Physician Assistants, Doctors, and Nurse Practitioners

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Physician Assistants, Doctors, and Nurse Practitioners

Updated : 08/08/2015
Over the last 200 years, several million public books and publications were archived into a database where a word search counted the number of times “physician assistant” or “nurse practitioner” was used. You can see the preliminary results here . Not so surprisingly, "physician assistant" began to pop up around the same time as "nurse practitioner," however, more folks seem to quote nurse practitioners in their novels than physician assistants. Could it be because your average American is less educated about all mid-level providers? Is AAPA doing a poor job of promoting physician assistants in the United States? Are nurse practitioner lobbyist groups stronger than we anticipated? Or is it because there are simply less well-known physician assistants in the scientific community? These are questions I do not have answers for, but if you're curious about the difference between the three different types of advanced providers, please keep reading and enjoy!

The Physician Assistant Pathway

PA School and Admission:
  • PAs cover about 400 hours in basic sciences in about 26 months (AAPA, 2014)
    • 75 hours of those are pharmacology
    • 175 additional hours are in behavioral sciences
    • 580 hours in clinical medicine
  • PA students graduate with a minimum of 2000+ clinical hours
    • Emphasis on primary care in ambulatory clinics, physicians' offices and acute/long-term care facilities
  • PA school is based on the medical model and medical school curriculum
  • PA school is thought to be just as competitive as medical school, with 2.25 applicants per available seat for both allopathic medical schools and PA programs (Jones, 2007)
  • As of 2010, 154 PA programs were operational and 152 of those had accreditation (99%) by ARC-PA (McCarty, 2011)
  • PAs are almost always required to attend lecture 8 AM-5 PM
  • You see a more continuous flow of study from the didactic phase into the clinical phase
  • PA and medical school seem to match up pretty well in what content gets covered, although medical students may cover much more depth of knowledge in some areas
  • PA school is much less expensive than medical school, requires less time (about 2-2.5 years usually), and allows more time for a family
  • PA school requires lots of prerequisites that medical schools do not. For instance, medical schools often do not require as many social science credits (psychology), nutrition, microbiology, and many others
  • Most programs require a bachelor’s degree and admission can require direct health care experience with most students having at least 2 years of experience (Nicholson, 2008)
    • In the 2005-2006 academic year, the typical PA stduent who matriculated had 29 months of prior health care experience with a baccalaureate degree and a 3.4 overall GPA (Jones, 2007)
    • Data from the 2009-2010 CASPA application cycle shows 15,186 applications were submitted for 5,816 seats (ratio of 2.61:1). The overall GPA was 3.25 with an average of 6.22 program designations per applicant. This number does not include 27 of then 173 accredited programs who did not participate in CASPA. (Cawley et al., 2013)
  • PA program accreditation is overseen in part by representatives from the American Academy of Family Physicians , the American College of Surgeons , the American Osteopathic Association , and other physician groups, in addition to numerous PA representatives including ARC-PA (Accreditation Review Commission on Education for the Physician Assistant)

