Both are very similar positions, but have important differences. As a PA, its important to know the difference since many patients and other health care practitioners often ask what the difference is between the two.
Educated by the Medical Model
Bachelor or Master’s in PA studies
Regulation dependent on jurisdiction
Practices in all areas of Medicine
Educated in Nursing Model
Bachelor’s in Nursing, then Master’s in NP Studies
Regulated Health Care Professional
Independent or dependent practitioner within a scope of practice (e.g. NP Clinics)
In Ontario: Primary Care, Medicine, Emergency, Paediatrics and OB/GYN
PA vs NP – History in Ontario
Physician Assistants have been in Ontario since 2007 (5 years) at the start of the Ministry of Health and Long Term Care for Ontario (MOHLTC) as part of a PA demonstration project to evaluate impact of PA’s in Ontario recruiting IMG’s and PAs trained in the US. They have been supported by the Ontario Medical Association since their introduction to Ontario. In 2008, two PA education programs were launched by McMaster University and PA Consortium (University of Toronto Medicine, Northern Ontario School of Medicine and Michener Institute of Applied Health Sciences). Military-trained PA’s have been working in the Canadian Forces for over 50 years graduating from the Canadian Forces Medical Services School at Borden, Ontario. Learn more about the history of PAs in Canada at the CAPA website.
Nurse Practitioners have a 40-year-history of working in Ontario (since the 1970s). They were originally pioneered to expand the RN role in remote communities in Ontario. Today there are over 400 NPs working in various settings. In August 2008, the title “Nurse Practitioner” became protected. Learn more about their history at the NPAO website.
PA vs NP – How much autonomy?
Physician Assistants will always work under the supervision of a Physician and do not have the ability to open up clinics independent of a supervising physician.
Nurse Practitioners have the option of opening up their own clinics. You can learn more about Nurse Practitioner led clinics on the NPAO site.
PA vs NP – Education
Physician Assistants: To become a PA, you are required to complete a minimum of 2 years of a university undergraduate degree (with some “recommended” courses), a minimum GPA, and if you are interested in PA Consortium (University of Toronto, NOSM, and Michener) then you are required to have 1680 hours of paid health care experience; this is not a requirement of the McMaster program. GPA of 3.0 or higher. You do not need a science undergraduate degree to apply to the program. Nurses may also apply to become PA’s.
- In Ontario, there are two schools that offer PA programs, both are Bachelor’s degree in PA studies.
- Education is based on the medical model
- Program length is 24 months. The first 12 months includes basic medical foundations, and the second year consists of clinical rotations through different areas of medicine. You cannot bypass any aspect of this training, and this applies irrespective of your experience or background.
- PA education is not tiered (unlike PA education, which allow you to graduate with specialty certificates). Once a PA graduates, they are open to practice in any area of medicine (whether surgical, generalist or non-surgical specialties).
Nurse Practitioners must complete a Bachelor in Nursing first, THEN apply to a Master’s in Nurse Practitioner studies. The NP programs are competitive to get into, they require minimum 2 years of direct RN nursing experience in the last five years (3640 hours) with a GPA of B or higher in an undergraduate nursing program.
- There are 9 schools in Ontario that offer the primary health care NP program, admission requirements differ between each school. At time of writing they include: Lakehead University, Laurentian University, McMaster University, Queen’s University (satellite site: Trent University), Ryerson University, University of Ottawa, University of Western Ontario, Windsor University and York University.
- Education is based on the nursing model
- Study is full time or part time. The full time option is one year with seven required NP courses. The part time option allows you to take up to three years to complete the courses.
- There are three different specialty certificates (Primary Health Care, Adult and Paediatrics) with different universities offering the different programs.
PA vs NP – Scope of Practice
Physician Assistants Scope of Practice:
- According to this OMA document, PAs should be “permitted to prescribe” medications and write orders as delegated by the supervising physician. These are usually done through medical directives (which is a way for the supervising physician “to incorporate frequently delegated acts that performed competency by the PA, and serve to increase efficiency of patient care and improve patient flow“) or as it falls under the Delegation of Controlled Acts (College of Physicians and Surgeons of Ontario).
Nurse Practitioners Scope of Practice:
- Nurse Practitioners have the ability to prescribe most medications according to the 1991 Nursing Act, but cannot prescribe controlled substances (See Controlled Drugs and Substances Act).
- Nurse Practitioners are able to order x-rays (chest, ribs, arm, wrist, hand, leg, ankle foot, hip, knee, and mammography), ultrasound (abdomen, pelvis, breast, specific organ, transvaginal technique and pregnancy), non-urgent ECGs, and spirometry (reference).
- Nurse Practitioners may also order labs as necessary.
PA vs NP – Where can they work?
Physician Assistants graduate as generalists, with supplementary experience depending on where they choose to complete clinical rotations during their 2nd year of clerkship. PAs may choose to work in any field of medicine ranging from family practice to Orthopaedic Surgery. A table provided during the McMaster PA Information Session outined some of the areas the graduates from the program were working. This includes family medicine, Hospital Medicine, Emergency Medicine, Orthopaedic Surgery, Colorectal Surgery, ICU, Specialty Clinic, Rehabilitation medicine, Paediatrics and Gynecology. In the US, there are some PAs working in highly specialized areas such as Interventional Radiology and Oncology.
Nurse Practitioners are considered Registered Nurses who are in the extended class with additional education and experience. They must use the title RN(EC) to represent RN in the extended class or Nurse Practitioner (NP).
- Categories of NP Roles:
- Primary Health Care Nurse Practitioner (NP-PHC): includes community health centres, long term care, palliative care, aboriginal centres, public health, occupational health, correctional services, ambulator care centres (urgent/emergency deparmtents) and family health teams.
- Adult Nurse Practitioner (NP-Adult): Working in internal medicine roles at a hospital. This program is offered by University of Toronto.
- Paediatric Nurse Practitioners (NP-Paediatrics): Work exclusively with paediatric patients (infants, children and adolescents). Specific work settings include neonatal care (McMaster has specific training program for this) and general paediatrics (University of Toronto has a specific child progam).
- NP-Anesthesia (NP-A): is the newest regulated NP specialty. Involves care of patients and families through perioperative process. Ther emay be intra-operative component to role, but are not administering anesthesia alone in the OR. Apart from OR, they may work in sedation/anesthesia with airway management diagnostic areas.
PA vs NP – Are they Regulated in Ontario?
Physician Assistants are not regulated in Ontario. An application was sent to the Health Professions Regulatory Advisory Council (HPRAC) who performed a jurisdictional review, HPRAC found that the evidence submitted did not meets its risk of harm threshold (Canadian Medical Association document). PAs are regulated in Manitoba under the College of Physicians and Surgeons of Manitoba.
Ontario Nurse Practitioner Resources
- College of Nurses of Ontario – Nurse Practitioners
- Nurse Practitioners’ Association of Ontario
- Ontario Primary Health Care Nurse Practitioner Program
Join the Canadian PA community
Unlock the resource library and take advantage of free newsletter-only content delivered to your inbox!