NICU then NP would be the way to go, if you like to assist in surgery PA would be the way to go. It is something to thorougly research though, they are both hard!! I think each has their own pro's and con's.

    Marilyn
    Last edit by marilynmom on May 3, '04
  10. by   Kabin
    Quote from marilynmom
    ... PA's of course have rx privileges and do not have to work under a Physicain, ...
    Marilyn
    Maybe it depends on the state, but I understood PAs to have rx priviledge but always with doctor supervision. In general, NPs have more rx autonomy, but it does depend on the state.
    Last edit by Kabin on May 3, '04
  11. by   marilynmom
    Quote from Kabin
    Maybe it depends on the state, but I understood PAs to have rx priviledge but always with doctor supervision. In general, NPs have more rx autonomy, but it does depend on the state.
    Physician assistants can prescribe in 47 states *without* any physician countersignature needed. NP's can prescribe in 48 states without physician countersignature....the same really for both.


    Here are some good links I found online really quick for the OP and there are many more:
    http://www.blitzresearch.com/site/in....asp?From=site
    http://www.gapa.ws/pec/faq.htm#13c

    Basically they are both mid-level providers who work in collaboration with physicians (at least for awhile, when both NP and PA's can go into practice for themselves though less than 1% actually do that). You either want to practive medicine or nursing, it's as simple as that really.

    Marilyn
  12. by   Kabin
    marilynmom,

    Here's a quotes directly from one of your supplied websites... http://www.blitzresearch.com/site/in....asp?From=site website...

    "PAs always work under the supervision of a physician. ... In contrast, NPs may work independently or in collaboration with a physician and must have an RN license before being accepted into an NP educational program."

    To me, this sounds like more of a difference than you're suggesting.
  13. by   marilynmom
    [QUOTE=Kabin]marilynmom,

    Here's a quotes directly from one of your supplied websites... http://www.blitzresearch.com/site/in....asp?From=site website...

    "PAs always work under the supervision of a physician. ... In contrast, NPs may work independently or in collaboration with a physician and must have an RN license before being accepted into an NP educational program.

    To me, this sounds like more of a difference than you're suggesting. "
    QUOTE]

    What?! LOL I have not "suggested" anything....

    PA's do not "always" work under the supervision of a physician, that is simply not true first of all. Both NP and PA may have their own practices (which I am sure depends on the state). When I go to the doc a lot of times the "doc" I see is a PA. With my daughter (she is 6) goes to her clinic she normally see's the NP.

    The only difference I have ever tried to point out is that one practices and is trained in medicine and the other is trained in and practices nursing (and for some people that is a big difference to decide upon....the OP may have no desire be trained in medicine)

    I have said over and over it all depends on if you want to practice MEDICINE or NURSING....that is the difference, simple as that (and that is a difference). The OP just wanted to know the difference and those sites give general info about the differences.

    Neither are "better" than the other if that is what you are suggesting and I have certainly never suggested that.

    Marilyn
    Last edit by marilynmom on May 3, '04
  14. by   career seeker
    I think that the regulations may vary betwwen states. In alaska a PA must work under a Doctor (although the doc does not need to be in the office). I worked in a federally-funded rural clinic where the doc would come up once a month and see the more complicated cases and do a chart review. Other than that, the PA's did everything (aside form signing off on DNR's). They could prescibe meds, including controlled narcotics.

    I now work for a PNP. she does not report to a physician and does own her practice.

    From what I know, the NP is a liscenced provider and and a PA is a certified provider. As for the holistic approach, I would have to agreee with the poster who siad that it depends on the provider. The PA's that I worked with were some ofthe most patient centered providers I have ever worked with. And the NP seems to have $$$ as her top priority.

    I am aslo looking into these two professions and the one thing that draws me more towards the Np is the fact that PA's are not really recognized in other countries. My husband and I intend to travel after I graduate and if I am to work oversees, I will not be a bel to do it as a PA

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