According to the Association of American Medical Colleges, there may be a substantial physician shortage by 2034, especially in specialty and primary care. While the U.S. population grew only 0.1% in 2021—the slowest rate since the founding of the United States—any shortage of health care professionals is concerning.
One potential fix involves expanding the scope of practice (the services that qualified health care professionals are permitted to perform) for patient care providers who aren’t medical doctors. Physician assistants, or PAs, and nurse practitioners, or NPs, are two examples of medical professionals who can care for patients with limited physician oversight. Existing physician shortages have already driven many states to adopt expanded scope of practice laws for PAs and NPs.
If you’re exploring patient-facing medical careers, the fact that PAs and NPs diagnose, treat and monitor patients in much the same way physicians do without going to medical school may be compelling. For example, students in the University of Pittsburgh’s 82-credit Physician Assistant Studies Hybrid (PAS-Hybrid) program enter the medical field after just two years of study. Even so, physician assistants and nurse practitioners are essential health care professionals capable of making as profound an impact on the lives of their patients as Medical Doctors (MDs) and Doctors of Osteopathic Medicine (DOs).
Answering the question ‘Should I be a physician assistant or a nurse practitioner?’ is challenging. Determining which path is right for you is a matter of exploring each to better understand how they are similar, how they differ and which option will be more personally rewarding in the long term.
Dedicated to expanding access to care and transforming health and wellness, physician assistants are licensed clinicians who practice medicine in every specialty and setting. While physician assistants are technically medical support staff—and often work under a supervising physician—they are legally qualified to diagnose, monitor and treat patients and often work in relative autonomy. Physician assistants work in family practices, hospitals, outpatient clinics, surgical centers, community health centers, nursing homes, mental health facilities and the armed forces.
Unlike other patient-care professionals, physician assistants can easily move between most specialties. PAs work in acute care, family medicine, neurology, oncology, psychiatry, emergency medicine and surgery. Depending on their specialty and setting, a physician assistant’s responsibilities may include conducting physical exams, interpreting diagnostic tests, diagnosing illnesses and injuries and prescribing medication. Some people in the PA profession conduct clinical research or work in academia.
The American Academy of PAs (AAPA) estimates that there are approximately 150,000 PAs practicing in all 50 states and the District of Columbia. Of these, just over 50% work in group practices. About a quarter work in hospitals, and the rest work in outpatient care centers, educational institutions and government agencies. The total number of physician assistants in the U.S. will likely grow over time as the need for primary care providers increases. When the congressional Office of Technology Assessment studied health care services provided by physician assistants, it discovered that “PAs provide health care that is indistinguishable in quality from care provided by physicians.”
Nurse practitioners are advanced practice registered nurses, or APRNs, with years of clinical care experience and a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP). Like PAs, NPs can practice semi-autonomously—though how much independence they have varies by state. Approximately 325,000 licensed NPs work in various medical specialties in the U.S.—mainly in primary care settings. In about half of states, nurse practitioners must have a collaborative agreement with, or work under the guidance of, a supervising physician. However, NPs can work independently in some states and even open practices.
NPs are typically certified in one or more patient areas, such as family medicine, pediatrics, women’s health or oncology. While nurse practitioners always take on more responsibility than the typical RN, their responsibilities are largely determined by their employer, work environment and specialty. Some NPs create care plans, examine and diagnose patients, prescribe and dispense medications, perform minor medical procedures and serve as primary care providers. Others manage registered nurses and medical assistants.
There are more similarities than differences between physician assistants and advanced practice registered nurses when it comes to scope of practice. These health care providers can examine patients, diagnose illnesses and injuries, create treatment plans, and write prescriptions. Some sources assert that nurse practitioners treat the whole patient (acknowledging how individual circumstances affect health) while physician assistants treat illnesses and injuries, but this simply isn’t true. PAs may look at pathology, biology, diagnostics and treatment options first, but they also include psychosocial factors in their assessments of patients.