What Is A Physician Assistant?
There are many ways to describe what a physician assistant is/does. The PA role was introduced in the mid 1960's by Dr. Eugene Stead and Dr. William Anlyan at Duke University. Together, they established a 24 month PA program based on the fast track medical training of doctors in WWII. Today, more than 90,000 certified PAs are practicing according to the NCCPA. Here are a few that may help you:
  • PAs provide a range of diagnostic and therapeutic services which vary by practice setting. These include physical examination, diagnosing and treating illnesses, ordering and interpreting tests, counseling on preventative healthcare, assisting in surgery, writing prescriptions, education, research, and administrative services. (Legler et al, 2007)
  • PAs are healthcare professionals who practice medicine collegially with, and under the supervision of, physicians
  • PAs are dependent practitioners who practice medicine alongside the physician-led team
  • PAs are physician extenders that are trained to diagnose and treat patients. They are trained in the medical model and are trained to do about 80% of what a physician does.
  • PAs are generalists and are represented across all medical specialties.
  • A physician assistant performs many tasks of the physician, NP/RN, but they must work under the supervision of a physician and cannot operate an independent practice (but they can work autonomously, with minimal supervision).
  • PAs that work in the ED can take histories and perform physical examinations, order diagnostic tests and interpret the results, prescribe medications, suture, splint, perform minor surgical procedures (foreign body removal, incision, abscess drainage), resuscitation (central line placement, intubation, inserting chest tubes, and arterial lines), discharge patients, admit patients, or refer patients to specialists.
PA Pros
  • The overall supply of PAs is likely to increase by as much as 72% to 127,821 PAs by the year 2025 (Hooker, 2011).
  • The strength of the PA profession lies in the technical skills and procedures they can offer, including their excellent physical exam (PE) skills!
  • PAs may be found working in hospitals, clinics and many other types of health care settings.
  • The benefit of a PA is that PAs retain the right to change specialty whenever they want, a feature physicians and NPs do not have.
  • The PA doesn’t have to go back to school for additional certifications for surgery or if they want to change specialties tomorrow - and no residency is ever required! Instead, they simply have to find a supervising physician willing to train them and they’re set!
  • Additionally, there are more PAs assisting in surgery than NPs. They perform procedures such as central venous catheter placement, chest tube insertion, diagnostic peritoneal lavage, arterial line placement, pulmonary artery catheter placement, wound evaluation and treatment (Ho et al., 2010)
  • There are laws allowing PAs who practice in rural areas to have supervising physicians meet with them a few times a month or sometimes one times a month to go over a few clinical cases, which allows PAs to run entire clinics or hospitals in rural areas.
  • A cohort of PA professionals and students have began petitioning for a name change from “physician assistant” to “physician associate” or “physician extender.”
  • PAs are trained in all specialties, which is why they are called the “jack of all trades, but a master of none.” This refers to the fact that PAs receive training in all specialties, but not enough to necessarily call them a master or “doctor.” This is seen as a positive benefit, because PAs have a wide variety of skills and are well-equipped right out of school.
  • PAs now follow a 10 year re-certification process, similar to physicians, as implemented in 2014; 100 hours of CME over a 2 year cycle
    • All PAs take the same certifying exam, administered by NCCPA
  • Care provided by PAs is equivalent to that provided by physicians in terms of safety (Ho et al, 2010; O'Conner & Hooker, 2007; Farmer et al, 2009)
  • PAs develop greater autonomy and efficiency in inpatient areas (e.g. hematology/oncology, bone marrow transplant) which allows them to develop expertise in a specialized area (Parekh and Roy, 2010)
  • PAs offer great value to their employers by providing high quality medical and surgical care, for which most public and private third party payers reimburse; services by the PA are billed under the PA's name or under the name of the physician, depending on policy of the third party payer
  • The PA profession has grown 34% since 2006
