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Do You Know the Differences Between NPs and PAs?

Nurse practitioners (NPs) and physician assistants (PAs) are increasingly mentioned as a collective solution to the nation’s primary healthcare shortage. There are approximately 234,000 NPs and 115,500 PAs in the United States providing cost-effective patient care, preventive care, and health promotion. But what exactly is the difference between these two groups of clinicians? Practicing Clinicians Exchange provides a quick snapshot of how these growing professions compare:

NURSE PRACTITIONER

Definition

  • Registered nurse (RN) with advanced education and clinical training
  • Provides a wide range of healthcare services, including the diagnosis and management of common as well as complex medical conditions
  • Practices independently or in collaboration with physician, depending on state requirements

Philosophy/Model

  • Medical/nursing model
  • Patient-centered
  • Focuses on health promotion, disease prevention, health education, and counseling, in addition to health assessment, diagnosis, and treatment

Certification/Licensure

  • Nursing accreditation and graduate education (master’s or doctoral degree), with preparation in the NP role and at least one specialty population
  • National board certification in acute care, adult, family, gerontology, neonatal, oncology, pediatric, psychiatric, or women’s health specialty
  • Major national certifying agencies: American Association of Nurse Practitioners, American Nurses Credentialing Center

Recertification

  • Recertified every 5 years
  • May sit for appropriate examination or meet clinical practice and continuing education (CE) requirements
  • Minimum of 1000 hours of clinical practice as an NP in area of specialization and 75 contact hours of CE relevant to the area of specialization
  • Pharmacology credits required for some recertification

Scope of Practice

  • Authorized to practice independently without physician oversight in 23 states and DC; in remaining states, practice with varying degrees of physician involvement
  • Prescriptive authority in all 50 states and DC

Third-Party Coverage and Reimbursement

  • Eligible for certification as Medicare and Medicaid providers
  • Generally receive favorable reimbursement from commercial payers

PHYSICIAN ASSISTANT

Definition

  • Nationally certified and state-licensed medical professional with advanced education and clinical training; trained in the medical model alongside physicians
  • Practices medicine in a collaborative team with physicians and other healthcare providers
  • May diagnose, treat, prescribe, and perform surgery—there are no limits on what a PA may do
  • Any setting in which you see a physician, you will likely see a PA

Philosophy/Model

  • Medical/physician model
  • Disease-centered; emphasis on the biologic/pathologic aspects of health, assessment, diagnosis, and treatment
  • Team-approach relationship with physicians

Certification/Licensure

  • Graduate education
  • Separate accreditation and certification bodies require successful completion of an accredited program

Recertification

  • Requires 100 continuing medical education (CME) credits every 2 years and examination every 10 years
  • PA certification maintenance mirrors physician maintenance of certification process

Scope of Practice

  • The scope of supervision of PAs by physician is determined by state regulations
  • Prescriptive authority in all 50 states
  • Controlled substance prescribing restrictions in Kentucky
  • Onsite collaboration not required

Third-Party Coverage and Reimbursement

  • Eligible for certification as Medicare and Medicaid providers
  • Generally receive favorable reimbursement from commercial payers
  • Embraced by large healthcare systems and private practices for ability to deliver high-quality, cost-effective care

Sources: aanp.org; aapa.org; deadiversion.usdoj.gov/drugreg/practioners/mlp_by_state.pdf; nursecredentialing.org/Certification/CertificationRenewal/RenewalFAQs

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