Nurse Practitioner vs Medical Doctor
This post summarizes the nurse practitioner (NP) vs medical doctor (MD) career pathways in Canada - including: career path, program facts, tuition, scope of practice, job prospects, and salary.
This post isn’t about whether being an NP or an MD is better - both roles significantly compliment our health care system in different ways. In fact, many NPs and MDs work together within interdisciplinary teams. What we will uncover are the differences in scope of practice, what the journey looks like for each, and programs in Canada.
I also want to say that Canada is highly regarded for it’s medical training across the board - for NPs, MDs, physician assistants, registered nurses, pharmacists, physiotherapist - pretty much all health care disciplines! All health care disciplines require rigorous training, licensing, and oversight by regulatory bodies to ensure safe and competent practice.
There’s a lot to consider when we are choosing a career path in medicine. If you’re deciding on whether to be a nurse practitioner or medical doctor, it’s important to understand each role and scope of practice. There will be nuance between Canadian provinces, but we will talk high level here. Let’s start with a quick comparison table:
NP vs MD
Category | Nurse Practitioner (NP) | Medical Doctor (MD) |
---|---|---|
How to Become One |
• Bachelor of Nursing (BScN) • RN license + 2+ years RN experience (≈2000 hours) • Master’s in Nursing – Nurse Practitioner (MN-NP) or Post-Master’s Certificate • NP Certification Exam + Provincial Registration • Maintain ongoing certification and professional development |
1. Bachelor’s degree with prerequisites in biology, chemistry, and math 2. Entrance exams: MCAT and often CASPer 3. Complete 4-year medical school program 4. Residency through CaRMS (2–7 years) 5. Pass MCCQE Part I (and NAC for international grads) 6. Obtain licensure + specialty certification 7. Maintain ongoing professional development |
Program Facts |
• 31 NP programs across 11 provinces • MN-NP: 2 years full-time or 3–4 years part-time • Post-Master’s Certificate: 1 year full-time (after completing prior masters degree) |
• 18 medical schools across 8 provinces • 4-year program combining classroom and clinical rotations |
Tuition Costs |
• MN-NP: $5,500–$9,000 (2 years) • Post-Master’s NP Certificate: lower cost • Plus 4-year BScN (~$25,000+) |
• Average medical school tuition: $20,000+ per year • Total cost varies by province and institution |
Scope of Practice |
• Independent practice • Diagnose, treat, order tests, prescribe meds • Perform procedures (suturing, biopsies, casting) • Provide psychotherapy • Scope varies slightly by province |
• Diagnose and treat medical conditions • Perform surgeries and complex procedures • Prescribe, dispense, and compound drugs • Deliver babies, perform allergy testing, manage serious mental health disorders • Broader procedural and specialty scope |
Job Prospects |
• Strong growth across provinces • 10% increase from 2021–2022 (largest in nursing professions) • Expanding roles in healthcare system • Many new funded NP training positions |
• Strong national demand, especially in family medicine • Aging population driving need for more physicians • High risk of labour shortage (2024–2033) • Excellent long-term job prospects across Canada |
Annual Salary (Canada) |
• Average: $97,000–$103,000 • Lowest median: PEI (~$49/hr) • Highest median: Ontario (~$57/hr+) • Factors: province, union status, leadership roles |
• Wide variation by specialty and province • Average income highest in Alberta • Ophthalmology ranks as top-earning specialty • Compensation models vary (fee-for-service, salary, blended) |
What is the difference between an MD and NP?
Nurse Practitioner Scope of Practice
Nurse practitioners are registered nurses who have additional education, nursing experience, and expanded scope to autonomously diagnose and treat, order and interpret tests, prescribe medications, refer to specialists, and perform medical procedures (1). NPs do not have to work with a collaborating physician, nor do they need medical directives to practice. Over the past several decades, nurse practitioners in Canada have seen a steady expansion of their scope of practice—driven by strong advocacy efforts and the growing need to address gaps in the health care system. Scope of practice varies between provinces but is fairly similar.