  • PAs work with an average of four physicians, three other PAs and one NP (AAPA, 2014)
  • 34% of PAs work in primary care and 37% work in medically underserved counties (AAPA, 2014; Hooker et al., 2011)
  • Nationwide, the compensation package for a newly graduated PA is between $80-86,000
  • PA salaries, on average, are higher than NP salaries (Clinicaladvisor, 2013)
  • The average malpractice payment of PAs between 1991-1996 was $55,241, while that of physicians was $139,581 (Nicholson, 2008). A newer study provides similar results, with settlements for PAs around $100,000 and physician settlements around $200,000.
  • Supervising physicians and their PAs experience a lower rate of malpractice litigation than physicians overall. This means that you and your supervising physician have less of a chance of being sued than physicians without PAs! (Medical Economics, 2011)
  • PAs have lower rates of claims and suits than physicians
  • On average, 9.9% of PAs saw 25 patients or less per week, 26.2% saw between 26-50, 24.3% saw between 51-75, 24.3% saw between 76-100, and the upper 17.3% saw over 100 patients per week (ClinicalAdvisor, 2013).
  • On average, 29.4% of PAs wrote between 0-25 prescriptions per week, 35.1% wrote between 26-75, 19.4% wrote between 76-125, and the upper 16.1% wrote 126 prescriptions or more per week (ClinicalAdvisor, 2013).
  • No discernible difference was seen between the amount of time PAs and NPs spend on the job. Approximately 80% of all respondents work between 30-50 hours per week.  
  • Physician assistants and nurse practitioners, compared to physicians, function at comparable levels, and are accepted by patients at a comparable level (Hooker et al., 1997)
PA Cons
  • The important part about becoming a PA is realizing that you don’t always get to “fly the plane,” and you’ll act as a co-pilot in most situations, with a more relaxed style of autonomy than physicians or NPs. You have to be comfortable with this style of practice if you want to be a PA.
  • PAs must be assigned to a supervising physician, and the services they provide are limited to
    • Those the physician can provide adequate supervision for
    • Scope of practice and services limited to supervising physician's specialty (Kimball et al, 2008; Horton et al, 2001)
    • Their training (Kimball et al, 2008; Horton et al, 2001)
    • Their experience (Henry et al 2011; Morgan et al, 2008; Kimball et al, 2008)
    • Their competence (Henry et al 2011; Morgan et al, 2008; Horton et al, 2001)
    • The setting in which they practice (e.g. urban v. rural) (Henry et al, 2011; Kimball et al, 2008)
  • Every state has their own restrictions on the PA profession (pronouncing death, order home health or hospice care, signing death certificates, make decision to admit or discharge a patient to a hospital, cannot be listed as a PCP, etc.), and you can find them on the AAPA website . However, individual institutions might have their own restrictions that prevent PAs from supervising conscious sedation, ordering certain medications, etc.
  • AAPA works to fight for PA legislation, but is often demerited as being less aggressive than NP lobbyists.
  1. Obtain a bachelor’s degree (do well in prerequisites necessary) - Side Note: there are bachelor level PA programs available, but I do not endorse them
    1. Take the GRE (for most PA schools) or use MCAT scores
    2. Gain health care experience (HCE) hours
  2. Apply to Master level PA programs
    1. Obtain letters of reference
    2. Write essays & fill out supplemental applications
    3. Interview
  3. Acceptances - most schools offer on a rolling basis
  4. Year 1 (some programs 1.5 years) - Didactic Phase
  5. Year 2 (1.5-3) - Clinical Rotation Phase
  6. PANCE Examination - certification exam given by the NCCPA ; Allows PAs to become certified in all specialties like psychiatry, family medicine, GI, endocrinology, dermatology, cardiology, neurology, and pediatrics - just to name a few.
  7. Residency or Fellowship (possible, but not required) - 1-2 years
Now the real questions come. Can you handle being asked to see the “doctor” instead? Do you have a strong backbone and can you withstand remarks about your profession from physicians and NPs and other medical personnel disrespecting you? Can you afford to take a pay cut from not being a physician or NP (in some cases, PAs make what physicians make)? Sure PA school might require the GRE, but it would probably beat the MCAT. If you feel passionate about practicing medicine, but you know medical school is not what you want, then PA school may be for you.

