It is estimated that more than 83 million people in the U.S. live in areas without sufficient access to a primary care physician, with larger shortages predicted to develop over the next decade or so. Both family nurse practitioners (FNPs) and physician assistants (PAs) are poised to step in and fill some of these gaps.
If you’re interested in a career in healthcare, you may be wondering whether you should pursue being an FNP or a PA. Here, we’ll look at the similarities and differences between these two degrees to help you determine which is the right one for you.
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Major Differences Between an FNP and a PA
The roles of FNP and PA are quite similar. The most significant difference is in the approach to education. FNPs attend an advanced nursing program, while PAs attend a program based on medical education. A PA is trained using a disease-centered model similar to that of a medical student, while an FNP follows a more patient-centered nursing model.
FNP is one of several nurse practitioner specializations, so FNP students learn about their area of expertise as they get their education. PA programs offer a more general medical education. To specialize, PAs must complete a residency, fellowship, or other type of specialized training after graduating.
To become an FNP, a registered nurse must have a BSN. (RNs with a diploma or an associate’s degree can either return to school to complete a BSN or enroll in an FNP program that accepts RNs and offers bridge classes to complete the necessary prerequisites.) Most BSN programs take about four years to complete, and the requirements usually include about 600 to 800 clinical hours where they receive hands-on patient experience.
After completing their BSN, nurses must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and apply for state licensure before applying for an FNP program.
FNP programs offer either an MSN or DNP. Master’s programs generally last about two years, while doctorate programs are about three or four years. At this time, FNPs only need an MSN to practice, but this may change in the future. Some professional organizations are pushing for a DNP to be the entry-level degree in this field. Many of these programs offer online options, though they all require in-person clinical hours. The clinical hours vary by program but are usually between 500 and 1,000.
After completing their FNP program, students must take either the American Nurses Credentialing Center (ANCC) Family Nurse Practitioner exam or the American Association of Nurse Practitioners Certification Program (AANPCP) exam and apply for licensure in their state.
FNP certification must be renewed every five years. There are two ways to obtain recertification: completing 1,000 practice hours (which can include direct patient care, administrative, research, and educational roles), 100 advanced practice continuing education contact hours (including a minimum of 25 in advanced pharmacology) OR retaking the recertification exam.
To become a PA, the first step is to complete a four-year bachelor’s degree, typically in something related to science. Some universities may offer pre-PA degrees to prepare students for their master’s studies.
After completing a bachelor’s, students must apply for a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). These master’s programs are usually two years long and consist of classroom work and clinical rotations. Clinical requirements vary per program, but generally, PA students complete at least 2,000 hours. Because these programs follow a medical school model, students rotate through various specialties throughout the program, including family medicine, emergency medicine, general surgery, and internal medicine.
After completing a PA program, graduates must pass the Physician Assistant National Certifying Examination (PANCE) from the National Commission on Certification of Physician Assistants (NCCPA). To maintain this certification, PAs must complete continuing education requirements every two years and take a recertification exam every ten years.
What Does an FNP Do?
FNPs are trained to provide advanced nursing care to patients of all ages, from infants to seniors. Depending on their training and interests, they can work in either primary or acute care in clinics, private practices, or hospitals. Specific duties depend on where they work, but FNPs are qualified to provide preventative care, patient education, routine checkups, immunizations, and to diagnose and treat illnesses.
An NP’s scope of practice varies depending on the state where they work. Some states, called full practice states, allow all NPs to work as independent providers. They can manage patient care, prescribe medications without a doctor’s supervision, and even open private practices.
However, in reduced- and restricted-practice states, all NPs must work under a physician’s supervision. Reduced-practice states give NPs some independence when diagnosing and treating patients but require collaborative agreements with doctors to prescribe medication. In restricted-practice states, NPs need physician oversight to diagnose and treat patients and prescribe medications.
What Does a PA Do?
PAs can provide direct patient care, diagnose and treat common illnesses, and perform minor medical procedures. The scope of practice of PAs is determined by state law, but they can generally make rounds, perform exams, assist in surgeries, order and interpret labs and x-rays, and prescribe medication.
Like FNPs, the state where a PA works affects their scope of practice. States are considered optimal, advanced, moderate, or reduced. In states with optimal practice, PAs can practice to the full extent of their training and establish a collaborative agreement with their employer that lays out what they can do beyond what is outlined in state laws. Advanced practice states are similar, with more restrictions on administrative requirements.
Moderate practice states have administrative laws that can impact the PA’s ability to practice, making their role on the healthcare team somewhat more limited. Finally, reduced practice states restrict at least part of PA practice, generally having restrictive supervision requirements.
FNP vs PA: Similarities
- Pay for these roles is similar. The average salary for a master’s-prepared FNP is $102,000 per year; for a PA, it’s $108,000.
- An FNP and a PA can act as primary care providers, assessing, diagnosing, and treating patients, including prescribing medications.
- FNPs and PAs have to work within the scope of practice of the state where they are licensed and working. Some states restrict their duties quite a bit, while others give them significant independence.
- To become certified, both FNPs and PAs must complete an undergraduate degree or equivalent and a master’s degree program and pass exams.
FNP vs PA: Differences
- FNPs can further their education by obtaining a doctorate in their area of expertise.
- FNPs focus on their specialization throughout their education, while PAs rotate through many specialties in their programs and can choose to specialize after graduation.
- FNPs complete specialized advanced practice degrees that emphasize treating whole patients, including their mental and emotional needs; PAs focus on a more generalized disease-focused curriculum based on a medical school model that emphasizes the biological aspects of health conditions and diseases.
- More growth is predicted in the advanced practice nursing field. According to the Bureau of Labor Statistics, the projected job growth for FNPs and other advanced practice nurses is 38% between 2022 and 2032; for PAs, the projected job growth is still much higher than average but slightly lower at 27%.
Which Path Is Right For You?
FNPs and PAs have many overlapping responsibilities and may face some of the same practice restrictions, depending on the state where they work. Their average salaries are similar, and both require a minimum of a master’s degree. The biggest difference between these two fields is the focus of their education.
FNPs are trained as nurses, with a focus on the holistic needs of the patient, whereas PAs are trained similarly to doctors, focusing on the disease process. Both careers offer valuable primary care support to patients; ultimately, it depends on the type of patient care approach you’re interested in.