In Ontario (where I work as a nurse practitioner) for example, NPs are authorized to:
Communicate a diagnosis identifying a disease or disorder as the cause of a client’s symptoms.
Perform procedures below the dermis or a mucous membrane.
Insert an instrument, hand, or finger beyond natural or artificial body openings (e.g., external ear canal, nasal passages, larynx, urethra, labia majora, anal verge).
Apply or order the application of a specified form of energy.
Set or cast fractures and dislocations.
Administer substances by injection or inhalation (either independently or under another professional’s order, depending on regulation).
Prescribe, dispense, sell, or compound medications within regulatory limits.
Provide psychotherapy for serious mental health disorders through a therapeutic relationships (2)
Medical Doctor (MD) Scope of Practice
A physician’s scope of practice refers to the range of medical activities they are trained, certified, and licensed to perform. Individual scope depends on their education, specialty training, patient population, procedures, treatments, and practice environment (3).
Physicians must only practice within areas where they are educated and experienced. While details vary slightly between provinces, the core principles are consistent across Canada (3).
For example, in Ontario physicians are authorized (subject to the terms, conditions, and limitations of their registration) to perform the following:
Communicate a diagnosis that identifies a disease or disorder as the cause of symptoms.
Perform procedures on tissue below the dermis, or below the surface of mucous membranes, the cornea, or surfaces of the teeth.
Set or cast fractures and reduce dislocations.
Move spinal joints beyond the usual physiological range using a fast, low-amplitude thrust.
Administer substances by injection or inhalation.
Insert an instrument, hand, or finger beyond normal external openings (e.g., beyond the external ear canal, deep nasal passages, larynx, urethra, labia majora, anal verge) or into artificial body openings.
Apply or order the application of a prescribed form of energy (permitted therapeutic/diagnostic energy treatments).
Prescribe, dispense, sell, or compound drugs.
Prescribe or dispense vision devices for eye problems (subnormal vision devices, contact lenses, eyeglasses).
Prescribe hearing aids.
Manage labour and conduct the delivery of a baby.
Perform allergy challenge testing where a positive result indicates a significant allergic response.
Treat serious disorders of thought, cognition, mood, emotional regulation, perception, or memory by psychotherapy delivered through a therapeutic relationship.
(4).
Bottom line: Both NPs and MDs play integral, often overlapping roles in patient care — but their training lens and procedural boundaries set them apart. NPs bring a nursing-based, holistic approach with strong autonomy in diverse health care settings, while MDs bring broad medical expertise with procedural and specialty depth.
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NP vs MD Education
How does the educational path differ between an NP and an MD in Canada?
Nurse Practitioner Education
If you want in-depth information on this, read this post. If you want a snap shot, here it is:
First you attain a bachelor of nursing degree (BScN) from any Canadian university - there are many programs to choose from. I went to Queen’s University.
After you complete the BScN, you are eligible to write a certification exam to become a registered nurse (RN) - and you register with a provincial governing body (e.g. College of nurse of Ontario, if practicing in Ontario).
Then you gain experience as an RN. Most nurse practitioner programs in Canada require you to have at least 2000 hours (~2 years full time) as an RN before you apply. In my opinion - the more experience you have, the better. I worked in both hospital and community-based settings for varied experience.
Then you apply to a nurse practitioner program (which is a masters’s-level program) - here is a full document of programs within Canada. There are programs in most provinces, with several universities to choose from. Ontario has the most NP programs - 10 in total. Most NP programs in Canada are “primary health care” or “all ages.” Meaning, they train you to provide care to patients of all ages (new born to old age). It is primary care/family focused, however there are some acute care programs in Canada, but they are limited. That being said, many NPs who have a primary health care NP designation work in acute care settings and other specialty settings (long term care, pediatrics, dermatology, etc.).
You have 2 options: either you can apply for a masters of nursing-nurse practitioner (MN-PHCNP) program, OR attain a masters of science in nursing degree first, THEN apply for a post-masters nurse practitioner certificate program. The NP curriculum is a combination of clinical courses, theory courses, and clinical placements or “practicums.”
