Nurse Practioner vs Physician Assistant

Hey everyone!! I’m a senior in highschool, and I was admitted to UPENN’s College of Arts and Sciences. Initially, I thought I wanted to become a PA (physician assistant) studying Health & Societies with a concentration in public health, but now that I’ve done a lot of research on what I want to do in the future with my career, I am considering nursing (NP) because it is much more direct, which will save me time and money. I know I don’t have to do this so early on, but I am a planner. I have steps for what I plan on doing and it just makes my type A personality a little more sane if I figure this out. There’s really no big difference between the two careers (PAs have lateral mobility, while NPs focus on a specific population), but other than that, they are basically the same for what duties and roles they have in medicine.

Reasons for NP:

  1. Direct options (no need for different prereqs. BSN will be accepted at any university for MSN or DNP programs).
  2. FNP - although it’s not lateral mobility, I plan on specializing in general pediatrics, urgent care, adult, family. Thus, FNP would allow me to do that. I’m not that big on extensive specialties (derm, neuro, cardio, oncology). I love kids, so most likely I would be working in general peds.
  3. Clinical hours and experience gained during undergrad. Penn has one of the best nursing programs in the US. They have connections to many hospitals and that would allow me to gain hands-on learning experiences early on. (Lab simulations, clinicals)
  4. If I wanted to become a doctor, I have that option through a DNP program
  5. Job security
  6. Deeper connections with patients. (nurses generally spend more time with patients)
  7. Saves time and money - my original plan of becoming a PA would overwhelm me during undergrad and post-grad because I would be scrambling to find clinical hours and gain certifications as a (MA, CNA, EMT, ER tech), but if I choose nursing, I would be focusing JUST ON NURSING. I would be gaining hands-on experience as a nursing student, and after undergrad, I have the option to work as an RN (gain more clinical experience) without extra certifications and paying extra money for classes. Plus, I wouldn’t have to take long gap years to get those hours for MSN programs (most just require 1 year of being an RN), while Pre-PA applicants generally have over 3,000 hours. I honestly think I would be much more overwhelmed choosing the PA option, which is why I don’t think it is a good fit for me.
  8. If I were to choose the PA route I would have to try and find jobs during my semesters on and off (I live 1.5 hours away from Penn), and I don’t think healthcare employers would hold my position during my breaks off from school.

Opinions? I personally think that NP is the route for me. It’s that feeling that you have when you know something is just RIGHT. I made a pros and cons list (which favored NPs).

I have put a lot of thought into this process. I am interested in hearing your opinions on my plan or what you think I should do.

Also, not sure if you know the answer to this question, but are students generally allowed to transfer internally into nursing?

Sorry. I know this is long.

How do you figure this will take less time?

To become an APRN! I believe you first need a RN degree AND a couple of years of nursing experience. You then take your NP coursework which can take a couple of more years.

I guess the only difference I see is that you could work as an RN while you pursue your APRN.

@Wayoutwestmom ?

Well at Penn, they have an option to get your MSN by applying your junior year of undergrad or they require a minimum of 1 year as an RN. Plus, as an RN I wouldn’t need to pay for extra prereq classes or certification classes to become an MA, CNA, EMT, etc.

Have you been accepted to the College of Nursing?

If not, you’ll need to apply for a transfer. Transfers into the nursing program aren’t guaranteed.

FAQs about transferring into the BSN program–Transfer FAQs

Have you shadowed both NPs and PAs? I would suggest doing that before committing to an irrevocable plan.

If you can’t shadow [due to Covid], then how about conducting some informational interviews with practitioners in both professions.

Hey there! I have not been accepted into the college of Nursing. However, I actually reached out to the appropriate people in the School of Nursing at Penn. Although I wouldn’t be able to apply for transfer during my freshman year, I can take nursing classes through a course permit (to explore the classes). I have not shadowed both of these professions, but I am always networking with people in these professions (and generally NPs have been a lot more thoughtful towards me in this process). I enjoy my conversations with NPs more than PAs. Assuming that I can’t shadow, I have watched several videos “Day in the life…” and they both are very similar (no big difference).

the FNP program at Penn is only 16 months.

I have a couple of comments:

A NP is not a physician (doctor)–despite what the various nursing groups say. NPs are mid-level providers and do not have the knowledge base, training and expertise that physicians have. Please do not conflate the two.

