The positions of both the physician assistant (PA) and nurse practitioner (DNP) are vital in the world of healthcare. In addition, these roles provide some of the best opportunities for professionals seeking to earn a higher salary, take on more responsibility, enjoy greater autonomy, and expand their score of practice. Both PAs and DNPs hold advanced positions and work under the supervision of physicians. However, in recent years, PAs and DNPs have gained more independence as states begin to relax the requirements pertaining to physician oversight and collaboration. This is mainly due to the growing shortage of physicians at a time when the healthcare system is facing more demands than ever before.
There is no doubt that both PAs and DNPs are the answer to some of these healthcare shortages. Both positions involve serving the preventative, routine, and primary care needs of diverse populations, particularly in medically underserved inner-city and rural areas. However, while similar, PAs and DNPs are not interchangeable, and there are a few clear differences between the two occupations. If you are considering becoming a PA or DNP but are not quite sure which career is best-suited for you, keep reading to learn more about the differences between a physician assistant and nurse practitioner as well as the degree requirements for both.
What Are the Differences Between a Physician Assistant Degree and a Doctor of Nursing Practice Degree?
Both degree programs prepare students to work as vital members of the healthcare team. However, during these programs, physician assistants rotate through numerous medical specialties, while nurse practitioners are expected to choose a specific specialty such as oncology, acute care, or pediatrics in which they can devote their clinical preparation. While both occupations are noble professions dedicated to the welfare and care of their patients, there are a wealth of differences in terms of education, responsibilities, licensing, and philosophy.
Physician Assistant Degree Programs
Once a student earns a four-year bachelor’s degree in nutrition, sociology, psychology, biology or a similar field, he or she enrolls in a master’s program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Most physician assistant degree programs are extremely rigorous and modeled on the curriculum found in medical schools. They typically take two to three years to complete, during which time students will learn more focused and detailed information regarding the healthcare industry, anatomy, medication, and health. Through the coursework, students will also gain both clinical and medical science experience, with classes covering pathology, pharmacology, emergency medicine, diagnosis techniques, and other topics. Around the second year of the PA program, students focus on areas such as behavioral medicine, gynecology, and general surgery. Once a student completes the physician assistant degree program, he or she is prepared to pass the licensing examination and become a legitimate, full-fledged physician assistant.
Doctor of Nursing Practice Degree Programs
Earning a doctoral degree in nursing will take several more years of study, the exact number of which will depend on the pathway chosen. For instance, most BSN to DNP programs require three to four years of full-time study, while full-time MSN to DNP programs can be completed in one to two years. While it is not required for all advanced nursing jobs, the Doctor of Nursing Practice (DNP) degree can help professionals move into nurse leadership roles and push their careers to the clinical side. However, obtaining a DNP does not automatically make professionals a physician; the training between the two occupations is starkly different. The DNP is ultimately designed to produce nurse leaders who possess the highest level of nursing expertise. These professionals work either in a leadership role or clinical setting and can influence healthcare outcomes through direct patient care, health policy implementation, and organizational leadership. The curriculum builds upon the knowledge and skills developed during the master’s program by including training in quality improvement, informatics, systems leadership, and evidence-based systems. DNP programs are more focused on the humanistic, behavioral, and natural sciences, emphasizing the state of the patient rather than the treatment of the underlying medical affliction. There are several tracks that one can take to earn a DNP, including a BSN-DNP track, an MSN-DNP path, or a post-master’s DNP for those with MPAs, MBAs, or MPHs.
Certification and Licensure
Both physician assistant degree programs and DNP programs prepare graduates for certification and licensure. However, there are significant differences between the two professions. In order to practice, physician assistants must be certified by the only authoritative body regulated to provide this certification: the National Commission on Certification of Physician Assistants. The NCCPA only certifies students who have taken and passed the Physician Assistant National Certifying Exam (PANCE). On the other hand, nurses with a DNP are not required to pass a national certifying examination, but doing so many provide increased opportunities for more responsibilities, higher salaries, and advanced credentials.
