36 Comments

The nurse practitioner, physician assistant, and physician professions each have a unique approach to training. Understanding these approaches to education is important for both employers and individual providers themselves. The way healthcare providers are trained impacts the decisions they make, their legal scope of practice, and the way they are employed and integrated into the healthcare team. Aspiring healthcare providers also must review these different approaches. Which fits best with one’s own career timeline?

At the most basic level, looking at the education differences between MDs, NPs, and PAs, starts with the length of education. Physician assistant, nurse practitioner, and medical programs consist of both didactic and clinical education. Looking specifically at the number of clinical hours included as part of each education path is also important. Hands-on patient care hours translate to experience related directly to one’s career. When it comes to length of education and clinical training, how do the NP, PA, and MD professions compare?

Length of Education

Overall, nurse practitioner and physician assistant programs are similar in the length. NP programs vary in length more than PA programs as both master’s and doctorate level tracks are available. Medical programs, of course, are significantly longer that NP and PA programs, requiring almost twice the amount of time to complete. The table below compares the length of education for nurse practitioners, physician assistants and physicians.

 

Number of Clinical Hours

Length of training is not the only component factoring in to scope of practice and the differences among healthcare providers in the clinical setting. Training in the patient care setting translates directly into experience relevant to employment for healthcare providers. The table below compares the estimated number of clinical hours completed as part of the nurse practitioner, physician assistant, and medical education. Note that he number of clinical hours completed in each program depends on the provider’s specialty and the college or university itself.

Overall, physicians spend significantly more time in the clinical setting during their education than do nurse practitioners and physician assistants. 

Why Do These Numbers Matter?

Studies show that NPs and PAs can manage about 80% to 90% of the care provided by physicians in the primary care setting. It is essential that employers and providers understand, however, that with significantly less clinical training in school, there is a significant onboarding process associated with hiring nurse practitioners and physician assistants. Support during the new grad learning curve is essential. 

Nurse practitioners and physician assistant themselves must also recognize the realities of this learning curve. Education does not end on graduation day. To reach one’s full scope of practice, NPs and PAs must continue to learn, seeking to reach their maximum potential. It isn’t easy, but with hard work and a few years of experience, you can reach the 80% to 90% benchmark. 

Do you feel like the length of education and clinical requirements for NPs and PAs are appropriate? How do you think they should be changed?

 

You Might Also Like: 3 Ways NP Programs Should Be More Like PA Programs

 

Are you ready to Thrive?

Support + education for early career nurse practitioners.

Learn More
clipboard

36 thoughts on “MD vs. NP vs. PA: Here’s How the Number of Clinical Hours Compare”

  • I believe nurse practitioner programs should require the same number of clinical hours as do the PA programs.

    • No because they are different paths to becoming a provider. A PA only has experience from their program, where as NP was a RN first for years and has clinical experience with patients already

  • Most NPs have spent years as Registered Nurses before beginning their Masters level program. Those years should be considered when discussing the preparedness of NPs versus PAs.
    Also, RN BSNs have undergraduate degrees in medicine whereas PAs are not required to have a medical undergraduate degree.

    • As a former practicing RN, BSN and now as an M.D., I have to disagree that “most” have years of experience prior to becoming NPs. Many programs only require 500hrs practice which is 13 weeks of 40hrs/week. This practice could be in virtually any clinical setting and working in a nursing home, primary care clinic, or ICU/ER are not equivalent in preparatory capacity. And while I am not discounting a ADN/BSN degree, my experience with pharmacology, anatomy, physiology, biochemisty, pathology, histology, and microbiology during med school can hardly be compared to what I experienced with combined anatomy and physiology, microbiology, 1HR of additional/separate pharmacology, and later (BSN) 3hrs pathophysiology of my nursing school.

      All that said, my colleagues that have chosen NP(or PA for that matter) are in no way “inferior” in a similar way as RNs vs MD/DO or LPN vs RN. When properly executed, a combination of these provider types can provide superior care that any one alone. When we decide to recognize our differences and yet embrace a common goal all of humanity will benefit.

