Nurse Practitioner, Physician Assistant, Doctor: What’s the Difference?

By Elizabeth Millard |

Here’s what each of these health care professionals does, and what you need to know when choosing one.

Senior woman getting a checkup

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When you need an appointment and call your regular doctor’s office — or maybe even a new office — you might be offered the choice of seeing a nurse practitioner (NP) or a physician assistant (PA) sooner than you’d be able to get an appointment with the doctor. Should you take it?   

To give you more info for making that decision, here is some insight into what these professionals provide, how they differ from one another, and why they might make a valuable part of your health care team.   

Nurse Practitioner vs. Physician Assistant 

Both professionals can offer the same level of care as a general practitioner, says Ronald Dixon, M.D., chief executive officer of the health care platform CareHive Health. For example, both an NP and a PA can:  

  • Establish long-term medical relationships with patients 
  • Diagnose both acute and chronic health issues 
  • Write prescriptions and review medications 
  • Collaborate with physician colleagues for a multidisciplinary approach 
  • Order imaging tests, like an X-ray or MRI, and lab tests 
  • Interpret test results 

“The key difference between NPs and PAs, versus the traditional model of becoming an M.D., is the curriculum and structure of the educational process,” Dr. Dixon says.   

Basically, they both come to the profession with different training. NPs are on a nursing track, which means they first become a registered nurse, and some take the additional step of getting a Bachelor of Science in nursing. From there, they must complete an NP-focused master’s or doctoral nursing program and then pass an NP board certification exam — a process that typically takes two to four years.  

By comparison, PAs are on more of a physician track, which means they take a program at a medical school that offers a PA program. They must first get a bachelor’s degree and undergo very thorough science prerequisites, such as organic chemistry, before applying to PA school, which takes about two years to complete. 

NPs tend to specialize in either one or several areas, such as gerontology or women’s health, while PAs undergo a more generalized education, although they can specialize if they want. An essential point is that one is not “higher” than the other — a PA is not at a higher level than an NP or vice versa — so they’re fairly equivalent in terms of what they offer.  

One difference is that an NP is often chosen for a long-term approach to working with patients, such as those with chronic conditions. They provide education, counseling, and preventive care. Since PAs are on a medical track, they work toward identifying acute problems and brainstorm with doctors on treatments.  

“In general, NPs are known for their compassionate, holistic approach to health care,” Dr. Dixon says. “PAs are known for their comprehensive care plans as well as their technical expertise. Both NPs and PAs spend a good portion of their advanced training doing face-to-face health care delivery with patients.”  

When Should You See an M.D. Instead? 

For everyday issues (symptom management, regular checkups, medication reviews, or acute illnesses or injuries, such as the flu or a sprain), NPs and PAs are just as effective as physicians and are often more accessible when it comes to getting appointments, Dr. Dixon says. Of course, doctors continue to serve a very valuable role, he adds, particularly when it comes to conditions that are becoming complex or require seeing a specialist. 

“Patients should seek out an M.D. when the situation at hand is becoming difficult to manage,” he says. For example, if you’ve been prescribed medication for an issue and it doesn’t seem to be helping, or if your condition is considered life-threatening or requires multiple specialists, you’ll need to see an M.D.  

Some people also feel more comfortable seeing an M.D. for an initial diagnosis and then switching to an NP or PA for follow-up appointments, which are more about maintenance and additional lab tests, or to fill prescriptions and do medication reviews. This is completely understandable, but keep in mind that NPs and PAs can also diagnose, so it’s not strictly necessary to see an M.D. first.  

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If you need a specialist — such as a cardiologist, rheumatologist, neurologist, endocrinologist, or surgeon — an M.D. would be required. But your NP or PA can often make that referral without an additional appointment with your general practitioner.  

Your Best Bet: A Team Approach 

Just because you’re offered an NP or a PA for your appointment doesn’t mean you can’t continue seeing your doctor for other issues. And if you regularly consult with your physician, you can likely do a follow-up with a PA or an NP, depending on what you need.   

The crucial thing to remember is that good health care often requires a team approach, says Scott Kaiser, M.D., a geriatrician and director of geriatric cognitive health for Pacific Neuroscience Institute at Providence Saint John’s Health Center in California. That can be especially true if you’re dealing with one or more chronic conditions  

Plus, keep in mind that these medical professionals are only part of your overall support team. You may also be working with a physical therapist, social worker, dietitian, mental health professional, clergy member, pharmacist, or personal trainer. Dr. Kaiser says that even friends, family members, your SilverSneakers classmates, and other social connections can be part of this team.  

“All of these people are part of your support system — they all play a role,” he says. “Seeing how much support you have, and continuing to build that network, can be a huge part of navigating care, because they address different aspects of your needs.”  

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