MN-NP program (MNPHCNP): has both non-clinical (e.g. statistics, research based) courses, and clinical courses (e.g. pathophysiology, advanced health assessment, pharmacology). This includes several supervised clinical placements. (2 years full time, 3-4 years part time). Total time to complete full time = 2 years.
Post-masters certificate program: only clinical courses (because you already have a masters degree). This includes several supervised clinical placements. (After initial masters degree, which will be 2 years full time or 3-4 years part time, an additional 1 year full time or 2 years part time). Total time to complete full time = 3 years.
Average clinical placement hours: 728 to 800 clinical hours
Once you complete the program, you will be eligible to write an NP certification exam, and attain a nurse practitioner license, similar to the RN registration process (5).
Continue Lifelong Learning: NPs maintain certification through ongoing education and professional development.
Tuition for NP programs: 2 year NP graduate programs can range from approximately $5,500 to $9,000 for a one to two-year program. 1 year certificate programs are cheaper. You have to factor in costs for the 4 year undergraduate BScN degree as well.
MD Education
1. Get a Bachelor’s Degree (BScN)
Most medical schools require at least an undergraduate degree with prerequisite courses in biology, chemistry, and matH (e.g. statistics).
There’s no specific “pre-med” major — students come from diverse academic backgrounds.
Entry is highly competitive, and the number of spots is limited by provincial funding and workforce needs.
2. Write Entrance Exams
Most schools require the MCAT (Medical College Admission Test).
Many also require the CASPer test, which assesses personal and professional qualities through situational judgment questions.
3. Complete Medical School
Canada has 18 medical schools across eight provinces.
Programs typically last four years, combining classroom learning with clinical rotations.
4. Match to a Residency
Graduates apply through CaRMS (Canadian Resident Matching Service) to secure hands-on postgraduate training.
Residency length varies: 2 years for family medicine to 7 years for surgical specialties.
Many decide to pursue additional fellowships after initial residency to sub-specialize - for example to become an ICU doctor, this requires completion of a fellowship after a 4 year residency like internal medicine
Students must pass the MCCQE Part I (and sometimes the NAC exam for international grads).
5. Get Licensed and Certified
Graduates are entered on the Canadian Medical Register (LMCC) and must obtain a provincial/territorial license to practice.
Physicians also need specialty certification from:
The College of Family Physicians of Canada, or
The Royal College of Physicians and Surgeons of Canada (or Collège des médecins du Québec).
6. Continue Lifelong Learning
Doctors maintain certification through ongoing education and professional development.
Tuition: medical schools in Canada are averaging over $20,000 per year (varies between schools).
Bottom line: If you’re already a registered nurse and are looking for autonomy and extended scope of practice, then an NP degree may be right for you. If you have health sciences undergraduate years under your belt and want to pursue a career in medicine, the MD path may be best for you. There are RNs and NPs who go on to pursue the MD career path too.
Where do NPs vs MDs work?
Nurse practitioner job landscape in Canada: The NP job landscape in the Canadian healthcare system is evolving at a rapid pace. Canda is incorporating NPs in healthcare workforce planning. Provincial governments are funding and subsidizing NP programs and jobs which is encouraging growth of the profession (7). In 2023, 121 training positions were added to the primary health care NP program in Ontario (7). In 2022, 7,113 NPs were employed in direct patient care, with a growth rate of 10% between 2021 and 2022, representing the largest percentile increase compared with other regulated nursing professions (8).
Medical doctor job landscape in Canada: The job market for physicians in Canada remains strong, with steady demand across all provinces. However, while the total number of doctors has grown, the supply of family physicians has not kept pace with population growth. An aging population and increasing care complexity continue to drive demand for medical services. Canada is projected to face a significant physician shortage between 2024 and 2033, with particularly strong job prospects nationwide (12).
