Which Is Harder To Become, Nurse Practitioner OR Physician Assistant? (PLUS, WHY)
Written By: Donna Reese MSN, RN, CSN
In our career, we will likely work with physician assistants. One of my most brilliant and supportive colleagues was a young PA who impressed me with his many “Pearls for Practice” and solutions to complex issues.
However, many patients confuse the role of a nurse practitioner and PA. On numerous occasions, I have explained the distinction to friends and family who really can’t tell the difference between the 2 professions. In reality, I can’t blame their bewilderment as many aspects of our roles are blurred together. One look at employment sites reveals that much of the time, we compete for the same jobs.
Although NPs and PAs may hold comparable positions, the schooling for each profession is entirely different, with a distinctive pathway of training that somehow culminates in a similar role.
If you have questions about the schooling and work of these 2 careers, I will detail the training of both professions. Along the way, I answer the question, “Which is harder to become, nurse practitioner or physician assistant?” Because if you are like me, I have always wondered about the similarities and differences of our training. Let’s find out!
BEFORE WE DELVE INTO WHICH IS HARDER, FIRST, LET’S LOOK INTO WHAT EXACTLY IS A PHYSICIAN ASSISTANT SCHOOL?
Physician assistant school is the postgraduate training a PA must undertake to become a certified physician assistant. Applicants cannot enter PA school until they have completed their bachelor's degree. This undergraduate degree can be in any field, although a biology or health science degree is helpful.
Physician assistant school is typically a 3-year program that includes coursework and clinical rotations. The program consists of general clinical instruction and does not specialize in any field. PAs follow a medical model of training and practice, the same as a physician. The training of a PA is quite broad and varied, whereas NP schooling focuses on the specialty that is chosen. Physician assistants are trained to become generalists and, therefore, have to learn a wide variety of medical content.
RECOMMENDED ONLINE NURSE PRACTITIONER PROGRAMS
BEFORE WE DELVE INTO WHICH IS HARDER, FIRST, LET’S LOOK INTO WHAT EXACTLY IS A NURSE PRACTITIONER SCHOOL?
Nurse practitioner school is a master's or doctoral program for nurses to become NPs. A prospective NP student needs to pick a specialty prior to enrollment. To become an NP, a nurse needs to complete specialized coursework in her prospective field and clinical hours in the same area.
Nurse practitioners continue to follow the nursing model of patient care, adding their advanced expertise to this method to practice holistically. This patient-centered approach focuses on prevention and health promotion, whereas PA schools are more disease-focused.
There are newly emerging NP specialty areas as our profession matures. However, the main areas to choose from could be one of the following.
• Family Nurse Practitioner (FNP) - the most common specialty
• Adult-gerontology Nurse Practitioner (A-GNP)
• Pediatric Nurse Practitioner(PNP)
• Neonatal Nurse Practitioner (NNP)
• Psychiatric Mental Health Nurse Practitioner (PMHNP)
• Women’s Health Nurse Practitioner (WHNP)
BSN nurses can complete an MSN with a certification as an NP in as little as 1 year.
PHYSICIAN ASSISTANT OR NURSE PRACTITIONER – WHICH TAKES LONGER TO BECOME?
Physician assistant schooling typically takes 3 years to complete. Add these years to the prerequisites of a bachelor's degree in any field. In addition, a PA must have some previous experience in medicine. This experience could be as an EMT, nursing assistant, or another medical career, such as radiology or venipuncture. Thus, it would require a minimum of 7 years to complete a PA degree, although it is typically longer (to gain the necessary medical experience required).
NP schooling usually is 5-6 years (BSN + MSN). Additionally, some universities require that an NP candidate have at least one year of experience as an RN. You can complete all of your schooling in a total of 5 years if you undertake your MSN full-time. However, many nurses work while going to nurse practitioner school and take NP courses part-time.
Considering all these factors, it typically takes longer to become a PA than an NP. In essence, the route to completion for a physician assistant is less streamlined than an NP. However, there are many types of programs offered for both specialties. Some offer accelerated programs, while others may take undergraduate courses into consideration. You can find programs that are shorter or longer in both fields.
PHYSICIAN ASSISTANT OR NURSE PRACTITIONER – WHICH COSTS MORE TO BECOME?
ThriveAP, an education platform for advanced practice providers, compared education costs
to become an NP vs a PA. Their findings showed that becoming an NP is less expensive than becoming a PA. A physician assistant program costs $ 63,141 on average, while an NP student spends approximately $44,606.
In addition, nurse practitioners can attend classes online, where most PA training is required onsite. Sometimes, online courses are less expensive than in-person options.
PHYSICIAN ASSISTANT COURSEWORK OR NURSE PRACTITIONER COURSEWORK – WHICH IS HARDER?