The Physician (MD/DO) Pathway

MD/DO School and Admission:
  • Physicians cover 150 weeks of material over 4 years
  • Equivalent to about 1.5 times the volume of what is taught in PA school
  • PA school is thought to be just as competitive as medical school, with 2.25 applicants per available seat for both allopathic medical schools and PA programs (Jones, 2007)
  • Most programs do not require students to attend lecture
  • While in medical school, you may see some programs giving students summers off, etc.
  • Medical students also cover basic background science (biochemistry/cell biology) much more than PA students, but the pace of PA school is what seems to make PA school appear more difficult.
  • Medical school takes up a lot of your time and resources - specifically, it is expensive, lengthy (4 years didactic, 4 years clinical + 3 years residency + 2 years possible fellowship), and does not allow much time for a family.
    • Eventually, there will be a 3 year fast track medical degree for students wishing to enter primary care.
  • Medical schools often require many more prerequisites than PA school, although they do require some very different prerequisites as well, such as organic chemistry and biochemistry.
  • Good medical schools require you take the MCAT and that you have an extremely competitive GPA (3.5+).
  • The American Board of Medical Specialties (ABMS) currently verifies doctor certifications and recertifications. Most of them require recertification every 6-10 years.  
What is a Physician?
Physicians, also known as allopathic physicians (M.D.) or osteopathic physicians (D.O.) are medical doctors who treat disease and injury using counteractive methods. Osteopathic physicians take on a more holistic perspective of medicine based on the believe of treating the whole patient and emphasize alternative and preventative methods, rather than pharmacological methods. 92% of physicians nationwide are allopathic, while only 8% practice as osteopathic physicians. 89% of physicians are board certified, and 69% of US physicians are male.

MD/DO Pros
  • A physician is the most autonomous provider, which means they are allowed to practice independently of any other provider, whereas PAs and (some) NPs must practice under physician supervision.
  • Few, if any, restrictions in practicing medicine and prescribing medications
  • As a physician, you will probably make more money and have a wider scope of practice by default
    • Physicians have reported earning higher incomes than nurse practitioners (Donelan et al., 2013)  
  • You will experience more respect from patients and coworkers, as long as you reciprocate this respect
  • Every specialty makes over $100,000, with 8 specialties earning over $300,000 annually (Medscape, 2014)
  • 40% of doctors see between 25-75 patients per week; 35% see between 50-99 patients per week; 25% see over 100 patients per week
  • 66% of physicians see patients up to 45 hours/week; 18% spend 50+ hours/week seeing patients
  • 22% of doctors spend 25 hours or more seeing patients in the hospital

MD/DO Cons
  • Like NPs, physicians do not have the lateral mobility PAs do in their career to be able to change specialities whenever they want
    • Unless they go back and do a residency in another specialty and become board certified in this new specialty
  • Medical school is extremely expensive
  • Male physicians earn 30% more than women; in primary care that gap is 17% (Medscape, 2014)
  • Physicians with board certification earn significantly more than those without it (Medscape, 2013). Unfortunately for physicians, they must continually maintain these expensive certifications.
  • 48% of physicians feel they are fairly compensated, while 51% of physicians in primary care feel they are fairly compensated
  • Given cuts to Medicare and changes in Medicare reimbursement, 9% of physicians plan to stop taking new Medicare patients and 2% will no longer treat their current Medicare patients. A whopping 29% have not made a decision yet on what to do.
  • Doctors are drowning in paperwork (paper or computer based) - 51% of doctors spend between 5-14 hours/week on paperwork; 17% spend more than 20 hours/week on paperwork
  • The medical school route is about 2-3 times as long as the PA route
  • It is more difficult to be a medical school student and have a family
  • The MCAT is much more difficult than the GRE or NCLEX
  • You have to take organic chemistry II and biochemistry and other prerequisites may exist for other programs
  • Residency is required
  • When asked if physicians would "do it all over again" - only 51% said they would choose to become doctors again. Only 42% said they would choose their specialty again. 19% said they would choose the same practice setting.
  • Physicians have reported working longer hours and seeing more patients than nurse practitioners (Donelan et al., 2013)