      Perhaps we should return to the days where everything was a ‘technical degree’ as you simply learned through apprenticeship and after arriving at a set supervised term you become a nurse, medical doctor, surgeon, etc.. If the argument becomes that hands on training and performing the actions of a profession for a defined amount of time, the titles of CRNA, LPN, RN, NP, PA, MD, DO, General Surgeon, Endocrinologist, Neurologist, etc become irrelevant as they are part of an endless continuum.

  • Bobby Rhudy says:

    As a new graduate FNP, I agree with Nell. The only caveat is that many (not all) NP programs require RN experience. Obviously this does not encompass the clinical training in the role of a provider, but it is significant and does account for more clinical contact than many if not most PA’s have. My school (honestly a crappy NP program) requires 3 years RN experience. Again I dont agree with the limited clinical time NP programs require, and as such I made a point of doing a whole lot more than mine required. Another consideration is the more limited scope of a NP as we must specialize, when compared to PA’s. We are only allowed to within our specialty (ie pediatrics, adult, acute care, family, psych). A PA can work in any of these and are given about a month clinical time for each, whereas an NP spends a year focused on only the population they are licensed to treat. Very different paths, but again clinical time is not emphasized enough. Instead NP students write paper after paper and become skilled in APA…..pointless….

  • NPs should require more clinical training, or a required residency for at least a year. 700-1000 hours is not enough to provide the experience required to manage the burden of diagnosing and prescribing. And it shows in practice, many NPs are clueless on how to manage anything besides a sore throat and a basic rash.

  • Most people don’t realize that a PA’s actual clerkship hours while in the PA program are not 2,000. This random claim of 2,000 hours includes the hours of some kind of medical volunteer or paid work that could include being a scribe, working as a medical assistant, or an EMT, a phlebotomist, & the list goes on. These hours are combined with the clerkship hours & counted as total clerkship time. The PA programs require a number of hours that is different from each school that students need to have to get into the program, and some may be working towards this in the first year before clerkship a start. When the actual clerkship or clinical rotation starts the range of hours for most is right in line with an NP, around 600 give or take. While there may be some NP & PA programs that require more hours, a lot do not.
    So if a PA can count non PA clerkship time towards their total clerkship hours, one can see how the number is misleading.
    In addition, they train in a lot of the same clinical areas that NP’s do & they can do their clerkship with NP’s, Residents, and MD’s. Whith both, the focus of the program influences the clinical rotations.

    • Jamie Bingham PA-C, MPAS, MPH says:

      ABSOLUTE SELF-ABSORBED LIE. DO YOU YOUR HOMEWORK. PA programs ANYWHERE count those things you mentioned as clinical hours. NONE.

      PA’s do close to, I know I did and I have the curriculum to prove it, 5000 hours not DOWN to 500. Good try though, but you’re ignorant. AND we intern, required by accreditation (there are no allowed “unaccredited” PA programs in the US – THEY ARE ILLEGAL.) in OB/GYN, SURGERY (I was made to do everything on the same rotation as the FP resident even carry a pager for emergency surgeries), EMERGENCY MEDICINE, PEDIATRICS, AND THEN WE SPEND 1/2 -1 FULL-TIME YEAR IN FAMILY MEDICINE. That is ALL second year (a little longer) . First year, we’re not doing “online learning at our pace like NP’s do now in almost all programs) we sat in the classroom 4 days a week 10 hours a day THEN Fridays was already clinical day first year BECAUSE we all HAD TO HAVE previous medical experience to even apply.

    • Michael Rosenberg says:

      You are incredibly wrong in this statement and don’t seem to understand how PA education works. Prior or concurrent healthcare experience for PA students absolutely DOES NOT count toward our clinical rotation requirements. All accredited PA programs through the ARC-PA must provide near identical rotation experiences in a comprehensive set of specialties, which very consistently averages out to approximately 2000 hours. There is no way for students to receive advance standing or credit for rotations through prior experience. I have 9 years of experience as a paramedic and still had to do the same ER rotation as everyone else in my program. I will do 12 mostly 4 week rotations that are required to be 40hrs per week minimum, which comes out 10 1920 hours. No one does less than this regardless of their background or other licenses. We literally have students who were physicians in other countries who for one reason or another could not get a license in the U.S.; they have to do the same clinical hours as everyone else. Again, this is all stipulated by the ARC-PA – you cannot graduate an accredited PA program without doing this. Programs require varying amounts of prior pt contact experience such as acquired by being an EMT, scribe, etc. for ADMISSION, maybe that’s where you got things confused.