We all agree that PA and NP coursework is rigorous and challenging. These 2 programs both include pharmacology and physiology. NP programs then niche down their coursework to dial in on the specialty area of the certification, while PAs continue a general medical study of all populations, such as pediatrics, women's health, and adult medicine. PA training also includes classes that nurses have already completed in their undergraduate programs, such as medical terminology.
PA schooling includes generalized medicine coursework such as internal medicine and surgery. In contrast, NP programs offer fewer clinically based courses and instead add broader topics such as leadership and informatics.
Most NP students have experience in their area of certification before enrollment. PAs need to learn the entire scope of their practice in their programs. The need to capture such a broad array of skills and information without a nursing background can be quite an undertaking. It can be hard
to keep up with an intensive course-heavy curriculum!
In NP school, I recall that my coursework was not overly difficult. The classes were a relief from the more challenging clinical demands in my program.
Based on my experience and this assessment, it is possible that PA coursework may be somewhat harder overall than NP classes. To further break down this conclusion, perhaps the coursework itself is not more difficult in PA school but the content may be more foreign for a PA student. Thus, it may appear more complex.
PHYSICIAN ASSISTANT CLINICAL TRAINING OR NURSE PRACTITIONER CLINICAL TRAINING – WHICH IS HARDER?
There have been times as an experienced nurse that I have felt that I possessed similar knowledge compared to some providers. I knew what they would diagnose and prescribe due to my many years in nursing. I imagine that I am not alone in this train of thinking. For this reason, clinical training for NPs can be second nature.
Of course, we have loads to learn in our programs, but we have a basic idea of what we should do and say when we step onto the floor as providers-in-training. That does not mean that I was not terrified as a student when I had to perform my first gynecologic or prostate exam! Although it was a fascinating learning experience to suture a hand or check for corneal abrasions, I had at least seen these procedures done as a nurse.
Our previous nurses' training and experience is why NP clinical hours are only 600 hours vs that of a PA, which is 2000. This considerable disparity in clinical training hours translates to a more intense and harder road for a PA student than an NP.
PHYSICIAN ASSISTANT ADMISSION REQUIREMENTS OR NURSE PRACTITIONER ADMISSION REQUIREMENTS – WHICH IS HARDER?
To be accepted into a PA school, you must possess a bachelor's degree. Many times, those with a biology degree transition to PA school. This scenario is helpful as most PA schools require that candidates have prerequisite courses in anatomy, biology, chemistry, and psychology. Additional college coursework will be needed for those who did not take the necessary classes.
Furthermore, PA preadmission requirements include prior healthcare experience. This background can be either paid or unpaid positions such as:
• Medical assistant
The number of hours and years of experience may vary with different schools, but the average PA applicant has about 3 years of healthcare experience under their belt.
Nurse practitioner school admission requirements can be relatively cut and dry. However, the landscape for entry into an NP program is quickly changing and soon to be even more complex.
Let’s start with the traditional NP program entry, a BSN to MSN NP certification. Once you have your BSN, you can apply for NP school. Some programs may require at least one year of experience working as an RN. It’s a pretty straightforward process.
However, there are now alternate routes to becoming an NP. There are even programs that take ADN and diploma nurses. This tract will obviously take longer as you need to complete a BSN, then a master's. ADN to NP programs are bridge programs that can fast-track a 2-year degree nurse to an NP. Schools offer differing variations to this route.
To make matters more complex, there is a groundswell movement towards NPs needing a doctorate to practice. Thus, you will find many DNP programs that prepare you to become a nurse practitioner. The requirement to hold a doctoral degree will certainly prolong the schooling of a potential NP.
PHYSICIAN ASSISTANT CERTIFICATION/LICENSURE EXAMS OR NURSE PRACTITIONER CERTIFICATION/LICENSURE EXAMS – WHICH IS HARDER?
Certification and licensure exams can give any potential provider a case of nerves and challenges. I am sure that both new grad PAs and NPs are well prepared to sit for their exams. Most NPs and PAs will agree that their exams were difficult.
Perhaps the best way to evaluate which certifying exams are harder is to examine pass/fail rates.
Family nurse practitioners can take 2 different tests for licensure, both with similar pass rates. According to the American Academy of Nurse Practitioners, the pass rate in 2020 for their exam
was between 85% and 89%, depending on the specialty.
The National Commission on Certification of Physician Assistants (NCCPA) is the only PA certification body. Their exam data shows a much higher pass rate
for the Physician Assistant Certification exam. In 2020, 95% of PA students passed their certification exam.
There may be several reasons why the PA certification exam yields a much better result. However, if you are going strictly by the pass rate, you may conclude that the NP exam is harder.
