Q&A: Physician Assistant vs Nurse Practitioner

In this podcast, we hear from Daniel Pavlik, DMS, PA-C, program director for the Physician Assistant Studies (PA) program, and Regina Day, a PA student. They talk to us about the PA program at Salus and how a PA education differs from a nurse practitioner's.

Daniel Pavlik:

My name is Daniel Pavlik. I'm the program director and chair of the Salus University PA program.

Regina Day:

I'm Regina, I'm a PA student at Salus University, hoping to graduate this October.

Q: What does a PA do and how does it differ from an NP?

Daniel Pavlik:

That's a little bit of a loaded question. What a PA does is very much situation-specific. PAs are considered mid-level practitioners, and we function specifically based upon our setting. As far as how it differs from the NP, we are hired and we function in similar settings. Our education is quite a bit different. We tend to actually have quite a bit more education than them. They usually go from a BSN (Bachelor of Science in Nursing), and they can take anywhere from 40 to 70 or 80 credits and get either a master's or a DNP (Doctor of Nursing Practice). Whereas our students, on average, the PA education is 110 credits after post-baccalaureate, and they have a master's degree.

As far as functionally, we end up often in the same roles. In a primary care office, in a family medical office, in urgent care, we functionally substitute for the physician or doctor. So, you go to an urgent care, half the people that I know of going to an urgent care who saw a PA thought they saw the doctor because they just will see us, and that's it. Same thing with family med office, outpatient services, emergency department. I worked in the ER yesterday and all my patients saw me and didn't see the attending physician.

If you're working in a surgical subspecialty like cardiothoracic surgery, in order for the surgeon to spend more time in the emergency department, the PA will manage the floor patients. The PAs are typically not performing the surgeries, but they'll likely be managing the floor patients so that the surgeon can be in the operating room. 

In that way they're sort of working as part of the team. Whereas in outpatient offices, based upon the type of office and how seasoned the PA is, they may be completely autonomous, seeing their own patients. So, in some instances they will substitute and other places they are part of a team. And NPs are pretty much used in the same way. 

Q: Regina, why did you end up picking PA over a nurse practitioner or any other healthcare career?

Regina Day:

For my journey to the PA route, I probably started back in elementary school when my dream was to be a doctor. At that time, I didn't really know what a PA or NP was. I was pretty young. But it wasn't until probably high school that I went to my doctor's office and I was treated by a PA at that time.

And I was pretty impressed by her care. I went into looking up more about how she became a PA and what it really meant, because she acted like a doctor, but she wasn't a doctor. Learning more about it, I was really drawn to the PA profession then over the medical route because of the flexibility to change fields once you're in the career. And then the programs, obviously, are shorter duration. So, that was very appealing to me. 

Going into college I was pretty set on PA, but thinking like PA versus NP. I chose PA more so because I didn't know what I wanted to practice in yet. PA programs allow you that flexibility to graduate and then choose any field you want, then switch between them pretty easily without having to go back to school. Unlike nurse practitioner programs, when you are trained for a specific patient population, from what I understand. 

So, that was a big reason. But other than that, to be honest, nursing school didn't really appeal to me. I liked the idea that I could have any major I wanted in college, as long as I get my prerequisites and then apply to PA school. I was able to work on a major in dance and public health at the same time, while trying to get to a Physician Assistant program. 

Other than that, I liked that there's no formal clinical requirements for PA school. Obviously, for NP programs, you'd be a nurse to get your requirement. But I did a variety of things in order to get my requirements. I volunteered as an EMT and I worked as a medical scribe. I was a clinical assistant. I was able to see medicine from a bunch of different aspects and ways, which I thought was exciting. 

Q: Back to Dr. Pavlik. Going off of what Regina said, could you describe Salus' PA program and how it prepares students to work with other healthcare providers like NPs? 

Daniel Pavlik:

Our education is pretty standard as far as PA programs go. Usually the way that they are is our students either have, or will have come in with, a bachelor's degree and they're either a pre-med biology major, or they have the prerequisites to satisfy that, like in Regina's case. 

They come in and they do three semesters of full didactic, which in our program is about 61 credits in three semesters. It's clinical medicine, it's physiology, it's gross anatomy with dissection, pharmacology, the things that they would need to be in a clinical setting. Then for the second year of the program, they go out on clinical rotations. The rotations are five weeks in our program: Emergency department, family medicine office, internal medicine, surgery, pediatrics. 

We have eight core rotations and two potential electives. They spend essentially an entire year rotating through these. Within that, they work with lots of different types of primarily physicians and PAs, but they also work with nurses, medical techs, EMTs, nurse practitioners. There's a lot of emphasis on interprofessional education out there, but our entire second year of our program is interprofessional. They spend all of it going out on rotations and working with these different groups and practitioners. 

Q: Back to Regina. What would you say to a prospective student who may be interested in PA, or Salus specifically, but is debating it over maybe an NP or a different healthcare career? 

Regina Day:

I would encourage the student to be very reflective about their own personality and their own goals. If they're interested in nursing school and they have an idea of what type of patient population they want to treat, nurse practitioner might be the better route for them. But if they're unclear about what population of medicine or what patient population they want to treat, and they like the idea of having core and elective rotations to really learn about a variety of healthcare fields, then I would say the PA route would probably be a better fit. 

They may also want to consider if they want to work while they're in school, because most of the PA programs that I'm familiar with, there isn't the flexibility of being part-time. You really can't accommodate a work schedule on top of that. I've talked to nurse practitioners, students on rotations, and they were able to work while doing their program because they have the flexibility to be part-time students. They could work while doing that, and I thought that was pretty neat. 

In terms of medical school versus NP or PA programs, they are obviously both very competitive and vigorous programs. I have a handful of friends right now in medical school and from talking to them, I kind of think of medical school like a marathon, and then PA school or NP, probably similarly, like a sprint. They're obviously both very challenging, but medical school would be a little bit more spread out over a longer period of time and then requires a residency, versus PA school, much more fast-paced, less time off, shorter duration. And you're able to continue learning while you start your career a little sooner. 

So, I would encourage them to think what would fit their personality best. My biggest piece of advice would really be to shadow all medical providers that you can in a variety of settings, so you can really get a better idea of what would be the best fit. Because you can read about the professions all day long, but until you really see them in action, you can’t really shape a better understanding about what it means to be a PA, NP, or whatever other medical provider. 

Q: Is there anything else you would like to add? 

Daniel Pavlik:

Having been in PA education for eight or nine years now, and still practicing, the way that someone described PA school, which was, I think pretty accurate is that it's supposed to be three quarters of medical school in half the time. So, it is comparatively accelerated and it’s a lot. I don't think it is for everybody and I don't think everybody could be successful in it, but it does provide you some flexibility that medical school doesn't. 

In talking about the nurse practitioner programs, because their education is quite a bit shorter, they have to specialize while they're doing it. Which, again, they have more flexibility. It can be done part-time, they can work full-time while they're doing it, but they do have to specialize. Whereas we do come out as generalists, which is a cool thing, I think. 

Regina Day:

I can add one more thing – just continuing to ask people questions all the time and shadowing as much as you can. For PA school specifically, there are schools who have a required number of clinical hours you have to meet in order to apply to the program or be considered competitive to get in. I would really stress not just sticking to the number, but just getting as much experience or exposure to the clinical field as possible, because that's going to really pay off in the long run and help you get a better understanding about what you want to do. 

To learn more about the Physician Assistant Studies program, you can visit salus.edu/physician-assistant.