Editor’s note: This blog post was originally published in 2014, and was updated in January 2021 to reflect the current career landscape of NPs and PAs.
With the United States facing a physician shortage, especially in primary care, nurse practitioners (NPs) and physician assistants (PAs) are stepping up to provide services to more and more patients. Let’s take a look at some facts about these providers that you may not have known.
1. Their Numbers Are Growing
While the number of physicians is shrinking, the number of NPs and PAs is growing. The American Association of Nurse Practitioners (AANP) estimates that as of 2019, there were more than 290,000 nurse practitioners practicing in the United States — three times the number practicing in 2003. The AANP also estimates more than 30,000 NPs completed their academic programs in 2018–2019 alone.
The National Commission on Certification of Physician Assistants (NCCPA) reports there are more than 139,000 physician assistants working across all medical and surgical specialties in all 50 states, the District of Columbia, U.S. territories, and the uniformed services. A report published by the United States Department of Labor predicts that the physician assistant job openings will grow 37 percent between 2016 and 2026, and nurse practitioner roles will increase by 31 percent.
2. Their Job Opportunities Are Growing
Survey research conducted by the American Medical Group Association shows that two-thirds of organizations increased their advanced practice clinician (APC) workforce, which includes NPs and PAs, within the past 12 months. That same percentage also expects to increase their APC workforce in the next 12 months.
Locum tenens opportunities are also growing. The percentage of organizations that used locum tenens nurse practitioners nearly tripled between 2012 (4.8 percent) and 2013 (12.35 percent). Use of physician assistants nearly doubled in the same time period jumping from 2.8 percent to 6.47 percent.
3. Their Scope of Practice Varies by State
State law dictates what medical services PAs and NPs can provide, how autonomously they can practice, and what medications they can prescribe.
Unless a State of Emergency is declared (which was the case for most of 2020-present day), laws in 24 states (and Guam) allow nurse practitioners to practice independently, without physician oversight, meaning they can open their own practices, prescribe controlled substances, and practice to the extent of their training. For more information on NP scope of practice laws, check out our NP interactive scope of practice tool.
All physician assistants require physician supervision; however, the level of supervision required varies by state. For example, some states require the supervising physician be physically present when PAs provide service, while others only require a physician be available via telephone. For more information on state PA scope of practice laws, check out the AAPA website or our PA interactive scope of practice tool.
4. They Provide Additional Access to Care That Is Comparable to Physicians
There is a growing body of evidence that shows NPs and PAs provide high-quality care, and usually care that is equal to the quality provided by physicians, with the added benefit of access to care for rural residents. With the physician shortage, healthcare facilities are looking to PAs and NPs to fill the gap where appropriate.
5. They Are More Likely to Work in Underserved Areas
About 20 percent of Americans live in rural areas, but only 9 percent of physicians practice there, according to Dr. Howard Rabinowitz, a professor of family and community medicine at Thomas Jefferson University’s Medical College in Pennsylvania.
On the other hand, 17 percent of PAs and 18 percent of NPs practice in rural areas. In fact, many NPs have established successful nurse-led community centers in rural and underserved areas. A 2011 article published in the Journal of Health & Human Services also shows that PAs have been successfully used to expand healthcare services within an urban community.
6. They Are Not Looking to Replace Doctors
Although there are many articles written that advocate more autonomy for NPs and PAs, these providers should not be viewed as a threat to physicians.
Opponents of increased NP and PA autonomy often argue that it may drive physician practices away from their state or reduce physician salaries. In fact, studies have shown physician salaries are on par and in some cases better in states that have favorable NP and PA scope of practice laws.
More importantly, states that allow NPs and PAs the ability to practice to the top of their education are better prepared to implement integrated healthcare systems and provide comprehensive care to their citizens.
7. They Work Well With Others
Initiatives such as Accountable Care Organizations and patient-centered medical homes have placed greater emphasis on providing patient care via multidisciplinary care teams. NPs and PAs have proven to be invaluable members of those teams. Because they are capable of performing many of the routine services physicians typically render, physicians are able to delegate some of their responsibilities to NPs and PAs, allowing them to treat more complex cases.
8. They Work in Nontraditional Settings
The growth of retail clinics, onsite corporate health clinics, and in-home healthcare companies has created opportunities for NPs and PAs outside the traditional hospital or doctor’s office. As the healthcare industry continues to evolve to meet the physician shortage shortage, NPs and PAs will find even more opportunities to provide care to patients in a variety of settings.