WHY YOU MIGHT FIND BECOMING A PHYSICIAN ASSISTANT HARDER THAN BECOMING A NURSE PRACTITIONER?
(The following are the 10 reasons why you might find becoming a physician assistant harder than becoming a nurse practitioner.)
REASON #1: Steeper Learning Curve
Probably the biggest reason that becoming a PA is harder than an NP is that the learning curve for PA students is steeper than for a nurse. Transitioning to an NP is a natural segway in our nursing career growth. We have the basic education, background, and experience to learn how to be a provider.
In most instances, PA students are just starting their medical education, while NP students are merely building on their previous background.
Sure, a PA applicant may have some biology and chemistry courses, but many have not experienced much direct patient care or working in a hospital. At times, previous medical exposure may be excellent, but many may have a scant background that does not prepare them to the extent of a nurse.
REASON #2: Path to Degree More Cumbersome
A BSN-prepared nurse should be able to transition into an NP program easily. Our undergrad coursework and nursing experience align with the prerequisites of most NP schools. I do not recall needing to take any additional classes or having any delays when I applied for an FNP program. The process was seamless.
On the other hand, there are many variables to consider and contend with for PA applicants. The first hurdle is to catch up on all of the required coursework.
An applicant then needs to have the appropriate medical experience. Some schools even required research exposure.
Having to delay schooling to take a medical job or volunteer position can throw off the trajectory of a potential PA student. This prerequisite takes time, and many are derailed at this juncture. Life happens, and many never go on to apply for PA school (or it is delayed).
REASON #3: Title Less Accepted by Public
Everyone is familiar with nurses and what they do. Although, as an NP, there is some role confusion among the public, people generally trust nurses. Nurses are perceived as competent and caring, so our role as an NP is accepted.
As a PA, some patients may not understand your role. Some think you are only an assistant and cannot function as a provider.
As a PA student, you must frequently educate your patients on your role and extensive medical training to prove your competence.
REASON #4: Higher Cost of Education
As this article explains, PA school can cost considerably more than an NP education. Perhaps this is because it takes longer to become a PA than an NP. Nonetheless, higher fees and tuition can be a hardship for a PA student.
This heavy financial burden may deter prospective students from even applying as life takes over. A job in another field may seem the best alternative to being strapped with big loans and expenses.
REASON #5: Longer Clinical Hours
Understandably, the education of a physician assistant will require more clinical hours than an NP student. NP students have already completed approximately 850 clinical and lab hours
in their BSN program. Add actual nursing job experience, and an NP student comes to the table with a healthy clinical background already in place.
Thus, clinical hours in an NP program are 600 vs. 2000 hours for a PA student. This more extended clinical period adds to the stress of a PA student.
REASON #6: Less Funding for Training
Everywhere you turn, there are incentives for further education for nurses. Local, state, and federal programs generously offer scholarships for nursing students and advanced practice nurses to help stem the nursing shortage. Universities, professional organizations, and community groups have joined in to help fund nursing programs and applicants.
Thus, nurse practitioner students can find numerous ways to get their schooling paid for
Although there is funding
for PA student tuition, the general public is less eager to fund physician assistant education than nursing.
REASON #7: Surgical Training
NP education does not include a surgical rotation. However, PAs must learn surgical skills while in training.
Although this additional expertise is exciting, surgical rotations can be intense and overwhelming. Adding surgical training to all the other educational requirements in PA school can make the experience more stressful than NP training.
REASON #8: Specialty Training Is Additional Coursework
Being a generalist has its advantages. A physician assistant is free to move from job to job and not be stuck in one specialty. However, there are times when a PA may want to narrow down and specialize in one field. If this is the case, additional coursework and training is required.
By its nature, NP education is designed to specialize in an area of interest. We do not need to go back for more training to work in our specialty area. Our certification is our ticket to a job in our field.
REASON #9: Schooling Takes Longer
There are many roads to take to become an NP or PA. However, the traditional schooling for an NP can take as little as 1 year. Add your 4-year BSN degree, and that is 5 years total of school to become an NP.
Physician assistant schooling takes 3 years on average. Combine a 4-year undergraduate education, and that totals 7 years of training to become a PA.
REASON #10: Limited Availability to Work while in School
Many RNs work full-time
or part-time while going to nurse practitioner school. I can attest that going this route can be done, albeit difficult. With the flexibility of working different shifts, nurses can juggle NP school while keeping their nurse job.
Physician assistant students typically do not have the option to work much while attending school. Their intensive training demands that they concentrate solely on their education.
The ability to keep working while attending school helps ease the financial burden of becoming a provider.
WHY YOU MIGHT FIND BECOMING A NURSE PRACTITIONER HARDER THAN BECOMING A PHYSICIAN ASSISTANT?