This isn’t entirely true. PAs have the option to specialize and complete specialty training (i.e. residency) in a specific area of medicine. There are residency programs for PAs in emergency medicine, acute & critical care, psychiatry, family planning/gynecology, dermatology, hepatology, cardiology, family medicine, pediatrics, neonatology, urgent care, primary care, hospitalist, and just about every surgical field you can think of.

But it sounds like you’ve made up your mind. If you’re happy with your plan–then go for it.

Good luck!

thank you for that, but I’m not confusing the two. I know there is the traditional path of MD/DO. However, nurse practitioners have the ability to get a DNP (doctor of nursing practice).

A “doctor of nursing” DPN is still not a physician.

And getting a DPN is a lengthy time process. My DPN relative says most folks do this who want to teach nursing. Do you?

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not sure yet, but I would have that option.

Congratulations on your acceptance at Penn.

I think your analysis of the differences between a NP and PA is good. I think you are correct that you can become an NP faster than you can become a PA, as an increasing number of NP programs do not require RN work experience and–unlike PA programs–do not require patient hours. Also, the trend is for states to expand the scopes of practice for NPs, including granting full prescription authority and abolishing requirements for physician supervision or oversight. (Western states that are experiencing physician shortages tend to be leading this trend.) To me, that is a big reason to favor becoming an NP over a PA, particularly if you ever want to start your own practice (as I do). Additionally, my sense is that PA programs tend to be affiliated with (higher-priced) private universities, whereas many (lower-priced) public universities offer PA programs. But, of course, if you go to Penn for grad school, that consideration is not relevant to you. On the flip-side, there has been an onslaught of new NP programs, particularly distance-based ones. Some have very high acceptance rates and may be of questionable quality. Again, not a consideration if you go to Penn.

I do not think that the DNP is primarily for folks that want to purue a career in academia. Although some nursing faculty do indeed have the DNP, many academics pursue the PhD in Nursing instead of the DNP. In addition, many think that the DNP will become the new expectation for clinical NPs in the near future. In this regard, some grad programs (with more expected to join) have ditched their MSN programs in favor of the DNP. Note that at most grad schools that offer the MSN and DNP for NPs, the DNP programs are only a year longer than the MSN programs (typically 3 years vs 2 years fulltime) if the student opts for the DNP straightaway. But if a student gets the MSN and then returns for the DNP, it frequently takes two more years to get the DNP. So it is more efficient to enroll in the DNP originally.

Based on your interests, you may wish to consider a Pediatric NP program rather than a FNP. I suspect it will make you more marketable if you apply to a pediatric practice.

I think you do need to carefully research your ability to transfer from your current college into nursing.

By the way, I am a (second career) undergrad BSN student who carefully researched the PA vs NP issue and decided to apply to a FNP DNP program. By the way, if you have not already found it, another good forum for you is AllNurses

Correcting a typo: the second “PA” in the above sentence should be “NP.”

The DNP degree is a clinician-based doctorate, so not a PhD which is what is typically sought after to become a college professor. The DNP was developed to be the terminal degree for clinicians - or those who still want to practice as an NP, CRNA, etc.

Also, by all means a DNP legally could use the term “doctor” if they wanted to (most I know do not), as they earned their “doctorate.” Physicians do not legally own the title of “doctor.”

My 2 cents on NP vs PA…

If you truly like the idea of NP and nursing, seriously consider working as a nurse for at least a couple of years to gain more clinical experience (student clinical experience is vastly different than true work experience as an RN). When I decided to return to school to become an NP, I had been an RN for 10 years. Best experience that prepared me for my role as an FNP was emergency department nursing. There you see the “non textbook” cases of situations that books can’t teach you, and in a sense you kind of have to have a general idea of a diagnosis for the patient in your mind to know what to start doing for the patient before the physician sees them. You learn very good assessment skills as an ER nurse. You get to see what the docs order testing-wise to help formulate their diagnosis and treatment plan. It is a phenomenal learning environment!

As an NP, you may not be a physician but in many environments (offices, hospitals, urgent cares, etc) you are expected to be able to work like one (and carry the full patient load as one). Knowing and realizing what you don’t know is very important as an NP. While many brick and mortar NP programs are great, I still think the NP education model still assumes that most students do have a few years of RN work experience under their belts (although they don’t tell you that).

The PA educational model prepares students well to hit the ground running right out of school. NP schools were initially developed with the thought that RN “experts” with experience would be the ones to become NPs, not new grad RNs. PAs do get a lot more clinical hours during their programs (again, NP schools assume you already have some clinical experience).