  • I’m a PA-C, when I was in training the NP’s I worked with in several levels of care stated they wished their clinical training was as intense as the PA training.
    I noticed in practice, now working in Emergency medicine, the older NP’s do well. But as a generalization that has proven over and over, our new NP’s are lost. The NP’s are smart enough to do well, just mainly lack the experience as a decision maker. As a side, I was a nurse long ago, my job nursing was delivering good on orders, not analyzing data, diagnosing and calling the shots. Although nursing helped me feel comfortable in any medical setting, it did not actually make me a better decision maker.

  • Re: pa’s do need medical hands on experience. There are few schools who state it is possible to enter their program without experience, however the likelihood of actually being selected for these programs without experience, considering the competitiveness of the applicant pool, is almost 0% acceptance unless you know someone and have absolutely stellar 4.0 GPA in core required classes. Otherwise you need hands on or care with at least 2000 hrs. Many schools require 4000+ hrs hands on as a EMT, nurse, rad tech, Pharmacist, all others will have slim chances of shining in the crowd.
    So, considering this PA’s do typically have years of experience other than Pa clinical hours and class time. W/c in my opinion is why the system has done well with the addition of PA’s into the medical system.

  • The advanced practice nurse is a medical professional who has already been practicing for many years prior to starting clinical training. Most PAs do not have prior clinical experience, and with this, I agree they need more clinical training.

    Nurse Practitioners are already far along I their understanding of patient care and physical exam by the time they start their training. Most schools require several a years practicing as an RN to be admitted. I disagree with the schools who permit new RNs into this “advanced practice” with no previous experience, as you can not advance into a practice you have not been practicing.

    NPs do not claim to be physicians, nor do they claim to know everything a physician knows. NPs are, however, qualified and provide competent care to patients in many settings, and know what they don’t know and when to ask for help.

    Training guidelines definitely need more consistency across the board. But I definitely think everyone needs to consider most NPs are seasoned nurses advancing in their field.

    • Michael Rosenberg says:

      “Most PAs do not have prior clinical experience”

      This is absolutely incorrect. Nearly every PA program in the country requires healthcare experience prior to admission. Many require as many as 2000-3000 hours just to apply. Even in programs with lower requirements, most applicants have some kind of healthcare background and have much better odds of acceptance the more experience they have. PA programs were specifically designed this way because they are condensed relative to medical school and students NEED to have some experience prior to starting in order for the curriculum to cover as much as it does in 2-3 years vs. 4 years of medical school. The only difference with NP programs is that PA students can come in with pt experience in a wide area of fields, anything from a CMA to a respiratory therapist, whereas NP applicants need to have been RNs specifically. And the idea that having been an RN entering an NP program should somehow excuse you from having to do the more rigorous clinical phase training of a PA or MD is a joke by the way, there is a HUGE difference from following orders as an RN vs. actually giving them as a practitioner and being responsible for making a diagnosis. RN vs NP are very different roles and the clinical training you receive in NP school needs to specifically train you how to be practitioner, for which I truly question how much benefit prior experience as an RN would be.

  • Double standard says:

    I have an issue with the DNP and PA practicing at the same level as physician as they only have about 10% of the clinical experience in diagnostics and treatment vs the physician. A DNP cannot claim they have experience in diagnosis and treating patients because they were an undergraduate nurse before becoming an DNP. People need to understand that it is not within the BSN’s scope of practice to diagnosis and treat patients. Furthermore, studies indicate that the higher prepared nurse has better outcomes at the bedside. Thus, the push for 80% BSN prepared nurses by 2020. How can we logically accept anything different at the provider level? If a person is expected to pay the same for a DNP/PA/Physician wouldn’t it make sense to demand the higher prepared provider as previous outcomes substantiate that the higher prepared professional has better patient outcomes.

