MD vs. NP vs. PA: Here's How the Number of Clinical Hours Compare
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?
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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.
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
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!
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.
It all comes down to EBP.... research shows that nurse practitioners are effective with similar outcomes to their colleagues.
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.
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.
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.
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.
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.