Differences in Education, Training and Practice between MDs, DOs, PAs, and NPs
| Physician (MD) | Physician (DO) | Physician Assistant (PA) | Nurse Practitioner (NP) | |
|---|---|---|---|---|
| Undergraduate Education | 4 years – Bachelor’s Degree | 4 years – Bachelor’s Degree | 4 years – Bachelor’s Degree | 4 years -Bachelor of Science in Nursing (BSN) |
| Entrance Exams | MCAT | MCAT | PA-CAT or GRE | GRE |
| Graduate Education | 4 years -Medical School | 4 years -Medical School | 27 months -PA School | 1.5 – 3 years – Master of Science in Nursing (MSN) Program |
| Pre-Clinical Hours during Graduate School | Approx. 5,700 | Approx. 5,700 | Depends on state (32 semester hours in New York) | 2,300 – 3,850 |
| Clinical Hours during Graduate School | Approx. 6,000 | Approx. 6,000 +200 hours of clinical training centered on osteopathic medicine | 2,000 | 500 – 1,500 |
| Residency | 3-7 years (and1-3 years of sub-specialty training, if desired) | 3-7 years (and1-3 years of sub-specialty training, if desired) | Optional | None |
| License Requirements/Renewal | United States Medical Licensing Examination; Renewal of license every 2-3 years,* requiring 0-150 CME credits* | COMLEX and/or USMLE; Renewal of license every 1-3 years,requiring 0-150 CMEcredits | PANCE; Renewal timeline differs by State (every 3 years in New York); 100 CME credits every 2 years | NCLEX-RN; Renewal timeline differs by State (every 3 years in New York) |
| Board Certifications/Renewal | Board Certification Exam in given specialty and subspecialty via ABMS** Member Board; Recertification Exam every 7-10 years (depending on specialty) | Board Certification Exam in given specialty and subspecialty via ABMS** Member Board; Recertification Exam every 7-10 years (depending on specialty) | PANCE to become board certified; PANRE every 10 years to recertify | Certification based on specialty; Recertification every 5 years via either 1,000 clinical hours + 75-150 CMEcredits OR re-examination |
| Scope of Practice | Full scope of practice | Full scope of practice + osteopathic techniques | Practice with supervision from physician; can prescribe | Practice with supervision from physician or independently*; can prescribe |
Many thanks to Nisha Khubchandani, AMC ’23, MD/MPH Student; Loretta Ponesse, CAE & the NY Chapter of the American College of Physicians for providing this chart.
*Differs by State
**American Board of Medical Specialties
Significant differences exist between physician anesthesiologists’ and nurse anesthetists’ education training and responsibilities
PHYSICIAN ANESTHESIOLOGISTS
Medical degree (either M.D. or osteopathic) following bachelor’s degree (8 years total)
- 1-year postdoctoral internship
- 3-year postdoctoral residency in anesthesiology
- Board-certified physicians may complete an additional 1 year to 2 years of subspecialty education and training in one of the recognized anesthesiology subspecialty areas after successful completion of a postdoctoral residency
Total of 12 years to 14 years after high school
Medical education and training covers:
- Continuum of the human life cycle including health and disease, functioning of all vital systems
- Emphasis on diagnosis and treatment, indications and contraindications
- Comprehensive medical care
- Preventive care
- Acute and chronic care
12,000 hours to 16,000 hours of clinical training
Trained to provide comprehensive medical care to patients needing anesthesia, pain medicine or critical care services
NURSE ANESTHETISTS
Bachelor’s degree in nursing
- 2-year associate RN degree, or
- 3-year diploma RN degree in nursing after high school
- 1 year working as a nurse in an acute care setting
- Master’s degree from graduate school of nurse anesthesia (not required prior to 1998)
Total of an estimated 7 years after high school
Nurse anesthesia education and training covers:
- Basics of anatomy, physiology and pharmacology
- Principles and techniques of nurse anesthesia
Almost 2,500 hours of clinical training
Trained to administer and assist in the provision of anesthesia services
References
Altus, A. (2018, April 23). Should you do a fellowship? 5 questions to ask yourself. The DO – American Osteopathic Association.
https://thedo.osteopathic.org/2018/04/should-you-do-a-fellowship-5-questions-to-ask-yourself/
American Academy of Nurse Practitioners Certification Board. (n.d.). Recertification for ANP, FNP, and GNP…When are you due to recertify?