  1. Obtain a bachelor’s degree (do well in core science coursework)
    1. Take the MCAT
    2. Obtain health care experience (HCE)
  2. Apply to medical schools (Doctor of Medicine or Doctor of Osteopathic Medicine)
    1. Obtain letters of reference
    2. Write essays & fill out supplemental applications
    3. Interview
  3. Years 1 & 2 (2 years of didactic general education)
    1. USMLE 1 (U.S. Medical Licensing Examination) - sponsored by the FSMB and the NBME ; covers concepts of the basic sciences to the practice of medicine (taken after 2nd year)
    2. COMLEX 1 (Comprehensive Osteopathic Medical Licensing Examination) for DO students - administered by NBOME ; covers basic mechanisms of health and disease (taken after 2nd year); 2 part exam
  4. Year 3: Clinical Education (Rotations)
    1. USMLE 2 - examines whether students can apply medical knowledge, skills and understanding of clinical science (taken during the 4th year); divided into 2 exams
    2. COMLEX 2 for DO students - examines student’s ability to demonstrate knowledge of clinical concepts and decision making (taken during year 3 or 4); 2 part exam
  5. Year 4: Specialty Electives & Residency Applications “match” occurs again in your 4th year of medical school to match you with a residency program; interviews are required for this as well;
  6. Residency (2 years) - Can last 8-9 years for surgeons
    1. USMLE 3 - examines whether student can apply medical knowledge and understanding of biomedical and clinical science essential for unsupervised practice of medicine (taken after first year of residency); divided over 2 days
    2. COMLEX 3 for DO students - covers clinical disciplines of medicine; (taken after starting a residency program)
  7. Board Certification - take board exams! Pay your dues!
  8. Fellowships (1-3 years) - available for medical or surgical specialties to become specialized

If you need to constantly be in charge and always have to have the last word, maybe medical school is for you. Physicians will usually always make the last call, unless they trust the midlevel provider (PA/NP) they are supervising to make a decision for them. If you feel you have the time and the resources to dedicate to medical school, and you have a passion for medicine, then you should go for it. There are PAs who to this day wish they had chosen to go to medical school. Don't let yourself wonder, what if? If your desires tell you that you are destined to be a doctor, then you should go for it. Taking the easy way out because you didn't score well on the MCAT, you already have a nursing degree, or you don't have the grades to get into medical school aren't good reasons to choose PA or NP school. If you need help in another area, you should decide what you need to do to better yourself in that area to get yourself to where you want to be. There is no rush in life and if medical school is where you are meant to be, then you shouldn't care how long it takes to finish.

The Nurse Practitioner Pathway

NP School and Admission:
  • Nurse practitioners can have an initial 1-2 years nursing experience (up to 4000 hours), but most have the minimum (around 2000 hours)
    • Not all programs require that you have a degree in nursing prior to admission; some allow non-nursing baccalaureate degrees, however, all programs will require that you be an RN prior to admission
  • Some programs require the GRE, some do not, while others may require scores from the Miller Analogies Test (MAT)
  • One benefit of NP school is that most allow you to participate part or full-time, while some programs give you the option to work as an RN during school
  • During NP school, many PAs claim that not enough clinical medicine, pharmacology and pathophysiology is enforced in NP school
  • Very few NP programs offer cadaver dissection
  • After NP school, 750-1400 clinical hours are required in a specialty, of which many NP students set up themselves, which explains why many PA students and professionals are so adamant that NP education is inferior and lacking in the clinical realm
  • NPs do not typically rotate in surgery during their clinical year, and spend many less hours on rotations
  • NPs have specialized training in one particular area (family practice, pediatrics, women’s health, psychiatry, etc.), which usually complements the area of their prior nursing experience. This experience amounts to anywhere between 500-1000 clinical hours.
  • Nurse practitioners face many of the same obstacles in federal and state advocacy that PAs do and you can find answers to their scope of practice here and here (page 22)
  • Nursing accreditation is overseen by nursing boards ( ACEN - previously NLNAC and CCNE )
  • Most NPs claim to practice "nursing" for legislative and political reasons, however, they do practice medicine.