    • Michael Rosenberg says:

      Well at least the PA profession actually understands its role in the healthcare system and remains closely tied to physician practice with all PAs needing to have a supervision physician in some capacity. PAs supplement physicians in the system, they don’t attempt to replace them. All of this push for independent practice by midlevels comes from the NP side, and the idea that someone with the amount of training an NP has relative to a physician should be allowed to practice independently at a level considered equivalent to them is negligent in my opinion. Also PA clinical training is far more rigorous with 2-3 times the required amount of rotation hours as NPs, so at least they enter practice better prepared for their roles in actual diagnosis and treatment of patients at the provider level.

  • Reluctantly, I agree with Fizz. As an NP you have a history of carrying out orders, not issuing them so it’s uncomfortable. As a doctor, of any kind (I’m a chiropractor), you are conditioned to give out orders-in which case PA’s are sitting right in the classroom with MD/DO’s and get the same training and so, more comfortable with it. In school, I noticed what other PA preceptors noted that NP’s generally lacked DDX skills and I would agree since the environment we come from (nursing) you are handed a patient with the diagnosis boxed and ready. So it’s a difference of figuring out a treatment plan from scratch or as in my case remembering one for a particular condition. Without the hard science background (which I received as a D.C.) NP’s have to play catch up on the basic and clinical science to get a full understanding. A full understanding isn’t always needed but be fully utilized though so they can practice but it takes a few years to get “comfortable” with the process.
    Conversely, PA’s tend to be younger academics who lack the age defined experience and wisdom that a seasoned RN might have (in other words…people skills). There are advantages to each although I have to say I have heard more than one PA tell me they wish they were NP’s and one actually talk his kid out of pursuing PA and go RN-NP. This has less to do with skill than politics, the nursing lobby is pretty powerful. At this point, I wish there was an effort to get more general patient care experience for PA’s and specialty experience for NP’s. It would be a more powerful reckoning force in healthcare if the two were homogenized, working together vs physicians directing everything to their advantage.

  • Emily –
    Just to clarify your comments above – I believe you are trying to distinguish between pre-PA clinical experience (where the number of required hours varies from program to program) and clinical experience hours done within PA school. The number of clinical hours done within PA school is nearly consistent across all PA programs at 2000 hours.

    – N Calhoun,
    Your statement that “most PA’s don’t have clinical experience” is incorrect. As faculty at a PA school, our applicants are required to have a MINIMUM of 2000 hours, with the average accepted student having well over 4000. Additionally, keep in mind that clinical experience is also not required for all MD/DO programs and more recently NP programs have moved in the opposite direction and now offer RNs the ability to go straight through to an NP program without ever working clinically as an RN.

    – Steph, please share the EBP information you are referring to. Thank you!

  • Not sure what NP programs you all have experience with. But in mine I have to do 1000 hours of clinical experience before I ever graduate AND a 3000 hour residency after I’m done. That is 4000 hours. That is for a DNP in Psychiatric Mental Health

    • Jamie Bingham PA-C, MPAS, MPH says:

      but what you don’t tell anyone is you could likely walk into an urgent care and get a job without ever even having put a foot in an urgent care or ER. There is an “assumption” that NP’s are on equal footing and they are not. Probably stronger in their online schooling in “preventative medicine” and things like immunizations, but true hands-on care. ALL PA’s in every program MUST intern in emergency medicine. ALL – it’s required for accreditation

  • Maria Perez says:

    I graduated from Quinnipiac University PA program. PA training is very intense so intense the didactic year consisted of ten hour days and exams almost every week. There is no chance of a PA going to school part time. The training is full time and rigorous. The clinical training is over 2000 hours. I see postings here from NPs regarding our clinical training ( clue less ) The rotations are six weeks long not four weeks long and require at least 40 hours attendance. Some rotations for example surgery or E.M. required 60+ hours weekly. There is no way anyone can complete a PA program and still be able to work; that is now intense the program is! Now I have mentored PA students and NP students. PA are definitely much better trained at thinking critically and coming up with a wide differential. NP students would come a few days a week for a few hours and were done with their training. The NP students I mentored had jobs, were able to become pregnant and take care of their families and still get their degree. The last NP student I mentored did not know the tests to rule out appendicitis. And when she was done rotating with me she had me sign a piece of paper ( there was no formal online evaluation ) . PAs have to complete 100 cme hours every 2 years NPs have to complete 75-150 every five years. The training and recertification is different.

