At the beginning of 2024, the problem of low physician workforce numbers was top of mind among leaders and many turned to advanced practice providers to help resolve access issues.
The U.S. faces an estimated shortage of between 37,800 and 124,000 primary care and specialist physicians by 2034. To meet the demand for access, systems and hospitals turned to APPs to help fill the gap.
From controversies to compensation, here are 18 shifts in the APP workforce to know from this year.
Workforce trends
1. According to projections from the Bureau of Labor Statistics, nurse practitioner is the fastest-growing occupation in the country, with employment in the profession expected to grow 46% by 2031. Physician assistant employment is also slated to increase nearly 30% in the same time period, placing it among the nation's 20 fastest-growing occupations. More APPs entered the healthcare workforce in 2020 than physicians. About 36,000 NPs, nearly 10,000 PAs and 2,600 certified registered nurse anesthesiologists joined the workforce that year, making up more than 60% of new providers.
2. Demand for APPs is rising in both rural and urban areas. For the fourth consecutive year, nurse practitioners were the most requested type of healthcare provider in AMN Healthcare's job searches. This could be due to the increasing number and variety of facilities, such as urgent care centers, retail clinics and telemedicine, using APPs. Overall, searches for APPs surpassed those for primary care physicians.
3. Organizations that leverage a higher percentage of APPs outperform peers on productivity and compensation metrics, a report from healthcare consulting firm Kaufman Hall found.
4. A growing number of health systems are creating executive roles to lead APPs. At least four systems added an APP leader position to their structure, including Melissa Stoudmire, MSN, APRN, Cleveland Clinic's first vice president of APPs, who stepped into the role Aug. 1 and Amanda Connoyer, DNP, APRN, Lewes, Del.-based Beebe Healthcare's first chief advanced practice clinician.
5. Turnover among physicians and APPs decreased from 2022 to 2023 but is still higher than 2019 and 2020, according to an annual report from the Association for Advancing Physician and Provider Recruitment. It also found demand for physicians has stabilized.
6. To address care gaps, more systems are turning to APPs to increase capacity and patient access. APPs are particularly successful in primary care, walk-in care and specialty care models.
7. Norfolk, Va.-based Sentara Health is working on doubling the number of APPs in its primary care facilities and anticipates a 70% increase in care capacity with each APP added. APPs in primary care will manage about 1,100 patients annually, compared to 1,500 patients for physicians. Sentara is also transitioning from a 1-to-1 pairing of physician and APP to a team-based care model where physicians lead a team of APPs, registered nurses, pharmacists, counselors, educators and care managers.
"APPs are crucial to expanding primary care access and meeting the growing demand for healthcare services," Steven Pearman, MD, vice president of Sentara Medical Group, told Becker's. "It's vital to integrate them thoughtfully into the care team, leveraging their skills to improve outcomes and reduce burdens on physicians. A collaborative, team-based approach is the future of primary care."
8. Such a heavy reliance on APPs does not come without some controversy. Critics have warned of gaps in nurse practitioner education that may leave doors open to potential patient safety risk. Comprehensive NP training programs in hospitals are rare and no standard curriculum for NP education currently exists.
Compensation
9. NPs are twice as profitable for hospitals to employ, according to 2022 data from Kaufman Hall. A primary care NP costs almost half as much to employ compared to a primary care physician ($156,546 versus $344,308 annually) while generating nearly the same revenue ($424,979 for NPs versus $462,000 for physicians).
10. The average starting salary for nurse practitioners grew nearly 9% year over year from 2023 to 2024, according to AMN Healthcare's latest report on physician and APP recruiting incentives. APPs are receiving average signing bonuses of $11,758, and relocation allowances average $7,910.
11. The West is the top-paying region for nurse practitioners and physician assistants at $152,935 and $149,603 respectively. Meanwhile, the lowest-paying region for NPs is North central at $124,125, and the lowest-paying region for PAs is the southeast at $127,991.
12. Total cash compensation for nurse practitioners and physician assistants, combined, increased by 17% for primary care, 15% for surgical specialties and 14% for both medical and hospital-based specialties between 2021 and 2024. Meanwhile, total cash compensation grew 22% for certified anesthesiologist assistants and certified registered nurse anesthetists during the same timeframe.
13. Half of organizations surveyed by SullivanCotter said they use incentives for at least some of their APPs and 74% of them said they are structuring this pay as add-on dollars instead of at-risk compensation.
Controversies
13. This year, some physician and nursing groups challenged efforts to enact a multistate licensing compact for advanced practice registered nurses. The compact would allow APRNs with more than 2,080 hours of practice to hold one multistate license without obtaining additional licenses and would allow them to be responsible for patient care independently. The American Association of Nurse Practitioners opposed the inclusion of practice hours as a prerequisite for the license and said states should pause adoption of the compact until an improved version could be developed.
14. In July, a Bloomberg Business report shed light on the rapid growth of nurse practitioner programs and the lack of standardized curriculum. More than 600 schools offered advanced nursing degrees in 2022, three times higher than the number of medical schools nationwide. However, training programs are not standardized and many students can complete coursework entirely online. NPs are required to log 500 hours of clinical training time, but this, too, is often unregulated and online students can struggle to find appropriate clinical site opportunities. Some professors said they were concerned that a lack of adequate training or clinical hours could put NPs at risk of making serious medical errors.
15. The American Academy of Physician Associates asked the AMA to end its "scope creep" campaign against APPs in two letters signed by more than 8,000 physician assistants. According to an AAPA survey, 96% of PAs said the AMA's campaign has had a negative effect on addressing workforce shortages in healthcare. The AMA responded to the letters in September, saying that it "greatly values and respects" contributions of physicians assistants to the healthcare team and that its scope of practice campaign is based on long-standing and extensive AMA policy that is often in response to legislative efforts.
"Physician assistants have neither the same skill set nor the breadth of experience of physicians, as is evident by the fact that physician assistants have a fraction of physicians’ education and training," the letter said. "To claim otherwise is simply incorrect and even more critically, confusing to patients. This is why the AMA firmly believes that all patients, including patients in rural and underserved communities, deserve access to physician-led team-based care."
16. The ongoing debate around expanding scope of practice for APPs continued to spark this year. Advocates for expansion say that the growing physician shortage and rise of patient volumes must be met. They argue that APPs and pharmacists can increase healthcare access in shortage areas and reduce healthcare costs. However, the AMA has maintained its opposition to expanding scope of practice, citing concerns for potential patient harm and cost of care. It also cites the difference in education and training between physicians and APPs. AMA President Bruce Scott, MD, told Becker's in June that expanded scopes are not the answer to physician shortages and healthcare access issues.
17. This year, a newer debate came to light: Should healthcare workers who have a doctorate legally call themselves "doctor"? A Medscape report found 74% of physicians said they disapprove of nurses with clinical PhDs calling themselves "doctor." Currently, several states regulate the use of the doctor title and multiple state legislatures are looking at this question. In 2023, three nurse practitioners sued California for its restrictions over the use of the term, citing the fact that other professions who hold a doctorate degree are allowed to refer to themselves as doctors without repercussions. The lawsuit is ongoing.
18. The American Academy of Physician Associates voted to replace the term "physician assistant" with "physician associate" in 2021, but the debate of what to call PAs is ongoing. The change came in an effort to better reflect their experience and roles, though the organization does not recommend PAs refer to themselves as physician associates with patients. The American Osteopathic Association and AMA rebuked the decision, saying the change would confuse patients.