(also an MD) I've always conceived of it as a good NP will have been around long enough to know you usually do X when Y, but they don't know the reasoning for X

(also an MD) I've always conceived of it as a good NP will have been around long enough to know you usually do X when Y, but they don't know the reasoning for X or the pathophysiology underlying Y, and they don't always know when you shouldn't do X. That said, especially in primary care, give me an NP over a PA anytime. Primary care is a numbers game and NPs roll the dice better. Specialty PAs are great; I learned some of my best ortho from ortho PAs. But generalist PAs scare me and have been the source of some horrific consults in the past.