The primary differences between PAs and NPs involve training and oversight.
PA training is based on the traditional medical school education and includes a broader range of clinical practice experiences. Physician assistants train as generalists. PA students complete at least 2,000 hours of rotations (versus 600 for NPs) and receive hands-on experience in a wider variety of medical specialties. Meanwhile, nurse practitioners typically train in a specialty area based on patient population (e.g., pediatrics or OB/GYN). As a result, NPs have more practice freedom than PAs in many states but less flexibility when moving between practice areas. PAs do not need additional education to switch specialties. Nurse practitioners must recertify.
Physician assistants work under the supervision of MDs or DOs in all 50 states—though what constitutes supervision differs widely. PAs are licensed by the same medical boards as physicians, and licensing is built around physician-PA collaboration. In 47 states, a PA’s scope of practice is determined by a supervising or collaborating physician. Meanwhile, many state licensing boards treat NPs as independent patient care providers. In 24 states, nurse practitioners have Full Practice Authority (FPA), which means they can serve as primary care providers without physician oversight. In an additional 14 states, NPs practice semi-independently in collaboration with a physician.
There is widespread support for giving PAs the same independent practice authority as NPs, which would establish separate state boards for PAs in more states and make physician assistants eligible for direct reimbursement.
Before you can answer the question ‘Should I become a physician assistant?’, you need to research the degrees you need to become a PA and the physician assistant career path that follows. Before applying to PA master’s programs like Pitt’s PAS-Hybrid, you may need to complete additional bachelor’s-level coursework in chemistry, biology, physiology, anatomy, microbiology, statistics and other STEM subjects.
You must also amass the required hours of patient care experience or health care experience. Like other PA school programs, the School of Health and Rehabilitation Sciences admissions committee requires that Physician Assistant Studies Hybrid Program applicants have a minimum of 500 hours of direct patient care experience. Keep in mind that what constitutes ‘direct patient care experience’ varies from university to university. In some cases, experience in medical support fields such as patient advocacy, medical translation, patient safety compliance and clinical research is sufficient. Students in PA programs are often already RNs, EMTs, paramedics, medical assistants, nurse’s aides or PT/OT assistants.
For a complete list of paid and volunteer patient care positions that meet the Pitt PAS-Hybrid application requirements, contact an enrollment advisor.
Once you have a four-year degree and sufficient experience, you can enroll in a graduate-level PA studies program. Typically, master’s programs for physician assistants last about two years and have two parts.
The first year of a physician assistant program is typically focused on a didactic or instructional core covering clinical practice fundamentals, pharmacology, working with patients, diagnostic and therapeutic procedures, health policy and surgical practice. Pitt’s PAS-Hybrid program is organized so that students can complete much of the synchronous Year One coursework virtually. They only visit the Pittsburgh campus for two immersive learning experiences in the didactic year and one the week of graduation in the clinical year.
The second year of most PA school programs consists of clinical rotations in which students amass thousands of hours of experience in several health care settings and specialties. According to the AMA Journal of Ethics, “PA education more closely resembles a condensed version of medical school than does any other health profession’s curriculum.”
After completing a physician assistant studies program, you must take and pass the 300-question, five-hour, multiple-choice Physician Assistant National Certifying Exam (PANCE). At that point, you are eligible to apply for state licensure. Be aware, however, that licensing requirements for PAs vary by state. The same is true for licensure fees and application timelines. You can consult the AAPA’s list of state requirements for PA licensure and license renewal to see what the requirements are in your state.
To become a nurse practitioner, you must first become a licensed registered nurse (RN) and earn a bachelor’s degree—which may or may not be a Bachelor of Science in Nursing (BSN). RN-to-BSN programs geared toward RNs with ADNs take just one or two years to complete. Students in BSN programs take courses in anatomy, care coordination, emergency care, nutrition, physiology and public health nursing. Additionally, most advanced practice nursing programs require applicants to amass at least two years of clinical care experience. This can be achieved in family practices, hospitals, surgical centers, long-term care facilities or an emergency room.