State licensing procedures are also slightly different. Physician assistants must complete all educational and clinical prerequisites and submit proof that they have passed the PANCE. Conversely, nurse practitioners typically need only provide evidence that they have graduated from a nursing program. Physician assistants are required to recertify every 10 years by completing 100 continuing medical education credits, while nurse practitioners need to recertify every five years. They may do this by meeting continuing education and clinical practice requirements, typically comprised of 1,000 clinical hours and 75 continuing education hours.
What Are the Differences Between a Physician Assistant and a Nurse Practitioner?
One of the biggest differences between these two occupations is evident in the training they go through to prepare for clinical practice as well as in the ways they approach patient care. Whereas physician assistants pursue programs in accordance with the medical or disease-centered model, nurse practitioners receive training in line with the nursing or patient-centered model.
Although slightly confusing at first, this nuanced and complex distinction begins to make sense as students begin to study medicine or nursing at an advanced level. In its simplest terms, however, it essentially means that the medical model emphasizes disease pathology and approaches patient care by looking primarily at the physiological and anatomy systems that make up the human body. On the other hand, the nursing model views patients and their outcomes as a whole, providing as much attention to a patient’s emotional and mental needs as their physical ones.
This significant difference influences the different specializations that PAs and DNPs may pursue. From the beginning of their graduate studies, PAs typically specializing in a particular area of medicine such as internal or emergency medicine, while DNPs often choose a specific population as their primary specialty of study such as women’s health, geriatrics, and pediatrics. Below, we look at these differences a little more in-depth to learn more about the comparisons between PAs and DNPs.
Differences in Depth and Breadth of Clinical Training
Physician assistant and nurse practitioner programs vary between schools. Each institution has its own strengths based on the specialty areas of its faculty as well as its available resources. Prospective students considering a PA or DNP training program should be sure that the schools they are researching are accredited by either the Accreditation Commission for Education in Nursing or the Commission on Collegiate Nursing Education.
All physician assistants must be accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). However, although this is a blanket certification required of all PAs, educational programs possess their own set of characteristics and requirements that influence the courses they offer. All PAs must hold a bachelor’s degree in order to practice. While there is no one specific major required for admission into a graduate program, many students choose to pursue bachelor’s degrees in fields such as biology, mathematics, chemistry, or physiology. In addition to holding a bachelor’s degree, graduate programs expect applicants to show evidence of experience in the field. An RN license is typically not required for admission.
In terms of the application process itself, aspiring PAs must produce documented evidence of experience in community service activities, shadowing experiences, and/or clinical situations. Graduate schools may also require letters of reference, Graduate Record Examination (GRE) scores, and/or transcripts that indicate academic success of science-based courses. Applicants may be required to submit to a background check. Concentrations that can be found in most physician assistant programs include pathology, orthopedics, transplant surgery, dermatology, or critical care. Sample courses may include: Physician Assistant Roles in Surgery, Professional Communication, Human Anatomy, Internal Medicine, or Imaging and Diagnostics.
It can take aspiring PAs up to six or more years to become a certified PA. A bachelor’s degree is typically comprised of 120 credit hours of study and can be completed in four years. Master’s degrees usually require 35 to 46 credits and can be completed within two additional years. However, some schools offer accelerated bachelor’s-to-master’s programs that allow students to pursue both degrees simultaneously. Most master’s programs require students to complete clinical hours, although the number of hours required depends on the area of specialty and the school itself. In some cases, students must complete up to 2,000 clinical hours before they can work as PAs; some graduate programs assist students in completing these hours through established internships or shadowing opportunities. No matter the academic pathway, prospective PAs should attend schools that are accredited by the ARC-PA.
Aspiring nurse practitioners must first earn their registered nurse (RN) credentials by completing either an associate degree or a bachelor’s degree. Those looking to become DNPs are required to earn a bachelor’s degree in order to be admitted into graduate school. While most undergraduates earn a degree in nursing, some graduate schools accepted bachelor’s degrees in related fields such as biology or physiology. Additionally, aspiring DNPs may be required to show evidence of work experience in the field, although some graduate schools understand that applicants will gain this experience throughout the master’s program. To become an DNP, students are required to earn a Master of Science in Nursing. Common application materials include application fees, GRE scores, proof of RN credentials, personal statements, transcripts, and resumes. A background check may also be required. Concentrations that can be found in most nurse practitioner programs include pediatric, psychiatric, neonatal nursing, anesthesia, or family nurse practitioner. Sample courses may include: Health Policy Issues, Gerontology Nursing Care, Practice Management of Clients and Families, Comparative Health, or Pharmacology.
