PA vs. NP
Both are licensed clinicians who diagnose, treat and prescribe, though in many states one or both must do so under a physician agreement. They're trained differently. AAPA, the PA professional society, says PAs are educated across general medicine on a curriculum modeled on medical school. NPs are educated in advanced practice nursing and certified in a population focus, which can be broad (family, all ages) or narrow. NPs hold an RN license; PA programs require a bachelor's degree plus prerequisite courses; the programs we checked, like UNC Chapel Hill and Albany, accept any major.
Side by side
| PA | NP | |
|---|---|---|
| Training model | Trained across all of medicine; curriculum modeled on medical school (AAPA) | Advanced practice nursing in a population focus. Family NP covers patients of all ages; others include adult-gerontology, pediatrics, women's health and psychiatric-mental health |
| Before the program | A bachelor's degree plus prerequisite courses; the programs we checked, like UNC Chapel Hill and Albany, accept any major. AAPA says incoming students average more than 3,000 hours of direct patient contact (an average, not a requirement; each program sets its own minimum). PAEA's 2022 survey found a median of 3,200 paid hours | An RN license, usually with a bachelor's degree in nursing (AANP). Direct-entry master's programs take people with a non-nursing bachelor's degree, who earn an RN license along the way |
| The program | Master's level; about 27 months, with more than 2,000 hours of clinical rotations (AAPA) | At least a master's degree in an advanced practice nursing role (BLS) |
| Certification | Pass the PANCE after an ARC-PA accredited program, then earn 100 CME credits every 2 years and pass a recertification exam (PANRE or PANRE-LA) in a 10-year cycle (NCCPA) | Pass a national NP certification exam in their population focus (AANP, BLS) |
| Working with physicians | AAPA says most state laws require PAs to have an agreement with a specific physician in order to practice | As of 2025, AANP counted 27 states, Washington, D.C. and two U.S. territories with full practice authority, though 11 of those states require a set period of practice under an agreement first. Elsewhere, a career-long collaborative agreement or supervision is required |
| Pay and jobs (BLS) | Median $135,880 (May 2025); 168,900 jobs in 2025; projected growth 21%, 2025–35 | Median $132,300 (May 2025); 336,300 jobs in 2025; projected growth 41%, 2025–35 |
AAPA notes that at the practice level there are likely more similarities than differences. Practice rules for both are set by each state and change; see AANP's State Practice Environment map for the current NP list. Pay varies more by specialty and location than the gap between the two medians.
Questions that can help you choose
- Do you want to become a nurse along the way? The NP path runs through an RN license, either from nursing school or a direct-entry master's program. The PA path doesn't.
- Broad training across medicine, or a chosen population focus? PAs train across all of medicine; NPs train in a population focus, which can be broad (family) or narrow.
- How do the practice rules work in the state where you want to live? Check that state's rules for both professions.
- What do people in the job say? Shadow or talk with both PAs and NPs where you live before you commit.
Related guides
Free: the Patient Care Hours Starter Kit. A 3-step check for whether a job counts at your schools, CASPA's categories on one page, and a simple hours log. Built from the same program pages as this guide.
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What is the difference between a PA and an NP?
Both diagnose, treat and prescribe, though in many states one or both must do so under a physician agreement. According to AAPA, PAs are educated across general medicine on a curriculum modeled on medical school. NPs are educated in advanced practice nursing, certified in a population focus, and hold an RN license.
Do PAs or NPs earn more?
BLS reports May 2025 median pay of $135,880 for PAs and $132,300 for NPs, a gap of about $3,600. Pay varies more by specialty and location than by profession.
Do you need to be a nurse to become a PA?
No. PA programs require a bachelor's degree plus prerequisite courses; the programs we checked, like UNC Chapel Hill and Albany, accept any major. NPs hold an RN license, though direct-entry master's programs let non-nursing graduates become RNs on the way.
Sources (all opened October 2026)
- AAPA: What is a PA?: https://www.aapa.org/about/what-is-a-pa/
- AANP: Full practice authority (issue brief): https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief
- AANP research snapshot: Full practice authority and time-in-practice requirements (Nov 2025): https://storage.aanp.org/www/documents/research/TIP_snapshot.pdf
- AANP: State practice environment: https://www.aanp.org/advocacy/state/state-practice-environment
- NCCPA: Become certified (PANCE): https://www.nccpa.net/become-certified
- NCCPA: Maintain certification: https://www.nccpa.net/maintain-certification
- U.S. Bureau of Labor Statistics: Physician Assistants (Occupational Outlook Handbook): https://www.bls.gov/ooh/healthcare/physician-assistants.htm
- U.S. Bureau of Labor Statistics: Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners: https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm
- BLS Employment Projections: Fastest growing occupations (nurse practitioners, 2025–35): https://www.bls.gov/emp/tables/fastest-growing-occupations.htm