Many students interested in healthcare and medicine find themselves deciding between becoming a physician with an MD or DO, versus going down the physician assistant or nurse practitioner path. After all, they all have substantial overlap, however they’re also substantially different. If you’re the type of person who would be happy being a physician, you may not be as happy as a PA or NP, and vice versa. Do note that all three are fantastic professions, and no single one is better than the other. You simply need to decide what you value most and choose accordingly.
The doctor training path, whether MD or DO, is the longest by far. After your 4 premed years in college, you’ll complete another 4 years of medical school followed by 3 to 7 years of residency in your intended specialty. If you want to further subspecialize with a fellowship, add one or more years after that.
To become a physician assistant, you’ll enter physician assistant school after college, which is 2 or 2 and a half years in duration. Whereas in medical school, you spend 2 years focused primarily on didactics and 2 years focused primarily on clinic time, in PA school you’ll have just one year of didactics and the remaining 12 or 18 months focused on clinical exposure. After that, there’s no residency, and you’re free to start practicing as a PA immediately.
To become a nurse practitioner, you can choose from two paths: traditional or direct entry. The traditional pathway involves first earning your BSN, ABN, or MSN to become an RN after taking your NCLEX exam. Next, they attend a master’s or doctorate program to become an NP. If you attend a full-time master’s program, it will generally take 2 years, but if you are undergoing a part-time DNP program, it can take up to 5. If you were to major in nursing in college and take your NCLEX, you could become an RN soon after graduation and become a fully trained NP just 2 years later.
It’s not just the duration of training, but also the competitiveness and rigor of each path. Getting into medical school is by far the most competitive of the three. At some schools, like at UCLA when I was there, over 80% of premeds on the first day of college are no longer premed by graduation time. And of those who do ultimately apply to medical school, only 40% get accepted. The average matriculant stats are 83rd percentile on the MCAT and a 3.73 GPA.
After medical school, PA school is next in the order of competitiveness. The average GPA for accepted PA students is 3.5 and they average around the 40th to 50th percentile on the GRE. Note that they do have a lower average acceptance rate at 33% of all applicants, and this sometimes confuses students into thinking PA school is more competitive. When you consider the outcome if the average premed with higher stats applied to PA school, or the average pre-PA student with lower stats applied to medical school, it generally clarifies any confusion.
Do note that many PA schools also require over 1,000 hours of direct patient healthcare experience prior to matriculating. This doesn’t make it any more competitive, but you will need to spend considerable time putting in those hours. While premeds don’t need 1,000 hours of direct patient experience, they do need to put in several hundreds of hours across multiple extracurriculars including clinical experience, research, volunteering, leadership, and others.
NP school is the least competitive of the three and it has the loosest requirements. Some programs require 1 to 2 years of prior nursing experience, while others don’t require any. GPA isn’t highlighted as a primary factor, with most GPA cutoffs around 3.0, but this isn’t a hard rule. Middle Tennessee State University, for example, is reported to generally accept applicants with a GPA of 2.9 or greater.
When it comes to rigor, your clinical years in medical school and your residency years will be extremely trying. The norm is to be working 70 to 80 hours per week, but expect over 80 hours in most surgical specialties. With the PA and NP training paths, you won’t be expected to put in such long hours or for so many years.
In terms of cost, medical school is the most expensive, followed by PA school, followed by NP school. The average annual tuition for medical school is $40,000 to $60,000 and graduates have an average debt burden close to $200,000. The average annual tuition for PA school is about $45,000 with an average graduating debt burden approximately $110,000. NP schools average between $18,000 to $32,000 per year, with the average graduating debt burden between $40,000 and $60,000 depending on the source.
Considering the training paths, it’s natural to assume that physicians have the deepest knowledge and expertise when it comes to the body and how to treat its various ailments. If you assume that, then you would be correct. Not only do physicians spend the most time focusing on the foundations, but they also spend several years focusing on their specific specialty in residency.
