Nurse Practitioner or Physician Assistant: Difference in Salary and Benefits

By: Kathleen Gaines BSN, RN, BA, CBC

Due to the implementation of the Affordable Care Act and the aging population, the demand for advanced practice medical professionals to take the reins on caring for a big portion of them has grown immensely. That means that nurse practitioner (NP) and physician assistant (PA) are two professions playing a vital role in America’s changing healthcare panorama.

  • What is a Nurse Practitioner (NP)? 
    • A Nurse Practitioner (NP) is an Advanced Practice Registered Nurse who has additional responsibilities for administering patient care than RNs. NP model draws from the nursing tradition, one that includes a whole person and wellness approach.
  • What is a Physician Assistant (PA)?
    • A Physician Assistant (PA) is a Master’s prepared individual that works interdependently with physicians who are licensed to diagnose and treat illness and disease and to prescribe medication for patients. The PA tradition draws from a medical model.

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Key Differences Between NP and PA

    • What is the difference between NP and PA salary? 
      • According to the Bureau of Labor Statistics, the median pay for nurse practitioners for 2018 was $107,030 with salary ranges from $85,880 to $143,480.
      • According to the Bureau of Labor Statistics, the median pay for physician assistants for 2018 was $108,610 per year or $52.22 per hour. The salary range is $61,230 and $151,850.
    • Does it take longer to become an NP or PA? 
      • Program length is roughly the same after earning a bachelor’s degree. Both are Master’s level programs and can be completed in 2-3 years depending on the specific program.
    • What are the difference in program costs?
      • NP school tends to be cheaper because the classroom portion is often completed online while PAs must be on campus for the program. 
      • The average cost for NP school is between $35,000 and $70,000.
      • The average cost of PA school is between $60,000 to $90,000.
    • Can NPs and/or PAs operate their own practice? 
      • PAs can never operate their own practice. By law, they are required to work under the direct supervision of a physician or a surgeon.
      • NPs can operate their own practice in states that allow full authority. This is very state-specific. See below for more information on these states. 

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  • What is the difference in the scope of practice of NPs and PAs?
    • Nurse practitioners are educated to serve a specific population while Physician assistants have a more general background.
    • Physician assistants tend to have a surgical specialty while NPs are more at the patient’s bedside throughout the hospitalization.
  • What is the difference in job outlook for NPs and PAs?
    • According to the U.S. Bureau of Labor Statistics, the need for nurse practitioners is expected to grow by 31% by 2026. This is much faster than the national average of other healthcare-related professions included Registered Nurses. 
    • According to the U.S. Bureau of Labor Statistics, the need for physician assistants is expected to grow by 37% by 2026. This is one of the largest growing fields in the healthcare industry. 
  • How long does certification last?
    • NP recertification is every two years and requires a minimum of 1,000 clinical hours in your certified specialty and continuing education hours.
    • PA recertification is two parts. Every two years, 100 continuing education hours are required and every ten years a recertification exam must be passed.

NPs and PAs include direct patient care at the advanced practice level, including working independently or collaboratively. With so many baby boomers aging, the need for more graduate-level health care providers is increasing by the day. Plus, the need for these professions has escalated because of the Affordable Care Act with more than 40 million more people added to the primary care systems after finally getting health insurance in the last two years.

“Physician assistants and nurse practitioners are more cost-effective in a health care system, and there has been an amazing up swell interest in how to integrate them into hospital systems in more and more ways,” says Jonathan Bowser, director and associate dean of the Physician Assistant Program at the University of Colorado Anschutz Medical Campus.

Here is a look at the growth outlook, salary range, strengths and advancements of a PA and an NP.

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Physician Assistant: Growth Outlook, Salary Range & Scope of Practice

Job Outlook

According to the U.S. Bureau of Labor Statistics, the need for physician assistants is expected to grow by 37% by 2026. U.S. World News & Report 2019 ranked PAs as #1 in best health care jobs, #3 in 100 best jobs, and #3 in best STEM jobs. 

