Differences in Education, Training and Practice between MDs, DOs, PAs, and NPs

Physician (MD)Physician (DO)Physician Assistant (PA)Nurse Practitioner (NP)
Undergraduate Education4 years – Bachelor’s Degree4 years – Bachelor’s Degree4 years – Bachelor’s Degree4 years -Bachelor of Science in Nursing (BSN)
Graduate Education4 years -Medical School4 years -Medical School27 months -PA School1.5 – 3 years – Master of Science in Nursing (MSN) Program
Pre-Clinical Hours during Graduate SchoolApprox. 5,700Approx. 5,700Depends on state (32 semester hours in New York)2,300 – 3,850
Clinical Hours during Graduate SchoolApprox. 6,000Approx. 6,000
+200 hours of clinical training centered on osteopathic medicine
2,000500 – 1,500
Residency3-7 years (and1-3 years of sub-specialty training, if desired)3-7 years (and1-3 years of sub-specialty training, if desired)OptionalNone
License Requirements/RenewalUnited 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 CMEcreditsPANCE; Renewal timeline differs by State (every 3 years in New York); 100 CME credits every 2 yearsNCLEX-RN; Renewal timeline differs by State (every 3 years in New York)
Board Certifications/RenewalBoard 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 recertifyCertification based on specialty; Recertification every 5 years via either 1,000 clinical hours + 75-150 CMEcredits OR re-examination
Scope of PracticeFull scope of practiceFull scope of practice + osteopathic techniquesPractice with supervision from physician; can prescribePractice 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


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


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


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