Physician assistants follow the medical model, similar to physicians, while nurse practitioners follow the nursing model. But note that after completing PA school or NP school, you’re fully trained and able to join the workforce, without any required residency for specialty training. PA’s and NP’s get a great deal of their specialty training on the job after joining a practice. While this is very useful in getting up to speed quickly with pattern recognition for common presenting concerns, you won’t be well equipped to identify and manage rare or complex conditions.
Given the on-the-job training, it’s also much easier to change specialties later in your career if you get bored of one or want a change of pace. That’s not feasible to do so for physicians, who would have to reapply to residency and complete another 3 to 7 years of structured training. PA’s are considered to have the most flexibility and are sometimes found in surgical specialties, either handling pre- or post-operative patient floor work or assisting in the operating room. NP’s have flexibility as well, but you’ll need to be intentional with which program you attend, as each program trains you toward a specialization, such as primary care, acute care, family, women’s health, and so on.
If you are interested in surgery, note that only surgeons with an MD or DO are qualified and have sufficient knowledge and expertise to perform surgery. With the PA or NP routes, the most you’ll be able to do in the OR is be first assist, helping the surgeon by retracting, suctioning, suturing, and the like. That’s the level of responsibility of a medical student or junior resident. This brings us to the hotly debated topic of scope of practice.
Historically, the NP and PA training paths were created to address a shortage of primary care physicians and were to serve as an adjunct to physician-led care, not as a replacement. In this model, NP’s, PA’s, and physicians all work together in harmony in service to the patient. Since physicians have the most robust knowledge and training, midlevels were generally working alongside physicians, and would easily be able to ask for assistance on more complex or rare presentations.
On one hand, NP’s and PA’s are lobbying for greater scope, meaning they want to do more things physicians traditionally do, such as independent practice. The primary arguments are two-fold: first, we have a shortage of primary care physicians, and midlevels can help alleviate that. And second, they argue that midlevels receive sufficient training to practice independently and safely.
On the other hand, physicians are pushing back, primarily focused on patient safety concerns. After all, NP’s and PA’s receive far less training. My physician mentors and colleagues have shared they find the NP’s and PA’s in their practice are valuable in handling much of the bread and butter, meaning the most common and simple cases. However, when it comes to a complex or rare presentation, the training differences are starkly contrasted.
But are physicians really more qualified? Comparing the expertise and capabilities of someone who receives over 20,000 hours of supervised patient contact compared to just 500 to 2,000 seems like a no-brainer. It would seem obvious that the physician with 20,000 hours will have greater clinical expertise than the NP or PA with a small fraction of that. The only way for all parties to be equally qualified, despite the massive difference in training hours and rigor, is if the following assumptions are true: either medical school is massively less efficient and medical students massively less intelligent or capable, or if midlevel training paths are massively more efficient and their students massively more intelligent or capable.
Scope of practice creep is very much about money. After all, if you’re able to do more and practice more independently, similar to a physician, then you can make closer to a physician salary. The average primary care physician makes $240,000 per year and the average specialist physician makes $340,000. In comparison, NP’s average approximately $110,000 per year and PA’s average approximately $100,000.
The reason this is important and you should care is because of patient safety. If you or anyone you care about will ever receive any medical care, then this is deeply relevant to you. The fields that are currently most significantly affected by scope creep include anesthesiology and primary care. But go on Reddit or med-Twitter and you’ll see other specialties cropping up. Ultimately, the surgical specialties are the safest from scope creep issues.
If scope creep is ultimately harmful to patients, then why has it gone so far? Two main reasons: first, in the current climate of prioritizing emotions over facts, many organizations are focused on inclusion to a fault. Being equal as humans doesn’t mean that we all have equal training and capabilities. Second, and more importantly, the AANP and AAPA are much more effective at lobbying compared to the AMA and physicians. It’s easy to point to the insanely demanding schedules of physicians to explain why they don’t have time for advocacy work, but that has to change. If you are looking to learn more, get involved, and make a difference, check out the Physicians for Patient Protection.
Doctor vs PA vs NP | Which is Right for You?
