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Difference in Scope of Practice for Nurse Practitioner and PA

by Beth Greenwood

Nurse practitioners and physician assistants perform many of the same tasks as a physician. Each state regulates medical and nursing practice, so requirements and scope of practice for these two disciplines may differ from state to state. PAs, however, cannot practice independently, and must have a supervising physician, unlike NPs, who are authorized to practice independently in some states, according to the National Institute for Healthcare Reform.

The Basics

NPs and PAs must have a minimum of a master’s degree to practice in all states, although NPs who graduate after 2015 will have doctorates, according to the American Association of Colleges of Nursing. Generally speaking, they are trained and allowed to diagnose illness and injuries, provide patient education, order and interpret diagnostic tests or lab work and prescribe medication. Both can bill private insurance companies and government payers such as Medicaid and Medicare for their services. PAs must be licensed and certified in all states, while NPs must be licensed in all states and certified in most.

Limitations and Requirements

Scope of practice includes what NPs and PAs are authorized to do in the course of their duties. Some tasks, such as performing major surgery, are reserved for physicians, and neither NPs nor PAs can perform these tasks. All three disciplines can prescribe medications. Some states place limitations on what NPs or PAs can prescribe, however. NPs and PAs in California, Idaho and Montana can prescribe controlled substances. Each state has slightly different requirements surrounding issues such as continuing education, the classification of the controlled substances or physician supervision requirements, according to the Center for the Health Professions at the University of California in San Francisco and the American Academy of Physician Assistants.

Supervision, Collaboration or Independence

The issue of physician supervision is the biggest difference between NPs and PAs. A PA must have a supervising physician in all states. Requirements for NPs, however, vary from one state to another, according to the Center for the Health Professions. Some states, such as Alaska, Arizona and Washington, authorize NPs to practice independently without physician involvement of any kind. Florida, Massachusetts and Nebraska, however, require physician supervision. Alabama, Maryland and Virginia require the NP to collaborate with a physician, although the physician does not actually supervise the NP’s work.

Specialty and Work Setting

Another major difference between NPs and PAs that affects scope of practice is related to their basic training. NPs are trained in a patient care specialty as well as a work setting, while PAs are trained as generalists without regard to work setting, and obtain specialty training after they begin to practice. Patient care specialties for NPs include adult-gerontology care, family practice, pediatrics and mental health. NP specialty work settings include primary care, acute care, critical care and trauma. An NP who is trained in adult-gerontology care in the acute care setting, for example, would not provide care to children in a primary care clinic.

More Similarities than Differences

These two careers have many similarities in terms of education, the length of the educational program, licensing, certification and general responsibilities. Even salaries are similar, according to the U.S. Bureau of Labor Statistics. NPs earned an average annual salary of $91,450 in 2012, while PAs earned $92,460. Your personal preferences and individual situation should determine your choice between these health care occupations.

About the Author

Beth Greenwood is an RN and has been a writer since 2010. She specializes in medical and health topics, as well as career articles about health care professions. Greenwood holds an Associate of Science in nursing from Shasta College.

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