Nurse practitioners (NPs) and physician assistants (PAs) are both advanced practice providers in the United States who can assess, diagnose, treat and prescribe. The main difference is training: NPs are registered nurses who complete a graduate nursing degree in a population focus (such as family or psychiatric care), while PAs train in a generalist medical model and can switch specialties more easily. NPs also have full independent practice in many US states.
Side-by-side comparison
| Nurse practitioner (NP) | Physician assistant (PA) | |
|---|---|---|
| Starting point | Registered nurse (BSN) with clinical experience | Bachelor’s degree with healthcare experience |
| Education | MSN or DNP in a specialty population | Master’s PA programme (about 2–3 years) |
| Model | Nursing model: holistic, patient-centred | Medical model: disease-centred, generalist |
| Certification | National NP certification in a population focus | PANCE exam, then ongoing recertification |
| Independence | Full practice authority in many states | Usually practises with physician collaboration/supervision, varies by state |
| Switching specialty | Usually needs another certification | Easier to move between specialties |
| Salary | Similar ranges, often six figures depending on state and specialty | Similar ranges |
Which fits you?
Choose NP if you
- Are already a nurse and want to build on nursing experience
- Want a defined specialty such as family, paediatrics, psychiatric-mental health or acute care
- Value the possibility of independent practice
Choose PA if you
- Aren’t a nurse and want a faster route into advanced practice
- Want flexibility to change specialties during your career
- Prefer a medical-model education
For international nurses
Internationally educated nurses usually need US RN licensure (NCLEX), US experience and an accredited graduate programme before becoming NPs. Advanced practice titles and scope differ greatly in other countries, such as advanced nurse practitioners in the UK and nurse practitioners in Australia and Canada.
Frequently asked questions
Who earns more, NP or PA?
National averages are similar; specialty, setting and state matter more.
Can NPs prescribe controlled drugs?
Generally yes, with DEA registration, subject to state rules.
Related reading: How to become a nurse practitioner · NP salary by state
Updated 5 November 2026. Scope of practice varies by state; check your state board of nursing.
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