https://www.aanpcert.org/newsitem?id=5
American Academy of Physician Associates. (n.d.). Become a PA.
https://www.aapa.org/career-central/become-a-pa/
American Board of Medical Specialties. (n.d.). What is ABMS Board Certification?
https://www.abms.org/board-certification/
American Board of Medical Specialties. (n.d.). Why Become Board Certified?
https://www.abms.org/board-certification/board-certification-requirements/
American Osteopathic Association. (2020, May). U.S. Osteopathic Licensure Summary.
https://osteopathic.org/wp-content/uploads/2018/03/US-licensure-Summary-MAY-2020.pdf
Association of American Medical Colleges. (n.d.). The Road to Becoming a Doctor.
https://www.aamc.org/system/files/2020-11/aamc-road-to-becoming-doctor-2020.pdf
Brigham Young University. (n.d.). MD (allopathic) vs. DO (osteopathic) Medicine.
https://ppa.byu.edu/md-allopathic-vs-do-osteopathic-medicine
Brown University. (n.d.). Health Careers Advising: PA-CAT.
https://www.brown.edu/academics/college/advising/health-careers/pa-cat
Doximity. (2018, June 11). When Will Your Medical License Expire? A Complete List of State Medical License CME Requirements.
https://blog.doximity.com/articles/when-will-your-medical-license-expire-a-complete-list-of-state-medical-license-cme-requirements
Emory & Henry College. (n.d.). Physician Assistant Studies: Minimum Clinical Training Requirements.
https://www.ehc.edu/live/profiles/3000-minimum-clinical-training-requirements
Limestone University. (2021, October 31). How to Become an Osteopathic Doctor: Where Should I Start?
https://www.limestone.edu/blog/how-become-osteopathic-doctor-where-should-i-start
New York State Education Department Office of the Professions. (n.d.). Certification Requirements for Nurse Practitioner.
https://www.op.nysed.gov/professions/nurse-practitioners/certification-requirements
Nurse Journal. (2022, November 15). What Is the Role of the State Board of Nursing?
https://nursejournal.org/resources/what-is-the-role-of-the-state-board-of-nursing/
Nurse Journal. (2022, December 6). Nurse Practitioner vs. Physician Assistant: What’s the Difference?
https://nursejournal.org/resources/np-vs-physician-assistant/
PhysicianAssistantEDU. (n.d.). New York Physician Assistant Programs for Licensure.
https://www.physicianassistantedu.org/new-york/
Primary Care Coalition. (n.d.). Compare the Education Gaps Between Primary Care Physicians and Nurse Practitioners. Texas Academy of Family Physicians. https://www.tafp.org/Media/Default/Downloads/advocacy/scope-education.pdf
Rabin, R.C. (2014, July 21). Docs Slam Recertification Rules They Call A Waste Of Time. Kaiser Family Foundation.
https://khn.org/news/docs-slam-recertification-rules-they-call-a-waste-of-time/
Regis College. (n.d.). Master of Science in Nursing (MSN).
https://www.regiscollege.edu/academics/majors-and-programs/nursing-msn
Regis College. (2021, June 7). What’s the Difference Between a Nurse Practitioner and Physician Assistant
https://www.regiscollege.edu/blog/nursing/nurse-practitioner-vs-physician-assistant
St. George’s University School of Medicine. (2021, March 10). PA vs. MD: Which Medical Career Is Right for You?
https://www.sgu.edu/blog/medical/pa-versus-md/
St. George’s University School of Medicine. (2021, April 5). MD vs. DO: The Definitive Guide to Help You Decide.
https://www.sgu.edu/blog/medical/md-versus-do/
The College of New Jersey. (n.d.). Nursing Requirements.
https://graduate.tcnj.edu/application-requirements/nursing-msn/
University of Bridgeport. (2022, January 24). How Long Does it Take to Complete a BSN Program
https://www.bridgeport.edu/news/how-long-to-get-a-bsn/
University of St. Augustine for Health Sciences. (2022, September 11). Nurse Practitioner vs. Physician Assistant: Key Differences.
https://www.usa.edu/blog/np-vs-pa/
UT Health San Antonio. (n.d.). I Want to Be a Doctor! What Now?
https://uthscsa.edu/medicine/education/ume/outreach/become-doctor