PA school requirements
The requirements for different physician assistant programs can vary. However, you can use the following typical requirements as guidance:
All physician assistant programs require applicants to have a bachelors degree from an accredited educational institution. These programs do not set requirements regarding your major, though individuals typically pursue a degree in a field related to science or healthcare. Choosing a major that aligns with the prerequisite courses required by physician assistant programs can put you at an advantage. Examples of common undergraduate degrees for physician assistants include anatomy, biology, chemistry, kinesiology or sociology.
Physician assistant programs may vary on the prerequisite courses they require applicants to have taken as an undergraduate. Typically, these programs require a combination of science and non-science coursework. This coursework can help prepare you for the more advanced concepts you will learn in the PA program. Common prerequisite courses for PA programs include:
You may also consider more advanced-level courses in science-related topics to showcase more in-depth knowledge. For example, you may pursue coursework such as organic chemistry, biochemistry, genetics and physics. Again, you can research PA programs to understand their minimum prerequisite requirements. Pursuing coursework beyond those requirements can help set you apart from other candidates. For example, some programs appreciate applicants who have taken foreign language coursework.
Physician assistant programs may set minimum GPA requirements for applicants. These programs typically seek applicants with at least a 3.0 GPA, though some set a lower or higher minimum. A high GPA often refers to a score between 3.5 and 4.0. They may examine applicants overall GPA along with their science coursework GPA and non-science coursework GPA. You can research programs GPA requirements, along with the average GPA of accepted applicants, so you can calculate your GPA throughout your educational career to ensure you meet them.
Physician assistant programs typically require applicants to have prior healthcare experience. Depending on the program, they may set a minimum number of healthcare hours required in healthcare or patient care experience. You can gain experience working within the healthcare field by pursuing internships or entry-level roles at medical facilities, such as physicians offices, hospitals or long-term care facilities. Based on your interests or educational career, you may find opportunities to work as an emergency medical technician (EMT), medical assistant or certified nursing assistant.
Having prior healthcare experience not only shows your preparedness for the physician assistant program but also your interest in the medical field. Beyond your professional clinical experience, you can also use other relevant experiences that may benefit you as a physician assistant. For example, you may highlight leadership roles youve held, scientific or medical research youve performed and volunteering or extracurricular activities in which youve taken part.
Physician assistant programs typically require applicants to take the Graduate Record Examinations (GRE). This standardized, multiple-choice test shows applicants readiness for their advanced degree program. Some PA programs set minimum score requirements, often at least 295, though that may vary. You can take the GRE up to five times within a year and choose which scores to send to schools. Research the GRE requirements and the average scores of accepted applicants for different programs to gain a better idea of what you should aim to achieve.
The Centralized Application Service for Physician Assistants (CASPA) enables individuals to apply to multiple physician assistant programs at the same time. Keep in mind that not all physician assistant programs use this service, so review application procedures when drafting your applications. Two essential components of the CASPA application include a personal statement and letters of recommendation. Even if your desired physician assistant program doesnt use CASPA, it may have similar application requirements.
The personal statement prompt asks you to describe your motivation for pursuing a career as a physician assistant. Use this statement as an opportunity to highlight the skills, traits and experiences that set you apart from other applicants. The CASPA also asks you to provide three to five recommenders who can provide an evaluation of your abilities. When possible, choose individuals who have seen you work in a professional capacity and interact with patients. Ask these individuals for permission first, as CASPA will send them an evaluation request to fill out and submit.
Should I go to med school or PA school?
Physicians and physicians assistants both perform essential patient care responsibilities. Both professionals diagnose and treat medical conditions, so their job duties may overlap. However, physician assistants typically work under licensed physicians supervision. For example, physicians can perform surgeries, while physician assistants can assist them. Physician assistants scope of responsibilities also depends on their state, as some have restrictions related to the amount of authority they have or supervision they require.
Individuals interested in becoming a physician must attend medical school while aspiring physician assistants go through physician assistant programs. Physicians must also choose and receiving training in their medical specialization before they can practice professionally. You can determine which path is right for you by learning more about the educational requirements associated with these roles.
How long is PA school?
