Last week in a restaurant in Lyon, France, my tablemate turned toward me and asked, “What’s the difference between a nurse practitioner and a physician assistant.”Lyon

My husband and I were on a tour. Our traveling buddies consisted of older folks like ourselves. The woman knew I was a retired NP and had told me she frequently saw either an NP or PA when she went for routine medical appointments. She was satisfied with either but didn’t know the difference.

I became an NP in the early 80s and worked in Chicago when NPs were trying to expand our practice by gaining prescription privileges. We were much maligned by the traditional medical establishment. “If nurses want to act like doctors, let them go to medical school” or something to that effect seemed to be the mantra of the American Medical Association. (Both the AMA and the Illinois Medical Association are located in Chicago).

I, with other NP’s, worked in a not-for-profit clinic on the west side of Chicago, caring for the medically underserved. There were few general practice doctors in this part of the city—most set up offices in the more affluent sections. In spite of the fact we NPs were supplying an unmet need, better accomplished if we could prescribe necessary medications, we were seen as competition.

Physicians counteracted the influx of NPs by cultivating their own homegrown subordinates: the physicians’ assistant. I, for one, thought the PA mimicked the doctor’s role in treating illness and didn’t take into consideration the broader aspects of patient needs: physical, mental, psychosocial, economic and functional ability. Aha, we all have some prejudices at one time or another.

As I dipped my crusty baguette into the last bits of a creamy Mornay sauce on my plate, I debated how to answer. Now here was an opening for me to tout the superiority of NP’s.baguettes

At first I did bore my table companion a bit by describing educational paths and state requirements of each profession. But then, remembering the many PA’s I had worked with over the years, I said, “There really is little difference. Both want you to stay healthy and independent.”




By Marianna Crane

After a long career in nursing--I was one of the first certified gerontological nurse practitioners--I am now a writer. My writings center around patients I have had over the years that continue to haunt my memory unless I record their stories. In addition, I write about growing older, confronting ageism, creativity and food. My memoir, "Stories from the Tenth Floor Clinic: A Nurse Practitioner Remembers" is available where ever books are sold.


  1. I’m happy to hear you restrained yourself! Good thing I wasn’t there with you. I bristle, though, at NPs or PAs being referred to as “midlevel” practitioners. I suppose then that the physicians are “highlevel”. I wonder who they consider to be “lowlevel”! At least they say the “midlevel” people work “with” the doctor, not “for” or “under”!


    1. I can see where you are coming from. However, the term “midlevel” has been around so long (that in itself doesn’t make it a good term) but it doesn’t raise a blip on my radar since it isn’t tied to the medical apron strings like “physician extender.”
      A good consciousness-raising comment.


  2. I was just speaking of this same subject with my Maternal/Newborn nursing instructor this morning. The discussion came back around to differences in NP and CRNA. she encouraged me to divert from CRNA oath because I am so good with patients and would have more direct patient contact with patients as a NP rather than CRNA. I sat there and smiled because I had already made the decision to pursue post-graduate work as a NP for that very reason…I crave more patient contact than what CRNA path affords…same with PA!


  3. I read your blog on my phone and thought it said ‘medieval’ practitioner! I kind of like the thought of us returning to our roots as wise women(and men!) giving out potions and health giving herbal remedies! But you are correct. If our goal is well being, hopefully any path will point us in the right direction!


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