Do you want to diagnose and treat patients but don’t have the time or resources to go to medical school? With the current shortage of primary care physicians the job outlook for advanced care practitioners is extremely good (ooh). Both Physician’s Assistants (PAs) and Advanced Practice Registered Nurses (APRNs) are options but what are the differences and how do you choose one program over the other?

When I was also considering these two paths I had to do some investigating to distinguish these two professions. Networking is crucial to exploring a potential career change. Not only does it help you better understand that profession, but you also make valuable contacts that may come in handy later when searching for job opportunities. I already knew a few nurses but I also talked to anyone else who would listen to make new connections with PAs and NPs. I joined LinkedIn groups for NPs and PAs, reached out with my questions on the group page and I got a lot of great responses and increased my network. Finally I also got the opinions of some physicians about their perceptions and experience with professionals from both career paths. 

Exploring your options

Everyone’s circumstances are different and the requirements and structure do vary by state and by program so you should decide what factors are important to you and do your own investigation. Conducting interviews or shadowing professionals in these two fields will help you tremendously by seeing first-hand whether you will like the work and building your professional network. Here are just a few great questions to ask professionals:

• What do you like most/least about your career?
• What are the most common problems/challenges you face in your career?
• Why did you choose this path?
• If you could go back and do it all over again, knowing what you now know, would you do it differently? Would you choose a different path?
• What do you think are the most important attributes for someone to be successful in you field? 
• What steps do you recommend I take to become a PA/APRN?
• For MDs – What is it like to work with PAs and APRNs?
• For MDs -If you were hiring and had both a PA and APRN candidate that were equally qualified, which would you choose? (This may make some MDs feel put on the spot so be discreet and cautious with this one!)

Training Model

At first, most responses I heard were very diplomatic but vague. People said things like “Oh there is really no difference” and “they can apply for the same jobs.” But that didn’t help me understand the differences or how to decide which path to take. Some people told me that the main difference is in the training model: PA’s are taught under the medical model while APRNs use the nursing model. I had some understanding of the medical model (from graduate training in clinical psychology) but I had no idea what the nursing model was or even that it existed. 

The medical model is a problem-focused approach to diagnose disease, disability or dysfunction in patients using history, physical assessment, and diagnostics tests (medical+model). Once a diagnosis has been identified, physicians are trained on the appropriate pharmacological and surgical methods for treatment. This is the approach to training for PA programs and in fact many of the PA students will take classes alongside the medical students. You may even take gross anatomy and get to practice with cadavers.

What I have observed and learned about the nursing model is that it is a more holistic way of treating patients. Nurses consider the patients’ family dynamics, psychosocial factors and environment in determining the cause and appropriate treatment. Nursing emphasizes lifestyle modification, prevention and non-pharmacological interventions. I think this may stem from the fact that registered nurses are on the front line of healthcare, assessing patients and making decisions without an advanced provider present. So they learn ways to fix a patient’s current issue without medicine or invasive procedures first. Now, Nurse Practitioners DO have the ability to prescribe medications and can learn to do certain procedures, but they start out as bedside nurses and are trained under the nursing model first.

I do believe that medical schools have increased teaching of preventive strategies such as diet and exercise, but nursing programs have entire courses devoted to nutrition, public health and health promotion while medical schools try to incorporate some of these concepts into other courses.

Scope of Practice

Although it is true that PAs and APRNs can apply for the same jobs, one of the other differences is their scope of practice. This delineates what they are allowed to do in their practice and the level of oversight by physicians. The restrictions for each profession varies by state. In some cases, PAs and APRNs must have a contract with a physician and may require the MD to sign off on their work. The PA profession is regulated by physicians boards and will always require some physician oversight in their practice. The nursing field is self regulated and has made strides recently in gaining independence in their practice. Some states now allow nurses to practice without a physician contract and have full prescriptive authority (Map of APRN Consensus Model). 

Practical Considerations

You should consider the amount of time, effort and other resources needed for each program you are considering. The structure may even vary among the same professional programs. How much time do you have? Do you have to work during school or have other responsibilities? What are your financial resources? Are you bound to a specific geographic area due to family constraints?

Although both PAs and APRNs require graduate degrees, they have different paths. To apply to a PA program you can have a bachelor’s degree in anything but it’s best to have a strong education in the sciences and healthcare (biology, chemistry, nutrition). On the other hand, to apply to most APRN programs you must have a bachelor’s degree in nursing. A few have bridge programs for associate level nurses or will accept bachelor’s degrees in other fields. Just check each program’s requirements. Many APRN programs allow you to go part time and have online options while most PA programs are full time only. There are also accelerated nursing programs for the BSN which may take as little as 12 months but you are basically going to school 6 days a week all day. 

When I was making this decision for myself I was as single parent of school-age children so the fast track wasn’t a good option for me. I had a bachelor’s degree in biology and psychology, so I was leaning toward the PA path. However, after looking at sample schedules and considering the course load I decided on nursing. I couldn’t move my kids, so the second degree nursing program near me was a better option because it was a two year program while the PA program crammed all your courses into one year before rotations. I was going a longer route, getting a second degree BSN before the Master’s in Nursing but in the long-run it was a better fit for me.

Also when it came to finances, I had to work at least part time to support myself and my kids. And I found more scholarship money available for nursing school. And now that I work full time as a registered nurse, I can take advantage of employee tuition benefits to pay for my APRN classes.

I hope this gives you a better understanding of the differences between these two professions and helps you decide if you want to pursue one or the other. Our country is in great need of primary care practitioners so this is an important calling to fulfill! Good luck!

Did you enjoy this article? Here are a few related topics you may also find helpful

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• Are you experiencing burnout?
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Categories: Healthcare, Nursing, Careers

Tags: career options, healthcare careers

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