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RN, NP, PA, MD... What?

A PA is not a medical assistant.

Physician Assistants are typically confused with medical assistants. A medical assistant is not a healthcare practitioner. They are more like the doctor’s personal organizer. They assure that day to day operations run smoothly. They are vital to the system, but are completely different from PAs. (See chart below)

What is the difference between a PA and a Nurse Practitioner?

The real debate is in the difference between a PA and a Nurse Practitioner (NP). A Nurse Practitioner is a nurse that has completed a master's degree (soon to be doctorate) in advanced practice nursing. In other words, they can diagnose and treat without the supervision of a doctor.

Differences

Educational Path.
Here's where it gets a little tricky. A Nurse Practitioner starts off as a registered nurse (RN). They must earn a bachelor's degree in nursing, take the NCLEX-RN exam, and then gain a certain number of clinical hours before continuing. Next they attain a graduate, post-graduate, or doctorate level of education as a Nurse Practitioner. Finally they are required to certify under one of the National Certification Programs.

The route for a PA comes with much more variability. PAs usually start in some area of healthcare such as EMT, CNA, paramedic, nurse, lab tech, acupuncturist, midwife, etc. They, like NPs, are required to take specific courses and a have certain number of patient contact hours before entering a PA program. The programs cover the entire range of scholarly degrees (certificate, associate, bachelor, & master degrees); however, most of the PA programs are graduate (master’s) programs. Regardless, they all have to meet the same stringent requirements to prepare a person for the Physician Assistant National Certifying exam (PANCE).

Specialist vs Generalist. PAs are generalists while NPs can be either depending on the area of medicine they practice. Individual states require NPs to obtain a National Certification in a nursing specialty to perform NP duties within that specialty. They then act as the specialist within that specialty. PAs are designed to be generalists and therefore can change areas with very little additional training. Residency programs are offered to PAs who are starting out in or are transferring to a specialized field such as cardiothoracic surgery, oncology, orthopedics, emergency medicine, OB-GYN, and others. These residency programs usually last 1-2 years and are designed to enhance skills and rapidly gain a lot of experience in a short amount of time but are not required. Furthermore, an important distinction is that the PA operating within a specialty is still a generalist. This is used to complement & integrate the services of the specialist, not to be the specialist.

Autonomy. Probably the most important difference is autonomy. Physician Assistants work with Physicians. There are times, especially in rural and underserved areas, where the PA is the primary care provider; however they still report to a Physician. The amount of autonomy varies greatly based on the physician's level of confidence in the PA and the state in which they practice. It may be that the physician merely signs the PA's charts once per week. Nurse Practitioners, on the other hand, were designed to be independent practitioners. They can even have their own clinic. The only exception to this is that some states such as Alabama, Florida, and Missouri still do not allow NPs to prescribe controlled substances.

For more information about individual state laws regarding PA scope of practice and prescription privileges please visit the AAPA's detailed explanation on their website

Similarities. In the healthcare system, the defining line between a practicing PA and NP is very fine. Both professions were born in the 1960's in response to a growing need for more medical practitioners. Both roles essentially fill the same niche. They both have short, intense training programs that allow them to provide the same standard of care and extend the reaches of healthcare to people that would otherwise have to travel many miles or wait several weeks for an appointment. They can both perform almost all of the same duties and they have incredibly similar salaries. They may have different upbringings, but the two are really much more similar than they are different.

So, which one should I see?

When making a decision about whether to see a NP, PA, or MD most of the time it should not matter. The reason is that the NPs and PAs are also trained to know when something is beyond their ability or understanding. They should know when to refer you to a specialist or a physician. Any of the above practitioners know how to research and consult other practitioners in order to bring you the care you require. Doctors have more formal education and training to draw from, but aside from that there is much more variance in personality and individual dedication to the patient then in the type of provider you chose. Our recommendation is that you chose the one that is the best fit for you.

For more information about Nurse Practitioners please visit the American Academy of Nurse Practitioners website

Profession Comparison Chart
Programs vary. The following represents averages for each vocation.
Category Medical Assistant Nurse
(RN, BSN)
Nurse Practitioner Physician Assistant

Physician
(Family Practice)

Prerequisite Education
None

None

Bachelor Degree in Nursing
& clinical hours

Bachelor Degree
& clinical hours
for most

Bachelor Degree

Learning Model
-
Medical-Nursing
Medical-Nursing
Medical-Physician
Medical-Physician
Time in Classroom
134 hrs
Varies greatly
by program.
500 hrs
1000 hrs
2 years
Time in Clinic
160 hrs
Varies greatly
by program.
500-700 hrs
2000 hrs
2 years
Total Post
High School Education
1-2 years
2-4 years
6-8 years
4-6 years
8 years
Residency
None
None
None
Optional
1-2 years
depends on specialty
3-8 years
Degree Awarded
Certificate or Associate Degree
Associate or Bachelor Degree

Master's Degree

Planned Transition to Doctorate by 2015

Physician Assistant Certified (PA-C)

Most also award Master's Degree

Doctor of Medicine (M.D.)

Doctor of Osteopathy (D.O.)

Recertification
60 education points or exam every 5 years
1000 hours practicing in area of certification  specialty OR exam every 5 years

1000 professional practice hours AND ~15 CE credits/year OR exam every 5 years

100 education hours every 2 years

Exam every 6 years

MD: 50 education hours every year & ABMS certification recommended

DO: 120 education hours every 3 years & ABMS certification recommended.

Base Salary U.S. National Average 2010

$29,708

$65,541

$89,845

$89,726
$173,175

Duties Performed

Independent Practitioner
   
MOST STATES
 
X
Complicated or High Risk Cases
.
.
VARIES
ASSIST
X
Perform Surgery
.
.
ASSIST
ASSIST
X
Deliver Babies
.
.
X
VARIES BY STATE
X
Write Prescriptions
.
.
X
X
X
Prescribe controlled substances
.
.
VARIES BY STATE
VARIES BY STATE
X
Conduct Physical Exams
.
ASSIST
X
X
X
Diagnose
.
.
X
X
X
Treat Illness
.
X
X
X
X
Order & interpret tests
.
ASSIST
X
X
X
Patient counseling
.
X
X
X
X

 

Article Co-Authored by Kendra M. Cutter, EMT-B

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Resources

1. American Academy of Nurse Practitioners – Facts about Nurse Practitioners
2. American Academy of Physician Assistants - 2008 Census National Report
3. American Association of Medical Assistants - FAQs on CMA Recertification
4. American Board of Medical Specialties – ABMS Maintenance of Certification
5. American Medical Association - Physician Education, Licensure and Certification
6. American Nurses Association - More About RNs and Advanced Practice RNs
7. American Nurses Credentialing Center – Renewal Requirements and Nurse Practitioner Specialty Certification
8. American Osteopathic Association – DO FAQ
9. Boston Reed College - Clinical Medical Assistant Training
10. Gordon Marshall. "medical model." A Dictionary of Sociology. 1998. Retrieved February 11, 2010 from Encyclopedia.com
11. Lori McMillian, FNP
12. National Association of Physician Assistants - PA FAQ
13. NurseWeek - New Doctoral Degree Aims to Advance Nursing Practice
14. Salary.com's Salary Wizard
15. Wisconsin Academy of Physician Assistants - Comparison of Physician Assistants and Nurse Practitioners

 
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