In most places of employment, PAs and NPs are treated similarly and are assumed to be somewhat identical in what they can do.

I hope this helps a little with your questions. Please feel free to reach out if you have any more questions or would like more NP info.

The biggest difference here is that PA’s assist MDs. They practice under the supervision and guidance of MD/DO’s. NPs in many states are allowed to practice independently. The path to NP is shorter, less-expensive than the path to MD/DO. Training time-wise, it’s about the same as the path to PA. Currently, PA programs have become very popular, and hence quite selective.

Frankly, neither pathway gives the education and training so that the practitioner understands why they are doing what they are doing, and has the breadth and depth of knowledge and training to recognize presentations outside of the usual ones, or to know what to do when faced with something outside the norm. PA’s however are trained to assist physicians, trained to ask for help from the physician when necessary, are usually trained by the MD to assist in MD’s practice, be it in the office, or the OR, or the ICU. NP’s are trained to work both with physicians, and independently. Both programs require less than one tenth the training hours required of physicians. There are many RN/BSN/MSN/NP programs that are not highly selective or competitive.

So, if what you want to do is assist a neurosurgeon, go for the PA pathway. If you want primary care, frankly, you won’t be well enough trained as an NP or as a DNP to do it well, but you’ll be permitted to do it independently, which frightens most physicians, and should frighten the general public, but since they are not cognizant of the full education of a physician vs an NP, they don’t realize. So based upon what you seem to want, you should go for the BSN and then the NP.

Or you could do the work to get into medical school, go to med school, and then do a three year family practice residency, and you’d be reasonably well trained to do family practice, or a four year med/peds residency, and you’d be very well trained to do primary care for both adults and children.

Sorry to be so blunt, and I am sure that the NP parents are sharpening their knives for me. The PA parents? Funny, not so much. But seriously, if you have what it takes to get into Penn, you probably have what it takes to get into med school. Penn has one of the best nursing schools in the country, and trains fantastic nurses - I’m not knocking Penn Nursing. But the curriculum is utterly, completely different from the classes at the college of Arts and Sciences. The science courses are science “lite”. It’s a much less demanding academic curriculum, with, of course, hands-on clinical nursing training. Once you transfer into nursing, the decision is made - the paths are not interchangeable.

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The research regarding what you are saying about NPs would state otherwise.

I have always had wonderful relationships with my collaborating physicians (in my state I need one and I am completely fine with that). I do know what I don’t know, and do not take random guesses when treating my patients. I fully admit to them if I don’t know what is going on with them and will bring in the physician. Most times when I need to do that, it’s not a cut and dry diagnosis and we both talk about it to decide the best course to take (that’s also why there are specialists). I also fully disclose to them that I am a nurse practitioner. Many times they ask to see me.

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thank you to everyone who has replied today. I have taken all your comments into consideration. I still think that nursing is the best path for me. I have put a lot of thought into it, and it’s something that I am really sure about. However, if in the future I do choose to become a doctor or a PA, I can still do that with a BSN; it may not be easy, but I can. That being said, NP is still the goal at hand. Thank you all!!

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Here here!!! Totally agree, if you are smart enough and motivated to go to Penn, keep it up and go to med school, it is worth the time and effort

I too am sometimes stumped. I’m very straightforward about it. I tell the patient that I think I know what this is, but I need to go do a bit of research, and I’ll come back in a few minutes. I think that there were three crucial things I learned in medical school: great familiarity with the ever-increasing medical literature and how to quickly find medical information, how to recognize a case of serious illness in a sea of minor viral illnesses, and that in the roughly 25,000 hours of clinical training I had (100 hrs/wk in last 2 yrs of med school and 3 yrs of residency), I had seen almost everything in my relevant field at least once. Add in the algorithmic thinking that was drummed into us in training.

Honestly, I think that it’s the NPs and PAs who should be doing the technical procedures (the bone marrow biopsies, the colonoscopies, putting in the transcranial bolt pressure monitors, the spinal taps, etc.) because they require technical ability, not algorithmic diagnostic thinking. But because the insurers reimburse for procedures at higher levels than for regular office visits, it’s the other way around. I always thought it was absurd that I’d do everything I could to diagnose a patient, then refer them to the gastroenterologist because I was stumped, and they had to be scheduled for a clinical visit with an NP, as a gatekeeper for the gastroenterologist, who was mostly doing endoscopies.