An increase in the number of patients with chronic diseases, such as diabetes, are causing an increasing demand for healthcare providers. Physician assistants often provide preventive care and treat the sick. Increases in medical technology and access to healthcare services further strains the healthcare system requiring an increase in advanced practice providers.

Salary Range 

According to the Bureau of Labor Statistics, the median pay for physician assistants for 2018 was $108,610 per year or $52.22 per hour. The salary range is $61,230 and $151,850. The highest-paying positions for physician assistants can be found in outpatient care centers, general medical and surgical hospitals, and physician’s offices. 

The BLS reports that in May 2018 the highest paying states for physician assistants  were:

  • Connecticut - $125,610
  • Washington - $123,980
  • Alaska - $122,260
  • Hawaii - $121,120
  • California - $117,230

The top five states with the highest concentration of jobs and locations for physician assistants include:

  • Alaska
  • Connecticut
  • Montana
  • New York
  • South Dakota

The BLS also reported that the top five metropolitan cities for physician assistant pay were:

  • Danbury, CT - $146,000
  • Salinas, CA - $145,700
  • Visalia-Porterville, CA - $141,400
  • Olympia-Tumwater, WZ - $139,770
  • Spokane-Spokane Valley, WA - $138,900

The top five non-metropolitan cities for PA pay, according to the BLS, were:

  • East Central Illinois - $148,810
  • Big Thicket Region of Texas - $130,060
  • Balance of Lower Peninsula of Michigan
  • Central Louisiana - $124,890
  • Northwest Minnesota - $124,870

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Requirements to Become a Physician Assistant

The first step in becoming a physician assistant is earning a bachelor’s degree. Most individuals take a science-heavy course load with specific requirements as these are needed when applying for physician assistants. 

Requirements often include coursework in:

  • Chemistry (lecture and lab component)
  • Physiology
  • Anatomy
  • Biology (lecture and lab component)
  • Microbiology
  • Statistics

A GPA of 3.0 or higher is required for both your overall studies as well as specifically in science classes. Furthermore, a minimum grade of B is required in all prerequisite classes. GREs are rarely required but it is important to investigate individual programs requirements. 

After successful completion of a bachelor’s program, individuals are HIGHLY encouraged to gain experience in healthcare either through volunteering or working in a healthcare field. For some programs, this is actually a requirement. This can include:

  • Medical assistant
  • EMT
  • Medic
  • Medical Assistant
  • EKG technician
  • Hospice care
  • Medical technologist
  • Licensed Practical Nurse
  • X-ray technologist
  • Medical social workers
  • Physical or Occupational Therapist
  • Peace Corps volunteer
  • Phlebotomist
  • Certified nursing assistant 
  • Surgical tech
  • Registered Nurse
  • Medical dietician
  • International healthcare mission trips
  • Physical therapy aide

Shadowing a medical professional such as doctor will not satisfy this requirement. 

Most accredited PA programs are roughly 26 months and are attended full time. Individuals are highly discouraged to work during this time. The program includes clinical rotations as well as classroom instruction. 

Classes include:

  • Anatomy and Physiology
  • Physical Diagnosis and Assessment
  • Pharmacology
  • Health Care Delivery
  • Psychiatric Medicine
  • Clinical Neurology
  • Clinical Lab and Diagnostic Methods
  • Principles of Surgery
  • Aspects of Primary Care
  • Aging and Rehabilitation Medicine
  • Research
  • Clinical Ethics
  • Pediatrics
  • Obstetrics and Gynecology

After successful completion of the classroom portion of the program, individuals will complete 2,000 hours of clinical training in the following fields,

  • Ambulatory Medicine
  • Emergency Medicine
  • Family Practice Medicine
  • Inpatient Medicine
  • Mental Health
  • Obstetrics and Gynecology
  • Pediatrics
  • Surgery

Programs will vary in their requirements but the above is fairly standard for most PA programs.