Physician assistant programs typically take two to three years to complete. The first year typically focuses on classroom and laboratory instruction. The second half of the program enables students to apply their medical knowledge and gain clinical experience. Students perform clinical rotations under the supervision of practicing physicians in hospitals or clinics. They may take part in rotations related to various clinical areas, such as family medicine, emergency medicine or internal medicine. Gaining familiarity with different medical specializations can help students choose what area to pursue.
Medical school requirements
Like physician assistant programs, the requirements for different medical schools may vary. You can use the following requirements as guidance:
Much like physician assistant programs, medical schools require a bachelors degree from an accredited institution. Individuals can apply to medical school after graduation or while completing their degree program. While medical schools dont set specific requirements for majors, you may consider a health-care related major or a pre-med track. Med school applicants typically pursue science-related undergraduate degrees, such as biology, chemistry or physics.
Medical schools require varying prerequisite courses. You can research the requirements set by your desired medical school program to ensure you take suitable courses as an undergraduate. Your coursework will showcase your relevant knowledge and prepare you for the more advanced coursework learned during medical school. Common prerequisite courses for medical school include:
Medical schools often expect applicants to display high academic performance as undergraduates. These schools may set GPA requirements and often seek at least a 3.0, though this minimum score can vary among med school programs. Again, a high GPA typically refers to a score between 3.5 and 4.0. You can research the average GPA reported by your desired programs to help you determine whether you meet their standards.
Having prior relevant experience related can support your chances of getting accepted into medical school. Schools look at various types of experience to gain a sense of your preparedness for the program and interest in the medical field. For example, you may seek opportunities to gain clinical experience by working as an EMT or medical assistant. As an undergraduate, you can find opportunities to shadow practicing physicians in various healthcare settings. Some programs also seek applicants with relevant research experience.
Like physician assistant programs, you can also highlight experiences related to leadership roles or volunteering and extracurricular activities. When mentioning these experiences, demonstrate why they have relevance to the physician career. For example, they may show your commitment to helping others or interest in scientific topics.
Medical schools require applicants to take the Medical College Admission Test (MCAT). This standardized, multiple-choice test assesses your potential as a medical school student. Your total MCAT score can range between 472 and 528, and schools often seek applicants with a score of at least 508. However, you can research your desired medical school programs requirements or data on accepted students scores to understand what score you should aim to achieve.
You can take the MCAT up to three times within a single testing year. Your prerequisite courses help prepare you for the test, which covers natural, behavioral and social sciences topics and problem-solving and critical thinking skills. To study for this test, you may seek MCAT prep courses or a tutor.
Letters of recommendation
Requirements vary, but medical schools often seek at least two letters of recommendation for applicants. Your recommenders may include academic advisors, professors or practicing medical professionals. These individuals can help provide proof of your impressive academic and professional abilities. Research your desired programs requirements, as some have specific requirements related to the number and type of letters required.
How long is medical school?
Medical school typically takes four years to complete. During the first two years, students learning occurs within classroom and laboratory settings. During the second half of medical school, students gain clinical experience by completing rotations at hospitals or clinics. Under the supervision of practicing physicians, students apply their medical knowledge by diagnosing and treating patients. After attending medical school, graduates often enter a residency program based on their desired specialization. Residency programs can last between three and nine years, often taking place in hospitals or clinics.
PA school coursework
The coursework provided during physician assistant programs varies, so you can research your desired programs to learn about their specific curriculums. During the classroom and laboratory portion of PA programs, students coursework often includes classes related to anatomy and physiology. These curriculums also have coursework on healthcare-related topics, including:
Med school coursework
Similar to physician assistant programs, the coursework provided during medical school varies. You may research different medical schools to understand their specific curriculums and determine whether they align with your interests. The curriculum may also differ depending on the type of medical degree you aim to receive. Initially, students take part in coursework about scientific concepts, such as anatomy, physiology, histology and biochemistry. In their last years, students learn about different medical specializations, such as family medicine, internal medicine and surgery. Other examples of the coursework offered in medical school programs include:
Should I go to medical or PA school?
Is PA school harder than med school?
Is it easier to get into medical school or PA school?
Is PA school like medical school?