  • Ibrahima Kake, RN says:

    First of all, to those has the belief that Pas are more trained than NPs, they are mistaken big. They’re forgetting the fact that before you become NP you have to be an RN and also have at least a year of experience working as RN depending on the school. Nursing school alone require you to do more than 1000 clinical rotation hours. After that some RN will work for years before going for their NP program. Which means NPs doing less clinical hours than PAs make a lot a sense because they’ve already been exposed for years. They have an idea about every little thing in healthcare. PAs are trained to help physicians in doing their work while NPs are trained to do what physicians do independently except surgical procedures. PAs do that as well not independently. Also RNs meaning before NP have been already trained to be able to assess patients and request for orders that are relevant to patients status. Being able to identify the need for appropriate orders gives an advantage in learning how to create them I think.

  • I just started my 2nd year of a 2 year MSN program with the end goal being able to pass the AANP board exam; even though I had 3.5 years of RN experience prior to starting my NP program, I do wish that the national requirement for NP students getting their MSN was to have 2000 clinical hours or perhaps more hours. I don’t think it is representative or accurate to quantify the clinical hours of RN work towards an advanced degree, because the job duties/focus/training/education for those RN “on the job hours” aren’t with the advanced practitioner mindset or scope of practice. I feel that the mindset and skill set and growth from RN to NP is quite different and it does take a significant amount of time to broaden your skill set/mindset from RN to NP and if the certification/licensing organizations required more clinical hours, the net benefit is for the practitioner and the patients.

  • I would just like to point out that the average time in residency as a physician is actually 4 years, not three, and that doesn’t include the fact that we also, many of us, do a fellowship. I averaged 80 hours a week in training, with a wink and a nod to the ACGME (the supposed max for us), and spent five years in training. That puts me at 19,600 hours after medical school. The 6,000 in my program is roughly accurate, at worst 500-1000 hours short. Not taking anything away from anyone else, but I wanted it to be clear that physicians frequently have over to 25,000 hours of training on the books. For most surgeons that is in reality 30,000 hours, but not reported.

  • I’d like to also point out, NP students choose a specialty when applying for programs. PA students have 2000 hours spread out over multiple specialties, where as NP students spend 500-1500 hours in the field that they will be working in. This allows NP’s much more time to learn what it is they will be practicing in once they graduate.

  • I strongly believe in the APRN role and the need for them in our healthcare system as primary care providers, specialties, and acute care. With that said, I do believe there should be a required 1 year residency following or before graduation/board exams to get another appx 2000-2500 hours in their respective specialty. My current FNP program requires a one year residency and then another 6 months to a year of “orientation/supervision” at our first assignment by another seasoned provider. This means that before I practice on my own, I’ll have appx 5000-6000 clinical hours in primary care (I have no idea on the numbers, but I’m guessing this isn’t staggeringly far off from other providers in just primary care hours). I feel I will be well prepared at that point. I do believe the 500-1000 clinical hours and off you go is very low, if those practitioners are actually going off on their own at that point (I doubt this is the case often, but once again, just a guess with no evidence). I believe and will discuss with with the AACN and AANP that they should collaborate to make a year long residency/orientation program mandatory. With all that said, some programs do require much more training and clinical hours that well prepare APRNs for their roles. Just my thoughts.

  • It is true that most NP programs have varying hours, 500-1500 sounds accurate, my DNP program is 1500 hours. That said it is very misleading to act as if these are our only hours. My Associates Nursing Degree had 1500 hours and my Bachelors had an additional 250. That is 3250 total clinical hours. On top of almost all NP students graduate with 5+ years experience as a full time registered nurse, most of us graduate with 10,000 + clinical hours and those are the ones with very minimal experience, most graduating NPs have 20,000-30,000 clinical hours, those hours make a difference. Anecdotal experience posted here means nothing, there is a reason NPs can practice independently in 21 states and growing and PAs cannot. Residency is also a huge part of any specialty NP position that is not discussed here but do exist.