It can take between six and eight years for students to become nurse practitioners, including the time required for both licensure and coursework. Initially, students earn a four-year bachelor’s degree by completing approximately 120 credits of study. Next, DNPs sit for state licensure by completing the National Council Licensure Examination for Registered Nurses. Those who do not pass the first time may take the exam again up to a maximum of eight times per year. Next, future DNPs must earn a master’s degree, which can take anywhere from one to three years to complete. Keep in mind that students who enroll on a part-time basis may require additional time to earn their degree, while those enrolled in accelerated online programs may be eligible to earn their degree sooner. Finally, graduate students who have earned a master’s degree must complete approximately 750 to 1,400 clinical hours over six months in which they learn about case management, common medical procedures, and diagnostic techniques as well as sit for and pass the certification examination. Keep in mind that there are several pathways that one can pursue to earn a Doctor of Nursing Practice: the BSN to DNP, MSN to DNP, or the RN to DNP.
Differences in Scope and Roles
Next, we look at nurse practitioner vs PA in scope of practice. Students who are interested in pursuing a specialized practice area are more likely to find success as physician assistants. For instance, according to the 2018 Statistical Profile of Certified Physician Assistants reported by the National Commission on Certification of Physician Assistants, approximately 18.5 percent of certified PAs had a surgical specialty. These professionals are responsible for many tasks ranging from the pre-operative stage to the post-operative stage. However, actually conducting surgery is rare, though the American Association of Surgical Physician Assistants reports several minor outpatient procedures that PAs could potentially perform. Other specialization areas that center on a specific area of medicine or disease type include emergency medicine and dermatology.
On the other hand, practitioners who are interested in fields such as neonatal or maternal care may consider becoming advanced practice registered nurses (APRNs). Keep in mind that although nurse-midwives practice at a similar level, they are not typically considered DNPs. However, some APRNs attain dual credentialing in both nurse-midwifery and women’s health DNP roles. Other examples of certification within a particular patient concentration include psychiatric-mental health, primary or acute pediatrics, neonatal, and primary, acute, or family adult-gerontology. DNPs may also further specialize based on the disease type (oncology) or practice setting (emergency medicine).
So, what can a PA and DNP do? Common duties for physician assistants include routinely diagnosing injuries and illnesses, providing treatment plans with no direct supervision from a physician, and performing examinations. Physician assistants also perform different services that might typically be provided by doctors such as prescribing medication. Nurse practitioners are also responsible for diagnosing and treating injuries and illnesses, though this practice area strongly emphasizes health promotion and preventative care. These professionals may also work autonomously under no direct supervision from a doctor. In many states, nurse practitioners can prescribe and practice medicine completely independently.
Although most physician assistants work together with the attending doctor, they rarely require direct supervision. PAs can be found in skilled nursing facilities, hospitals, physicians’ offices, and other settings in which they work as a team alongside the doctor and other healthcare professionals. They may also be found working in schools or for PA-led, standalone clinics. Nurse practitioners also work in environments in which direct doctor oversight is rare such as schools and summer camps, skilled nursing facilities, private physician practices, and hospitals. DNPs may also establish independent partner practices with other DNPs or DNP-led clinics.
In terms of autonomy, each state maintains laws pertaining to the level of independence physician assistants have when working. In all but a few states, PAs are required to work under a collaborative agreement with an attending doctor, but very little of their daily responsibilities require direct supervision. In this sense, nearly all PAs work autonomously. In fact, PAs may even choose to operate independent clinics in which physician involvement is limited to just a few on-site visits each month. Conversely, about 50 percent of states implement laws for advanced practice registered nurses, granting them the freedom to practice as their training and education permit. In other words, in states where laws are developed in accordance with the APRN Consensus Model, DNPs can prescribe and practice without any collaborative agreement with an attending physician. Still, other states do require these agreements, and although DNPs can work without direct supervision, they are not independent practitioners. Many DNPs choose to form partner practices or private practices with other DNPs, although most are employed in hospitals and healthcare facilities as part of a larger team.