(The following are the 6 reasons why you might find becoming a nurse practitioner harder than becoming a physician assistant.)
REASON #1: Responsibilities Associated with Independent Practice
Although practicing independently is probably the best reason to become an NP compared to a PA, this responsibility makes NP training even more serious. Knowing that you will not always have a physician to consult makes the profession “real” right from the start. Unlike a PA, who must always team up with a physician, you will not hold onto anyone's coattails for long as an NP.
Even if you are not planning to practice in an independent practice state
, NPs bear full responsibility, and their license is on the line if there is a mishap. In contrast, the pressure is slightly off PAs as the doctor is responsible for their physician assistance. The doctor’s license is also on the line in case of a problem which is an incentive to keep a close eye on their PAs.
REASON #2: More Focused Career Trajectory
NP training is very focused right from the start. We go to undergraduate school to become a nurse. We then work as an RN. From there, we enter NP school, dialing in on one specialty area. We basically never waver from our individual nursing goals.
However, have you ever felt like your life was all school and nursing work and no play? As nurses and NPs, most of us have never had the chance to explore other careers or travel the world when young.
On the other hand, PA students may not have had such an intensive undergrad experience as nursing students. They may have enjoyed all the opportunities college had to offer, lived life fully, worked another career, and then focused on their final destination as a physician assistant.
As an NP student, you may be coming into the last training phase with limited life experience. There is nothing wrong with being focused on your nursing career. However, some PA students may have an advantage over NP students regarding worldly issues such as conflict resolution and business.
REASON #3: Physician Resistance
Although physician resistance to NPs has waned over the years, some holdouts remain. Frequently, I come across editorials from MDs bashing nurse practitioners. The advancement of our profession still irks and possibly threatens some doctors.
As an FNP, I have worked with doctors who have welcomed me with open arms. On the other hand, there have been several physicians who did not support me and even one who ignored me. As an NP student, feeling and experiencing negative vibes from physicians can be intimidating and a real limitation
REASON #4: Youth
Many PAs turn to their profession as a 2nd career. They have held jobs other than as a PA. They bring maturity and experience to the table when they apply for PA school, as this is a requirement.
On the other hand, NP students tend to transition to their advanced practice education at a younger age. Many fledgling nurses enroll in an NP program. (However, don’t let this fact scare seasoned nurses from becoming an NP. It is never too old
to become a nurse practitioner.)
Although youth has many advantages in nursing, there are times when maturity and life experience can lend a wise perspective to sticky situations as a provider.
REASON #5: Forging Own Way
Although the NP sisterhood is strong, we do not belong to the greater medical fraternity of physicians and PAs. Physicians tend to mentor and take care of their PAs.
Upon graduation, nurse practitioners are left to forge their own way. At times, we are left floundering without direction. There have been numerous instances where new NPs have asked me upon graduation,” Now what”? Transitioning to our new role as an NP can be overwhelming, and without a safety net in place, newbie NPs can feel alone and lost.
REASON #6: Cannot Work Outside of Specialty
As an NP student, you had better be certain that you will love your specialty. PAs have an advantage as generalists on this topic. They do not need to go back to school if they want to try out different areas of medicine. Once a nurse begins their NP program, they are locked into one area of expertise.
However, with a nursing background as the base of our training, we probably have a pretty good idea of what field of study would best suit us as an NP.
BONUS! SO, WHICH IS HARDER TO BECOME: PA OR NP – MY PERSONAL OPINION
As a nurse practitioner, I may be slightly biased toward NPs on this topic. With that being said, I vote that becoming an NP was not as hard as a PA. I feel that we are ideally situated to take the next step in the natural progression of our profession to that of an advanced practice nurse.
However, I am not discounting the challenge of our rigorous training. I sweated out my clinical rotations, along with my graduate nursing peers. Although my coursework and training were intense, my background as an experienced nurse helped to pave the transition to an NP without too many unpleasant surprises.
MY FINAL THOUGHTS
The bottom line is that if you are not a nurse and want to become a provider, becoming a PA is the obvious choice. The question of “Which is harder to become, nurse practitioner or physician assistant?” may not be an issue as typically nurses become NPs and non-nurses become PAs.
However, by knowing the similarities and differences between the 2 professions, we can respect each other’s specialties, knowing that each is well-trained and competent. We just took different paths to arrive at a similar career. NPs and PAs each bring their own brand of expertise to best serve our patients.
Donna Reese MSN, RN, CSN
Donna Reese is a freelance nurse health content writer with 37 years nursing experience. She has worked as a Family Nurse Practitioner in her local community clinic and as an RN in home health, rehabilitation, hospital, and school nursing.