Advanced-practice nurses and PAs are in high demand. Here's what the future holds

Karen Acevedo, MS, RN, CPNP-PC decided to become a nurse practitioner during undergrad at Stanford University. As her classmates prepared for careers in fields like law and engineering, she considered being pre-med, but balked at the cost of attending medical school.?

Then she found out about a program at University of California, San Francisco that would allow her to get a nursing degree in about a year and a half, before advancing to a masters program for her NP degree.

Since then her career has taken her from Fresno, Calif., where she was the sole pediatric NP specializing in pulmonology, to tech company RubiconMD, where she now works as senior clinical operations manager – her skills in high demand across industries.

Advanced practice provider – a term that includes NPs, physician associates, certified nurse midwives and certified registered nurse anesthetists – is one of LinkedIn’s top Jobs on the Rise, surfacing in our data as one of the fastest-growing roles of the past five years. The profession came in seventh on this year’s list, which looked at data from January 2018 through July 2022. (You can see the full list and methodology here.)

It’s not hard to understand why. The COVID-19 pandemic created an immense demand for healthcare workers – while simultaneously spurring hundreds of thousands to leave the field entirely.?

A shortage of clinicians had been looming even before the pandemic, driven by demographic trends like an aging population, rising rates of obesity and more people living with chronic conditions. But now, with the healthcare workforce shrinking by the equivalent of about 2% each month, the demand for clinicians with advanced training has only strengthened, said Jennifer M. Orozco-Kolb DMSc, PA-C, DFAAPA , president of American Academy of Physician Associates .?

The need is especially great in primary care, which is often seen as the front door to the healthcare system – and the specialty that can keep patients from needing more complex care later on.

“For the first time, we're starting to see how short [staffed] we’re truly going to be,” Orozco said, noting that job growth for PAs is expected to be 5x higher than the average for other professions. “I don't think there's a better time for people to choose to be a PA in any specialty, especially in primary care.”

The demand for NPs – who number 355,000 today – is similarly expected to grow 46% by 2031, said April Kapu , president of the American Association of Nurse Practitioners . In the past year alone, NPs had 1.6 billion patient visits – much of that demand, she said, increasingly coming from patients themselves.

“Twenty years ago, I might be having a conversation with somebody, and they would say, ‘Well, what is a nurse practitioner?’” she said. “Today that is not the conversation.”

Although the specifics vary by state, APPs typically can make diagnosis and treatment decisions, prescribe medications, assist in surgeries and coordinate care across specialties.

For this two-part story, I spoke with a number of NPs, PAs and CRNAs about their career paths. Like Acevedo, some said they initially were on track to attend medical school, but were put off by the cost or years of training involved – which made an NP or PA degree seem like the better investment. Others started out as bedside nurses, but wanted to have their own relationships with patients or more decision-making power.? Stay tuned next week to hear what they had to say.?

As it stands now, 89% of NPs are trained in primary care – but that’s changing, according to Kapu. A greater number of NPs are going into acute care, and the need is also great in psychiatry, women’s health and pediatrics, she noted.

Making sure people have access to preventative care is also getting more important as an increasing number of insurance plans – both private and government-funded – are tying reimbursement to health outcomes, rather than just the number of procedures performed, a payment model known as value-based care.

“What value based care has done is say, we need to use every single person. We have to have all hands on deck to drive change,” Orozco said. “There's no way, unless we use everybody to the full scope and top of license, that we're going to be able to make any sort of impact.”

Yet scope of practice has been one of the more controversial issues facing APPs, with the American Medical Association heavily opposing any move that it sees as encroaching on physicians.?

While NPs and PAs have national standards for education, training and board certification, getting licensed is still on the state level. That means that states control to what extent APPs can practice without physician oversight, or what’s known as full practice authority.

But there’s evidence that the tides are turning in their favor.

With the need for clinicians so dire, many health systems and even physicians want the flexibility to deploy healthcare workers where they’re most needed, said Orozco, who also serves as the director of advanced practice providers at Rush University Medical Center in Chicago.?

“When [a healthcare site in] the middle of Illinois is calling me, and there's only one PA for 150 miles, I have to make sure that they're working to the fullest extent that they can, and that's what my goal is now,” she said.

NPs and PAs aren’t trying to replace physicians, they insist, but instead offer complementary skill sets that allow doctors to practice to the tops of their license. The differences between states also can make the regulations feel arbitrary.?

“Honestly, the physicians who work closely with PAs, they get just as aggravated by these artificial things,” said Todd Pickard, DMSc, PA-C, DFAAPA, FASCO , who specializes in oncology at the MD Anderson Cancer Center.?

“I don't really describe it as a story of scope of practice,” he added. “I describe it as folks being able to do what they are trained and knowledgeable and experienced in, without artificial barriers.”

For NPs, there are currently 26 states, plus the District of Columbia, that allow full practice authority – which, according to the American Association of Nurse Practitioners, has led to more NPs working in underserved areas. Four of those states expanded their regulations during the pandemic, to help ease the clinician shortage.?

Other states, like California, are also pushing forward on full practice authority.?

“I think quite often people might get the impression that we want to practice completely independently, and that is not the case,” Kapu said, “We want to practice to the extent of what we were educated and trained to do. We need everyone working to the fullest extent of their education and training, to really tackle some of the needs that we're seeing in healthcare today.”