Once you’ve graduated from an accredited PA program, you’re eligible to take the Physician Assistant National Certifying Exam (PANCE) administered by the National Commission on Certification of Physician Assistants (NCCPA).

If you pass the PANCE and maintain your certification, you may use the title Physician Assistant-Certified or PA-C. After successfully passing the certification exam, obtaining licensure in the state you wish to practice is required. The specific requirements will vary state to state so it is highly recommended to check your state’s credential website for additional information. 

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Scope of Practice

The role of a Physician Assistant is confusing because the scope of practice is often similar to that of a general doctor but there are some key differences. The main one is that PAs are required by law to practice under the supervision of a licensed physician or surgeon. 

Responsibilities of a Physician Assistant include: 

  • Take or review patients’ medical histories
  • Examine patients
  • Develop treatment plans
  • Order and interpret diagnostic tests
  • Diagnose a patient’s injury or illness
  • Provide treatment
  • Educate and counsel patients and their families
  • Prescribe medication
  • Manage and monitor inpatients in the hospital setting
  • Conduct pre-employment physicals 
  • Perform worker compensation assessments
  • Assess and record a patient’s progress
  • Research the latest treatments
  • Conduct or participate in outreach programs
  • Educate managing diseases and promoting wellness
  • Assist in surgical procedures

Nurse Practitioner: Growth Outlook, Salary Range & Scope of Practice

Nurse Practitioners deliver advanced care to a variety of patients in the clinical setting. According to the American Association of Nurse Practitioners (AANP), NPs work “autonomously and in collaboration with healthcare professionals and other individuals, to provide a full range of primary, acute, and specialty health care services.”

Job Outlook

The idea of working independently of physicians is a great incentive for some people to move into the nurse practitioner career. In fact, the profession rates #5 as the best job in health care and No. 7 job overall in the top 100 jobs, according to the U.S. News & World Report 2019.

The U.S. Bureau of Labor Statistics (BLS) reported that employment opportunities for all nurse practitioners would grow by 31% between 2016 and 2026. This is much faster than the national average of other healthcare-related professions included Registered Nurses. Additionally, as the healthcare industry continues to change there will continue to be a need for CRNPs. 

Salary Range

According to the Bureau of Labor Statistics, The median pay for nurse practitioners for 2018 was $107,030 with salary ranges from $85,880 to $143,480.

The BLS reports that in May 2018 the highest paying states for nurse practitioners were:

  • California: $133,780
  • Alaska: $122,880
  • Massachusetts: $122,740
  • New Jersey: $122,100
  • New York: $120,970

The top five states with the highest concentration of jobs and locations for CRNPs include:

  • Mississippi
  • Tennessee
  • Maine
  • Alabama
  • New Hampshire

The BLS also reported that the top five metropolitan cities for nurse practitioner pay were:

  • New Bedford, Massachusetts: $156,980
  • San Francisco-Oakland-Hayward, California: $150,790
  • Spokane-Spokane Valley, Washington: $148,440
  • Sumter, South Carolina: $145,890
  • Vallejo-Fairfield, California; $145,400

The top five non-metropolitan cities for nurse practitioner pay, according to the BLS, were:

  • Big Thicket Region of Texas nonmetropolitan area: $143,480
  • Central Louisiana nonmetropolitan area: $141,380
  • Eastern Sierra-Mother Lode Region of California nonmetropolitan area: $128,410
  • Coastal Plains Region of Texas nonmetropolitan area: $127,370
  • Southwest New York nonmetropolitan area: $125,260

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Scope of Practice

In 23 states, nurse practitioners have “full practice authority” which means they do not have to work under the supervision of a doctor. Full practice states include Oregon, Maine, Alaska, Hawaii, Washington, and Iowa. 

In states with reduced practice (Ohio, Pennsylvania, and Utah) and restricted practice (Texas, California, and Florida), NPs must have a medical doctor sign certain medical patient care decisions. NPs have prescriptive privileges in all 50 states and can administer controlled substances in 49 states.

