I don't think you're exactally correct. Both PAs and nurse practitioner's need the backing of an MD. In California, PA's are more common and in demand. A nurse practitioner can have his or her own office, while a PA cannot, but they still have to have an MD behind them. also, I note that the pay scale is a little higher for PA's in California. (No, I'm not a PA, and my daughter plans to be a FNP.)