FNP or PA: How to decide between these two options

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Nurse practitioner talking with care team.

Nurse practitioner (NP) and Physician assistant (PA) are both popular career paths within health care. However, while overlap exists between these roles, there are key distinctions to understand. Most important are the different job responsibilities and requirements for education and certification.

A graduate education will be highly important. At the very least, a master’s degree is needed to become either a nurse practitioner or physician assistant.

NPs and PAs who specialize in family care may seek a doctorate to advance their careers or gain new skills. Those who plan to become a family nurse practitioner may want to investigate how they can benefit from earning an online doctor of nursing practice. Let’s further compare and contrast the two roles:

What is a PA?

According to the American Academy of Physician Assistants (AAPA), PAs are medical professionals who are educated to assist physicians by diagnosing illnesses, developing and managing treatment plans, and prescribing specific medications.

Other core job responsibilities may include:

  • Taking medical histories and performing physical assessments
  • Ordering and interpreting diagnostic tests
  • Assisting in surgery or performing procedures
  • Participating in clinical research
  • Leading rounds in hospitals or nursing homes

PAs work as part of a team of care professionals, alongside either a physician or a surgeon. However, they usually serve as the main point of contact for the patient on questions related to care. The relationship between the attending physician and the PA is a close one. States require PAs to have practice agreements with specific physicians to practice medicine.

What’s the job outlook for PAs?

The job outlook for physician assistants is largely positive. According to the U.S. Bureau of Labor Statistics, the profession is expected to see a rate of job growth much higher than average. Between 2018 and 2028, the BLS estimates PA employment will climb 31%, far above the 5% rate predicted for all occupations.

PAs are found in many diverse care settings, which include:

  • Hospitals
  • Urgent care centers
  • Retail clinics
  • Community clinics
  • Outpatient offices
  • Educational institutions
  • Correctional facilities

In terms of specializations, the AAPA found the most common areas of practice for PAs in 2019 were:

  • Surgical subspecialties (27.4% of practicing PAs in the U.S.)
  • Primary care (20.8%)
  • Internal medicine subspecialties (12.2%)
  • Emergency medicine (9.4%)
  • Pediatric subspecialties (1.4%)
  • Other practice areas including psychiatry, hospice care, obstetrics and gynecology (28.8%)

The median annual salary for PAs in 2018 was $108,610, according to the BLS. That range may increase depending on factors like work environment, advanced education and clinical experience.

How to become a PA

The first step to becoming a PA is earning a bachelor’s degree. The most important step, arguably, is graduating from an accredited PA program. According to the AAPA, PA programs generally last 26 months (three academic years) and award master’s degrees. Courses cover anatomy, physiology, pharmacology, microbiology, behavioral science and medical ethics, among other topics. Completion of a PA program entails more than 2,000 hours of clinical rotations. If interested in further education, PAs can pursue various doctoral degrees. According to the Physician Assistant Education Association (PAEA), the doctor of medical science (DMSc) is a terminal degree suited for clinically focused PAs.

Once you’ve earned a master’s degree and chosen a specialization, it’s time to get certified. Graduates of PA programs take the Physician Assistant National Certifying Exam (PANCE) administered by the National Commission on Certification of Physician Assistants (NCCPA).

Finally, PAs need to receive licensure by the state in which they will practice. Also, continuing education is needed to maintain their certification: 100 hours every two years and a recertification exam every 10 years.

Nurse practitioner looking at X-rays.What is an NP?

A nurse practitioner is an advanced practice registered nurse (APRN) who has extensive clinical preparation and expertise. NPs predominantly practice in delivering primary care to diverse patient populations. Family nurse practitioners (FNPs), for example, provide care throughout the family’s lifetime, from expecting couples to young parents to retired empty-nesters. According to the American Association of Nurse Practitioners (AANP), 87% of NPs are prepared in primary care. Some core job responsibilities include:

  • Conducting physical examinations and recording medical histories
  • Ordering and interpreting diagnostic tests
  • Diagnosing patients and creating treatment plans
  • Prescribing and managing medications
  • Counseling patients and their families
  • Delivering preventive care and promoting healthy lifestyles

Looking at this list, it’s hard not to notice the overlap between NPs and PAs. These two medical professionals operate closely along the same lines of practice.

What’s the job outlook for NPs?

Nurse practitioners and prospective NPs also benefit from a healthy job market. BLS predicts that employment of NPs will grow 26% between 2018 and 2028. The similarities don’t end there, as the 2018 median annual salary for NPs was $107,030. The employers for an NP include:

  • State, local and private hospitals
  • Outpatient clinics
  • Long-term nursing facilities
  • Educational services
  • Physicians’ offices
  • Urgent care
  • Prompt care
  • Health Departments

The top clinical focus areas of practicing NPs in 2018, according to AANP, include:

  • Family (66.9%)
  • Adults and geriatrics (19.8%)
  • Acute care (4.8%)
  • Pediatrics (4%)
  • Women’s health (2.7%)

How to become an NP

In short, these are the steps to become an NP:

  1. Earn a bachelor of science in nursing (some master’s programs may accept associate degrees in nursing, nursing diplomas and non-nursing bachelor’s)
  2. Become a registered nurse by passing the National Council Licensure Examination (NCLEX-RN)
  3. Earn a master of science in nursing or a doctor of nursing practice
  4. Pass a certification exam administered by a national board (like one for FNPs)
  5. Secure licensure by the state in which the NP will practice

Is there a difference?

Despite the similarities, there are a few ways in which the roles of NP and PA are distinguished:

  • PAs are generally educated through a medical philosophy of disease management. This means PAs may naturally have job duties and professional interests more related to the the pathological aspects of care such as diagnosing, analyzing and treating conditions.
  • NPs, on the other hand, may be more observant of patient factors, as they are educated through a holistic approach. An NP focuses on the entire patient when designing a treatment plan, whereas a PA may recommend a treatment based on the medical model.
  • Depending on the state in which you reside, many NP’s may seek full practice authority and practice independently, whereas a PA works alongside either a physician or a surgeon and may not practice independently.
  • PAs are more likely to be generalists and many have nonmedical bachelor’s degrees, as a specific undergraduate degree is typically not required. Also, there is one major certification for PAs: the Physician Assistant-Certified (PA-C) designation offered by the National Commission on Certification of Physician Assistants (NCCPA). Other certificates of added qualifications (CAQs) can be obtained for specialties, like cardiovascular and thoracic surgery.
  • NPs pursue certification for specific populations, such as family care, gerontology, adult care or prenatal care. There are multiple bodies that offer NP certifications: including The American Academy of Nurse Practitioners National Certification Board (AANPCB), The American Nurses Credentialing Center (ANCC), American Association of Critical-Care Nurses (AACN), The Pediatric Nursing Certification Board (PNCB) and the National Certification Corporation.

Earn your DNP online from Bradley

NPs are already highly skilled, but they still have an opportunity to grow. The DNP is the terminal degree for clinically focused nurses like APRNs. Completing such a program can provide you with new skills, knowledge and experience to improve and manage care in real-life settings.

Want to learn more about how you can earn your DNP-FNP from Bradley online? Contact an enrollment advisor today.

Recommended reading:

Should I Move from an MSN to DNP?

What is a DNP Degree?


American Academy of Physician Assistants



Physician Assistant Education Association

Bureau of Labor Statistics


American Association of Nurse Practitioners