Differences in Salary and Job Outlook
As students consider both careers, two of the most important factors likely to be considered are the future employment prospects and the DNP vs PA salary. The job outlook for physician assistants appears promising. According to the U.S. Bureau of Labor Statistics (BLS), employment of physician assistants is projected to grow 31 percent from 2018 to 2028, much faster than the average for all occupations. In 2018, there were 118,800 jobs, which is expected to grow to reach 155,700 positions nationwide by 2028. This rapid growth is largely due to the fact that PAs can earn their degrees faster than physicians while providing many of the same services.
According to the BLS, PAs earned $108,610 per year as of May 2018. The top 10 percent of PAs earned more than $151,580, while the lowest 10 percent earned less than $69,120. In May 2018, the median annual wages for PAs in the top industries in which they worked were:
- Outpatient care centers: $115,560
- Private, local, and state hospitals: $111,540
- Employment services: $109,890
- Physicians’ offices: $107,230
- Private, local, and state educational services: $102,870
Similarly, the job outlook for nurse practitioners also looks positive. While there were 189,100 positions in 2018, the BLS projects that number will grow 28 percent over the next 10 years to reach 242,400 positions by 2028. Additionally, DNPs enjoy salary figures well above the national average. The median annual wage for DNPs was $107,030 as of May 2018 — similar to that of PAs. In terms of top-paying industries, the BLS groups DNPs together with nurse midwives and nurse anesthetists, reporting the highest-paying industries were:
- Private, local, and state hospitals: $120,540
- Outpatient care centers: $115,720
- Offices of other health practitioners: $112,740
- Physicians’ offices: $111,440
- Private, local, and state educational services: $104,310
Keep in mind that the specialty chosen will also affect salary earnings. For example, certified registered nurse anesthetists earned an average yearly salary of $174,790, according to the BLS. The top 10 percent earned more than $208,000 per year, while the lowest 10 percent earned less than $116,820 per year. Other specialties and their annual salaries as reported by Payscale.com include:
- Psychiatric Nurse Practitioner: $104,260
- Neonatal Nurse Practitioner: $100,379
- Orthopedic Nurse Practitioner: $100,035
- Gerontological Nurse Practitioner: $94,551
- General Nurse Practitioner: $94,124
- Family Nurse Practitioner: $93,525
- Pediatrics Nurse Practitioner:$89,092
As we can see based on the data presented above, the salaries of both physician assistants and nurse practitioners are relatively similar. However, the specialty area chosen as well as factors such as location, previous experience in the field, the specific employer, and level of education will affect earnings. In some cases, nurse practitioners who have gone on to pursue a doctoral degree beyond the master’s may be entitled to command more advanced roles that come with additional responsibilities and, ultimately, higher salaries compared to those who have earned a master’s degree.
Conclusion
To put it simply, physician assistants are more disease-centered, while nurse practitioners are more patient-centered. Physician assistants must complete a master’s degree and follow their own certification process: the Physician Assistant National Certification Exam (PANCE). Similarly, nurses advance from a bachelor’s to either a master’s or a doctoral degree in nursing and complete their own required examination. Both parties must maintain their certification by retesting every few years. While both occupations are vital to the field of healthcare and perform many of the same functions such as prescribing treatments, conducting patient assessments, and performing diagnostic tests to determine the health of their patients, there are some stark differences to consider before selecting either a physician assistant degree program or a Doctor of Nursing Practice degree program.
Professionals who seek a well-paying and challenging healthcare career may find themselves deciding between two comparable disciplines: physician assistant and nurse practitioner. Both physician assistants and nurse practitioners are independently licensed providers. While they are not physicians, they may take on roles traditionally reserved for physicians, including prescribing medication and making diagnoses. However, even when they perform similar functions, physician assistants and nurse practitioners draw from different traditions, and they are educated in separate departments or schools. In fact, there are many pros and cons of the PA vs DNP degree to weigh before making a decision. When considering which career is best, students should consider basing their decision on their previous healthcare experience, their interest in particular specialized roles, and their healthcare philosophy.
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