Once you have the required clinical experience, you can enroll in an accredited Master of Science in Nursing (MSN) program. All nurse practitioners have master’s degrees—some even have doctoral degrees. In most MSN programs, you will choose a focus patient care area and graduate ready to work in one specialty area of health care. Once you complete an MSN program, you can sit for the national NP Certification Board exam, and provided you pass, obtain your NP licensure.
Unfortunately, looking at job prospects probably won’t help you answer the ‘physician assistant or nurse practitioner’ question. That’s the bad news. The good news is that according to the U.S. Bureau of Labor Statistics (BLS), these medical professions are growing rapidly and providers in both earn about $121,000 annually. The BLS predicts employment of PAs will increase by 31% between now and 2030, while employment of advanced practice registered nurses will increase by 45%. However, don’t assume the abundance of new jobs for nurses makes nursing the better career pathway. The BLS prediction applies to all APRNs, not just nurse practitioners. Some of those new positions for APRNs will be for nurse anesthetists, nurse midwives and clinical nurse specialists versus independently practicing NPs.
The choice is yours—and it’s not an easy one to make. U.S. News & World Report ranks physician assistant #1 in its lists of the 100 best jobs in the United States, best health care jobs, and best STEM jobs. NPs are hot on the heels of PAs in their rankings, however. Nurse practitioner ranks #3 in its lists of the 100 best jobs in the United States, #2 in best health care jobs and #3 in the best STEM jobs. Both are essential members of collaborative health care teams.
Choosing may become easier as you consider the following:
As mentioned, these positions have similar job responsibilities, and it may not be long before both have FPA in most of the country. However, PAs come out on top with better work-life balance and lower rates of burnout than nurses or doctors. According to a Physician Assistant Education Association Student Survey, the number one reason people want to become PAs is to work in medicine and have a personal life.
If you’re an experienced RN, becoming a nurse practitioner may take less time, allowing you to make a bigger impact more quickly. But if you have a STEM background and health care experience, you may already be qualified to enroll in a PA program. In that case, becoming a physician assistant will take less time and give you more career flexibility. Keep in mind that the qualities that make PAs great aren’t necessarily the same as those that great NPs share.
Some states are more NP-friendly, while others are more PA-friendly. Consider which path will let you do the most good and give you the level of autonomy you prefer.
Another way to determine which path is the correct one for you is to shadow actual providers. In a shadowing program, you can see first-hand what the day-to-day responsibilities of PAs and NPs are like. Once you understand how you will spend your days if you become a physician assistant or nurse practitioner, you can make an informed choice about which career will be the best fit.
Ultimately, there’s no right or wrong choice. Whatever career path you choose, your medical education will be comprehensive, and your potential to do good will be unparalleled. Becoming either a PA or an NP is a big decision, but you will earn the greatest reward in both scenarios: the ability to help others.
Ready to learn more about enrolling in the University of Pittsburgh School of Health and Rehabilitation Sciences’ PAS-Hybrid? Review the program’s application deadlines or sign up for an upcoming enrollment event before you apply.
The ARC-PA has granted Accreditation-Provisional status to the University of Pittsburgh Physician Assistant Studies Hybrid Program sponsored by University of Pittsburgh. Accreditation-Provisional is an accreditation status granted when the plans and resource allocation, if fully implemented as planned, of a proposed program that has not yet enrolled students appear to demonstrate the program’s ability to meet the ARC-PA Standards or when a program holding accreditation-provisional status appears to demonstrate continued progress in complying with the Standards as it prepares for the graduation of the first class (cohort) of students.
Accreditation-Provisional does not ensure any subsequent accreditation status. It is limited to no more than five years from matriculation of the first class.
The program’s accreditation history can be viewed on the ARC-PA website at http://www.arc-pa.org/accreditation-history-university-of-pittsburgh-hybrid/.