  • I would like to add that PA school is not really 2 years. It is 27 months, which is the equivalent to three academic years. Also, we are required by almost all schools to have at least 2,000 hours of professional health-care experience before even applying to PA school, and a bachelors degree, most of us with degrees in biology or other sciences.

    that being said:
    There are more similarities between NPs and PAs then there are differences, and each profession offers a unique service to patients. I would like to see us working together more and criticising each other less. NPs may have an easier time getting jobs, but that is because they have a very old and powerful lobbying group, not because they are more prepared. Both PAs and NPs are essential for increasing access to more affordable, high quality care.

    FYI: I majored in Biology and Nursing, and I’m about to start PA school.

  • Dayna, you have the ability to do your own research; I suggest CINHAL. Please look up any information on NPs and their care at their site above. Would you really want me to site it for you here? That will only fuel this argument. That way you can see it with your own eyes, and share it with others that have questions concerning the NPs care.

    With the NP–there are around 8 years period–shorter timing would be convenient, but not a reality. I like the fact that NPs are focused on “nursing/medical” and not on another degree prior and are already very focused on the human being before starting any other degrees, not “just science, or biology.” I think the continuing education and the solid foundation that NPs have, and continue to develop are imperative to their development and ability to care for humans… just humans as their focus is the goal–so there can be provided holistic care and focused on health and wellness. The important thing that we do is focus on the patient, and not on competition with providers. The most important thing one can do is… ask questions, and never assume. Also, for heaven sakes, be careful with RX opioids… implanted stimulators, PT, get active, lets move to action so we can get our Pts to move! ALTERNATIVE PAIN MANAGEMENT! Make it happen… now that’s a subject we can debate. Let’s talk about this as a controversy.

  • You know, there is the opportunity to engage in the argument “I’m better, no I’m better,” but I digress. You know, I didn’t see a physician on here bragging that he knows more…This is an open site, and patients can read you all trash talking each other. “NPs are trained on the human all 8 years’ one says, “PAs can have a BA in anything with no med training and treat patients.” NPs don’t know how to do DDX or are scared to practice, which is false, and elementary to accuse NPs of. “PAs can become a provider in just a few years after a BA in Science with minimal practice.”
    Guys, stop it! Practice, practice, practice and shhhhhhhh. Be your own secret weapon, and keep it off public forums. Instead, let’s talk about getting our patients off opioids, and on alternative therapies. Now–that’s a subject we want our patients to read about.
    Happy practicing…

    • Jamie Bingham PA-C, MPAS, MPH says:

      For PA’s it’s about the market. NP’s have sold themselves in the public eye forever and mislead. It’s okay to say this. For example, we are a huge urgent care. The new NP hired needs NO supervisor and interned with a slow internal medicine doc for his 500 hours +/- but is seen as perfectly capable. He’s an NP that went straight through and worked “some” ER in between his online NP studies, and his time with the internal medicine clinic. But he has to read ECG’s (there are no doctors just PA’), start the IV’s (sometimes only the MA is there) , do everything. Run a code. Bet his only code was in ACLS or watching a doc in an er and handing things over. But he is “perceived” instantly has perfectly qualified.

      The PA’s of which there were 2. Both interned in emergency medicine. I was a career paramedic and probably ran hundreds and hundreds of codes and emergencies long before PA school. Yet I and my colleague must have “babysitters”. So they can hire 100 NP’s but only 2 PA’s since there is only 1 supervising doc and that is the state limit.

      I see something wrong in this and don’t intend to be quiet about it. It’s not about the “individual” but about professions. And yes, it IS TIME PA’S toot their own horns instead of always hiding and feeling, well, like your example, just get along. But we’re losing too many jobs having this supervisor so it’s time wave our flag and come out of our medical cupboard.

  • I will digress again; I feel it is harmful for this site to have PAs and NPs arguing over who is better, and I am requesting this argument to be taken down for the rapport and professionalism of all medical providers.

  • Melanie IGould says:

    You ignored the clinical hours to obtain the ADN and BSN. Most DNP programs don’t accept an RN without significant ICU experience.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes:

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>