What is a Nurse Practitioner?
A registered nurse (RN) performs great range of duties such as recording medical histories, examining patients, providing treatment, and assisting in the administration of diagnostic tests whereas an NP can do all of the things that RNs are known for, but additionally they can also order diagnostic tests and interpret test results. The NP role extends to the 1930s, when nurses in the Frontier Nursing Service provided medical care to residents of Appalachia with minimal supervision by MDs. Not until the 1960s would the NP role see a big break, though. With the shortage of primary care physicians, medical specialization allowed NPs to expand into specialty and acute care areas. Today, more than 106,000 NPs practice in the US (AHRQ, 2010). Other descriptions of nurse practitioners include:
  • NPs are trained in a designated field and specialty and are also registered nurses prior to becoming a NP. NPs are trained in a nursing model, but practice medicine specific to their field of study.
  • NP practice emphasizes a holistic approach to patient care with particular attention to disease prevention, health promotion, and risk reduction.

NP Pros
  • NP is that they are now allowed to practice independently of physicians in many states.
  • 52% of NPs practice in primary care, while the remainder are distributed across a variety of settings and specialties
  • Patients reporting NP as their primary care provider (PCP) were more likely to be Medicaid recipients than those reporting care from a PA or physician (Hooker et al., 2005)
  • The costs of many NP schools are often much cheaper than PA schools
  • If you plan to work for Doctors Without Borders (Médecins Sans Frontières) or Global Health Service Corps , being a NP would be the only way to get onboard as a midlevel, as they do not accept PAs
  • NPs work collaboratively with physicians, but may diagnose and treat autonomously in as many as 28 states.
    • All NPs can practice advanced nursing independently REGARDLESS of the supervising physician's specialty*
  • NPs have authority to prescribe without permission from a physician or Board of Medicine, pending state requirements are met, in as many as 18 states.
  • NPs can effectively sign death certificates in 23 states, with access to sign death certificates in 2 other states pending setting and physician notice
  • In all but 14 states, NPs are allowed to sign workers' compensation claims
  • In 44 states, NPs are allowed to sign handicap parking permits.
  • 48 states allow NPs to make referrals for physical therapy, while 4 are pending this ability.
  • NPs may be certified in both a population-focused area AND specialty area of practice - but must be certified by a national specialty or certifying agency accepted by their state board of nursing
  • On average, 14.8% of NPs see 25 or less patients per week, 30.1% see between 26-50,  25.5% see between 51-76, 19.5% see between 76-100, and the upper 10% of NPs see over 100 patients per week (ClinicalAdvisor, 2013)
  • On average, 35.1% of NPs write between 0-25 prescriptions per week, 36.8% write between 26-75, 17.2% write between 76-125, and the upper 10.9% write over 125 prescriptions per week (ClinicalAdvisor, 2013)
  • No discernible difference was seen between the amount of time PAs and NPs spend on the job. Approximately 80% of all respondents work between 30-50 hours per week.
  • Increasing availability of NPs and how they compare to doctors in primary care shows they are likely to have higher levels of patient satisfaction and higher quality care (Hooker et al., 2005).

NP Cons
  • There is less consistency in many NP programs and many NPs disapprove of the standard NP curriculum and expectations
    • Ex. Direct entry programs - must be routinely evaluated to ensure the programs are providing sufficient clinical experience and preparation for safe, effective, and independent practice after graduation
  • Some NP rotations may not be of good quality because the students may have to find them wherever they can to meet the minimum requirements
  • Scope of practice regulated through state nurse practice acts (ACNP)
  • NPs require an additional certification to work in surgery, which explains why you see less NPs in surgery than PAs
  • Nurse practitioners must be recertified every 5 years

