PAs and APRNs: How Do These Midlevels Differ?

Physicians interested in hiring a midlevel practitioner for their practice sometimes wonder whether they should hire a physician assistant (PA) or an advanced practice registered nurse (APRN). 

The general answer is that it’s an individual business decision. But here’s a quick rundown of the basic difference between these two types of professionals, gleaned from TMA’s Nonphysician Practitioners: Hiring, Billling, and Delegation of Duties for a Nonphysician Practitioner.

A physician assistant is a nationally certified, state-licensed medical professional whose training includes some 2,000 hours of clinical rotations in primary care specialties, emergency medicine, general surgery, and psychiatry. Their scope of practice encompasses providing any medical services delegated by a physician that are consistent with the PA’s training, education, and experience. 

A supervising physician oversees the PA’s activities. This physician doesn’t have to be physically present at all times where the PA is performing services, but the two have to be able to contact each other easily.

PAs may obtain patient histories, perform physical exams, order procedures, formulate a working diagnosis, develop and implement a treatment plan, and perform other activities listed in Texas Occupations Code Section 204.202.   

An advanced practice registered nurse is an RN who has completed an advanced educational program approved by the Texas Board of Nursing. The APRN’s scope of practice is based on education, experience, and the accepted scope of professional practice of his or her particular specialty area (as defined by national professional organizations). 

APRNs work under protocols or some other written agreement that specify how the APRN and physician will cooperate, coordinate, and consult with each other to provide patient care. Typical agreements detail documentation practices; how the nurse and physician will share practice responsibilities and trends, maintain access with one another, and provide coverage in absences and emergencies; and how and when the physician will review the nurse’s charts.

Physicians may never delegate duties to either PAs or APRNs that require independent medical judgment. Physicians may delegate prescriptive authority to both PAs and APRNs. Texas’ delegation and supervision requirements for prescriptive authority apply equally to both.

Nonphysician Practitioners is available in the TMA Education Center as a downloadable PDF or in print. Through Dec. 31, you can read a free excerpt from the book on the TMA website.

Published Nov. 25, 2015

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Last Updated On

December 09, 2016

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