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?

 

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

 

Comments

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.

Jessica B

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.

Mick

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.

Zack

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.

Samantha

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.

Explant

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.

Kumkum

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.

Ibrahima Kake, RN

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.

Maria Perez

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

HD

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!

Dayna

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