One Step at a Time · Blog

Pre-med vs nursing vs PA: which health career fits your teen

By Dr. Evan J. Hasson, founder · 2026-11-05 · 8 min · English

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“I want to work in health care” is a good place to start. But a doctor, a nurse and a physician assistant (PA) take very different roads. The degree is different. The years in school are different. So are the exams. This guide puts pre-med vs nursing vs PA side by side, then shows which high school courses help with all three.

Every number below comes from an official source, linked in the sentence. Requirements differ by school and change over time, so always confirm with each program.

Pre-med vs nursing vs PA at a glance

Here is the short version. Pay is the national median for May 2025 from the U.S. Bureau of Labor Statistics (BLS). Pay varies by state, setting and experience, and it is not a promise of pay or a job.

Pre-med: the path to doctor (MD or DO)

Pre-med is not a major. It is a group of courses a student takes while earning a bachelor's degree. Cornell's health professions advising office says health professional schools do not prefer any specific major. Most future doctors still take a lot of science. The American Association of Colleges of Osteopathic Medicine (AACOM) says premedical coursework generally includes at least one year of biology, one year of physics, one year of English composition and two years of chemistry.

Physicians earn either a Medical Doctor (M.D.) or a Doctor of Osteopathic Medicine (D.O.) degree. Medical school takes 4 more years after the bachelor's degree, followed by 3 to 9 years of internship and residency, depending on the specialty. It is the longest road of the three.

Exams on the pre-med path

• MCAT, before medical school. Most U.S. medical schools require recent MCAT scores. The test has four multiple-choice sections and about 7 hours and 30 minutes of seated time.
• USMLE or COMLEX-USA, for the license. The USMLE is three exams, called Steps, used to grant the first license to practice medicine. COMLEX-USA has three levels and is the licensing path for osteopathic physicians.

The full course list and licensing details are on our Pre-Med (MD / DO) page.

Nursing: a ladder with many steps

Nursing is different because a student can start working early and keep climbing. The BLS describes three ways to become a registered nurse (RN): a bachelor's degree in nursing (BSN), an associate's degree in nursing (ADN), or a diploma from an approved program. A BSN typically takes 4 years. Employers, particularly hospitals, may require a bachelor's degree.

Every RN needs a license from the state where they work. That means graduating from an approved program and passing the NCLEX-RN, the national exam for new, entry-level registered nurses.

Here are the steps below and above RN:

• Nursing assistant. State-approved programs are offered in places that include high schools and community colleges. In some states the title is Certified Nursing Assistant (CNA).
• LPN or LVN. These programs typically take about 1 year. An LPN can later complete an LPN-to-RN program.
• Advanced practice nurse. Nurse practitioners, nurse anesthetists and nurse midwives need an RN license first and at least a master's degree. BLS projects 36% growth for this group from 2025 to 2035.

Each step, with its training and exam, is on Nursing: the career ladder.

Physician assistant: a master's degree after college

Physician assistants examine, diagnose and treat patients under the supervision of a physician. PAs are educated at the master's degree level. Programs last about 27 months and include more than 2,000 hours of clinical rotations.

The big difference is patient care experience. Admission is highly competitive, and the American Academy of Physician Associates (AAPA) says incoming PA students bring an average of more than 3,000 hours of direct patient contact, from jobs such as paramedic, athletic trainer or medical assistant. One example, Duke University's PA program, requires at least 1,000 hours of patient care, asks for GRE scores and does not accept AP credit for its prerequisite courses.

After PA school comes the PANCE, a national exam of five blocks of 60 questions. All states require PAs to be licensed, and a PA who passes the exam may use the credential PA-C.

Courses and exams for this path are on Pre-PA (Physician Assistant).

Which health path fits your student?

There is no wrong answer here, and many students change their minds along the way. These questions can help a family talk it through:

• How long does the student want to be in school? Medicine is the longest: a bachelor's degree, 4 years of medical school, then residency. PA school is about 27 months after a bachelor's degree. An RN can start working after a BSN, an ADN or a diploma.
• Does the student want to work while studying? Nursing has steps. A nursing assistant or LPN can work, then move up through bridge programs such as LPN-to-RN or RN-to-BSN.
• Does the student like hands-on patient work? PA programs look for real patient care hours, so a future PA plans a health job during or after college.
• PA or nurse practitioner? Both need graduate school. A nurse practitioner must finish a master's or doctoral program and must be an RN first. A PA applicant typically needs a bachelor's degree plus patient care experience.

High school courses to take now

The good news: the same high school courses help on all three paths.

• As much math and science as possible. That is the first tip for high school students from the Association of American Medical Colleges (AAMC). If AP or IB courses are not offered, it suggests choosing the most rigorous courses and talking with a school counselor.
• Biology and chemistry. The University of Pennsylvania says its School of Nursing applicants should have strong preparation in the sciences, particularly chemistry and biology. These two subjects also sit at the center of pre-med and pre-PA college courses.
• Math every year. As one example, the University of California requires three years of college-preparatory math and strongly recommends a fourth. It requires two years of science from biology, chemistry or physics, and recommends a third.
• English, history and social studies. The AAMC says these classes give students practice in writing and presenting.
• Study habits and real experience. The AAMC also suggests learning to study and manage time, volunteering at hospitals or clinics, and asking a doctor if the student can spend a day with them.

A note on AP credit: AP courses can help a student place into more advanced college courses. But many medical and dental schools do not accept AP credit for their prerequisite courses, and the Duke PA program does not either. Plan on taking the college versions too.

Your next step

Strong science starts with strong math and reading. Here is a simple order:

1. Take the free placement test. It adapts to the student and shows where the gaps are in math and reading.
2. Open Pre-Health Professions to compare more health careers, such as physical therapy and pharmacy. The College Preparation page covers majors, test prep and paying for college.
3. Work through the high school Biology and Chemistry courses in the UpOnly Learning library, and review key terms with the high school flashcards. Both are included with the Every Step membership.