  1. Become an RN by obtaining a BSN (Bachelor of Science in Nursing) - 4 years
    1. Obtain State License as RN (NCLEX-RN) as administered by the National Council of State Boards of Nursing
  2. Choose a Specialty and Gain Experience - 1-2 years
    1. One of the hallmarks of NP is that you must choose your specialty early on and stick with it. You don’t have the lateral mobility in changing specialty like you do with PA.
  3. Earn a Nurse Practitioner Master’s Degree from an Accredited Program - 1-3 years
    1. Graduates with non-nursing bachelor’s degree - can opt for a BSN-to-Master’s fast-track-program (typically 3 years)
    2. Nurses who want a master's degree in a different specialty than their BSN may opt to complete a post-master's graduate certificate program as a nurse practitioner. This can take five months to a year to complete, depending on the specialty.
  4. Apply for Certification - Requires 750-1400 clinical hours in a specialty

Side Note: The American Association of Colleges of Nursing ( AACN ) has recommended that all entry-level NP programs transition the Master of Science in Nursing degree to the DNP (Doctor of Nursing Practice) degree by the year 2015. Typically, “doctor” means “holder of a highest degree in university,” however, there is much debate about whether NPs should be called this or not. In 2011, the American Medical Association launched the “Truth in Advertising Campaign” to promote transparency so that patients could truly know who was providing their care. They contested that the confusion undermines the reliability of our healthcare system and puts patients at risk.This movement will put NPs on equal footing with those in pharmacy and physical therapy, requiring 32 additional degree course credits beyond a master's degree. This presents the challenge of a longer, possibly more challenging journey to become an advanced practitioner. The question arises whether more students, including nurses, will pursue PA rather than DNP?

If salary is what you are concerned about, you can find results from a 2013 survey of nurse practitioners and PAs here . For more up-to-date information on PA salary, read about the AAPA Salary Report article I posted recently here .

Choosing a pathway can be difficult at any age. It’s hard to know what you want to be when you know so little about being in that profession besides observing others. There are many “bridge” programs that allow you to bridge from a PA to a DO, PA to NP, etc. in 3 years or less. These are secondary options for you if you decide while in school that PA may not be for you, because it does happen and PA school isn’t for everyone. It is better to ensure PA is the right pathway from the get-go and to eliminate any detours along the way. You’ll save yourself a lot of money and time and you’ll give someone else the opportunity to attend PA school! From the words of an elder PA, “Life is not about doing something just because you might as well, or because you are capable of doing it. It’s about being whatever you want to be, at least for today. Tomorrow you might just want to be something else. Lead your own life. If you want to be a doc, then by all means, be one. If you don’t, then don’t. Don’t feel that there are laws of nature dictating that people of a certain age have to do anything in particular.”

For more information, I encourage you to continue your own research, ask a PA/MD/DO/NP you may know, or visit sites like and .

Sources: (great comparison chart)
Medscape -
2013 AAPA Salary Report, AAPA -
Physician Assistant History Society -
The 2012 Pearson Report -
Agency for Healthcare Research and Quality -
The Nurse Practitioner's 24th Annual Legislative Update -
Physician Assistant: State Laws and Regulations, 13th Edition
Hiring Into Advance Practice Positions, Ponte et al. 2013
Physician Assistants: A Literature Review, HPRAC -
Physician Assistant Medical Practice in the Health Care Workforce (Nicholson et al, 2008)
Medical Economics (2011)
Perspectives of Physicians and Nurse Practitioners on Primary Care Practice (Donelan et al., 2013)
Physician Assistant Education in the United States (Jones, 2007)
Predictive Modeling the Physician Assistant Supply: 2010-2025 (Hooker et al., 2011)
Personal Communication (McCarty, 2011)
Hiring a Physician Assistant or Nurse Practitioner (American College of Physicians, 2010)
Patient Satisfaction: Comparing Physician Assistants, Nurse Practitioners, and Physicians (Hooker et al., 1997)
Patient Satisfaction with Physician Assistant, Nurse Practitioner, and Physician Care: A National Survey of Medicare Beneficiaries (Hooker et al., 2005)
Institutional Sponsorship, Student Debt, and Specialty Choice in Physician Assistant Education (Cawley & Jones, 2013)