NP vs MD Salary
Nurse practitioner salaries in Canada: they vary between provinces and work environment (e.g. primary care vs. acute care). According to the Government of Canada Job Bank website, in 2024 the lowest median hourly rates for NPs were reported in PEI at approximately $49/hour, and the highest median rates in Ontario at approximately $57/hour (9). The annual NP salary is approximately between $97,000 and $103,000 annually - with Ontario reporting the highest median salaries. There are many factors contributing to variability of wages - including union vs. non-union positions, stipends or bonuses added to annual salaries, whether an NP is in a leadership position (higher wages), among other factors.
MD salaries in Canada: there is significant variation in how much MDs make annually. This hinges on your specialty, and payment model (fee for service, salary, salary with stipends etc.). This MD financial article features a break down of average physician income by province, specialty, and specialties by province - Average annual gross income appears to be highest in Alberta, with ophthalmology ranking as the top-earning specialty overall.
If you’re looking to advance your career in healthcare, both the NP and MD paths are excellent options—it really comes down to your background and long-term goals. In Canada, NPs and MDs are making a huge impact on patient care and strengthening our health system. As an NP, I have deep respect for my MD colleagues—their knowledge and professionalism are invaluable. At the end of the day, we’re at our best when we learn from one another and work as a team, not in isolation.
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References
Canadian Nurses Association [Internet]. [2023]. Nurse Practitioners. [cited 2025 Oct 1]; https://www.cna-aiic.ca/en/nursing/advanced-nursing-practice/nurse-practitioners
College of Nurses of Ontario [Internet]. [2025]. Scope of Practice. [cited 2025 Oct 1]; https://www.google.com/search?q=cno+nurse+practitioner+scope+of+practice&oq=cno+nurse+practitioner+scope+of+practice&gs_lcrp=EgZjaHJvbWUqBwgAEAAYgAQyBwgAEAAYgAQyDQgBEAAYhgMYgAQYigUyDQgCEAAYhgMYgAQYigUyCggDEAAYogQYiQUyCggEEAAYogQYiQUyBwgFEAAY7wXSAQgzNzk4ajBqN6gCALACAA&sourceid=chrome&ie=UTF-8
Ontario. Medicine Act, 1991, S.O. 1991, c. 30. Available from https://www.ontario.ca/laws/statute/91m30
College of Physicians and Surgeons of Ontario. Ensuring Competence: Changing Scope of Practice and/or Re-entering Practice. 2019. Available from https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Ensuring-Competence.
NP Reasoning [Internet]. [2025]. How to become an NP in Canada. [cited 2025 Oct 1]; https://www.npreasoning.com/practice-management/how-do-you-become-a-nurse-practitioner-in-canada
Maier CB, Batenburg R, Birch S, Zander B, Elliott R, Busse R. Health workforce planning: which countries include nurse practitioners and physician assistants and to what effect? Health Policy. 2018 Oct;122(10):1085-1092. doi: 10.1016/j.healthpol.2018.07.016. Epub 2018 Aug 11. PMID: 30241796.
Ontario Helping More Students Become Nurse Practitioners. Government of Ontario [Internet]. [2023; 2025 Oct 1]. Available from https://news.ontario.ca/en/release/1003850/ontario-helping-more-students-become-nurse-practitioners
Canadian Institute for Health Information. CIHI [Internet]. [2023; 2025 Oct 1]. Available from https://www.cihi.ca/en/nurse-practitioners#:~:text=In%202022%2C,growth%20rate%20of%2010%25
Government of Canada Job Bank. [Internet]. [cited 2025 Oct 1]. Nurse practitioner in Canada. Available from https://www.jobbank.gc.ca/marketreport/wages-occupation/26454/ca
Canadian Medical Association. How do I become a doctor in Canada? Available from https://www.cma.ca/healthcare-for-real/how-do-i-become-doctor-canada
Government of Canada. Medical Doctor in Canada. 2025. Available from https://www.jobbank.gc.ca/marketreport/outlook-occupation/24432/ca