Nurse Practitioners evaluate their patients holistically, including both the emotional and mental aspects of the patient’s condition and not just the physical. For this reason, a great deal of time is spent on the education aspect of patient care.

CRNPs provide teaching and supportive counseling and refer patients and families as appropriate. They focus on health education, health promotion, and disease prevention. CRNPs also collaborate with others to provide health care services to individuals, families, and communities. 

Additional CRNP responsibilities include:

  • Order, perform and interpret diagnostic tests
  • Diagnose and treat acute and chronic conditions
  • Record and examine medical history, diagnoses, and symptoms
  • Prescribe medications
  • Manage patients’ overall care
  • Counsel patients and their families
  • Educate patients and families on disease prevention and plan of care
  • Monitor and operate medical equipment
  • Perform physical examinations and patient observations
  • Collaborate with other healthcare professionals
  • Detect changes in a patient’s health and change the treatment plan if necessary

Nurse Practitioner vs Physician Assistant Comparison

Length of Program

  • Nurse Practitioner (NP): Individuals with a BSN should expect to spend 2-3 years to obtain their advanced practice nursing degree through a combination of didactic classroom learning and practicum hours. 
  • Physician Assistant (PA): With a bachelor’s degree and the required prerequisites, a PA program takes an additional 2-3 years of classroom and clinical practice hours.

Average Salary

  • Nurse Practitioner (NP): According to the Bureau of Labor Statistics, the median pay for nurse practitioners for 2018 was $107,030 with salary ranges from $85,880 to $143,480.
  • Physician Assistant (PA): According to the Bureau of Labor Statistics, the median pay for physician assistants for 2018 was $108,610 per year or $52.22 per hour. The salary range is $61,230 and $151,850.

Job Outlook

  • Nurse Practitioner (NP): According to the U.S. Bureau of Labor Statistics, the need for nurse practitioners is expected to grow by 31% by 2026. This is much faster than the national average of other healthcare-related professions included Registered Nurses. 
  • Physician Assistant (PA): According to the U.S. Bureau of Labor Statistics, the need for physician assistants is expected to grow by 37% by 2026.

Certification

Nurse Practitioner (NP): The American Nurses Credentialing Center requires certification renewal every two years. 1,000 clinical hours during the two-year certification and completion of 75 CEU hours including 25 of pharmacology CEU hours are required. 

The National Council of State Boards of Nursing website also mentions the following five Nurse Practitioner certifying organizations, 

  • American Academy of Nurse Practitioners (AANP-CP)
  • American Association of Critical-Care Nurses (AACN)
  • American Nurses Credentialing Center (ANCC)
  • National Certification Corporation (NCC)
  • Pediatric Nursing Certification Board (PNCB) 

Chart Source NCSBN.org

Physician Assistant (PA): The National Commission on Certification of Physician Assistants has 10-year certification cycles. During every two-year period, professionals must earn at least 100 continuing education credits. At the end of each 10-year cycle, PAs must pass a recertification exam.

Work Environments

  • Nurse Practitioner (NP)
    • Hospitals, acute care or ambulatory care settings
    • Outpatient settings
    • Long-term care facilities and nursing homes
    • Private homes providing health care services
    • Hospice and palliative care services
    • Government and community health agencies
    • Universities and research agencies
    • Healthcare or health industry businesses
    • Private practice
    • Phone triage centers
    • Rural health care facilities
    • Nurse-managed medical centers
  • Physician Assistant (PA)
    • Physician offices
    • Hospitals
    • Employment service office
    • Outpatient care centers
    • Urgent care centers
    • Surgery centers
    • Government and community health agencies
    • Universities and research agencies
    • Healthcare or health industry businesses
    • Phone triage centers
    • Rural health care facilities
    • Nurse-managed medical centers
    • Psychiatric Hospital
    • Orthopedics
    • Dermatology
    • Pathology
    • Critical Care
    • Surgery
    • Emergency Medicine
    • Adolescent Medicine
    • Pediatrics

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