Employers seek clinicians who deliver physician-level care with faster training and lower costs
Becky Peterson graduated this month, qualified to examine patients, prescribe medications, and diagnose conditions—responsibilities traditionally reserved for physicians. But she won't be called "Dr. Peterson," and her path to practice took just two years, not seven or more.
Peterson is entering one of healthcare's fastest-growing and most lucrative fields: nurse practitioner.
"There is a place for medical-school doctors, and a place for nurse practitioners," said Peterson, who completed her program at the University of North Carolina at Chapel Hill and lives in Morrisville, N.C. "All of us are trying to do the same thing: meet the needs of people who need help." Now preparing for her certification exam, she will begin a mental-health residency this fall.
Filling the Gap
Increasingly, a visit to the doctor's office doesn't involve a doctor—at least not directly. Nurse practitioners have become essential gap-fillers in a strained healthcare system. Between 2019 and 2025, their ranks swelled by 60%, reaching 461,000 nationwide, according to the American Association of Nurse Practitioners.
Physician assistants (PAs) and other non-MD providers are similarly in high demand, reflecting a broader shift toward decentralizing basic care. In many states, pharmacists now prescribe contraceptives and flu treatments—tasks once exclusively reserved for physicians.
This evolution has sparked debate. Medical associations warn that allowing clinicians without medical-school training to practice independently risks patient safety. These groups have actively opposed state efforts to expand practice authority for NPs and PAs.
Yet demographic pressures are hard to ignore. An aging population requires more care than the current physician workforce can supply. The U.S. adds only a limited number of new doctors each year due to residency slot constraints, and many new MDs opt for higher-paying specialties over primary care. The result: a shortage of approximately 16,000 primary-care physicians, according to KFF, a nonprofit healthcare policy researcher, a gap projected to widen significantly.
NPs and PAs help bridge that divide—and often at lower cost.
"Doctors cost a lot of money, and nurse practitioners don't," said Brian McKillop, president of physician solutions at AMN Healthcare. Employer demand for clinicians whose skills overlap with physicians—but without the MD credential—is at an all-time high.
The Economics of Care
Nurse practitioners earn an average of $132,000 annually, federal data show—a substantial increase over registered nurses' $98,000 average, yet well below the $257,000 typical for primary-care physicians.
Training costs tell a similar story. Peterson's two-year NP program cost roughly $50,000, a fraction of the $207,000 in debt the average medical-school graduate carries. The less-intensive pathway also made it easier for Peterson to plan for family life—a priority for many NPs, most of whom earn a bachelor's in nursing before pursuing advanced degrees.
Rural communities, in particular, have come to rely on these providers. Federal data indicate that 66% of rural Medicare beneficiaries receive some or all of their care from NPs or PAs, compared with 54% of urban residents.
Danielle Howa Pendergrass, a nurse practitioner, founded a women's health clinic in Price, Utah, in 2012—one of only two such clinics serving her remote region. Today, she sees 100 patients weekly, prescribing medications, ordering diagnostics, and managing conditions ranging from diabetes to cancer.
"We're excellent in what we do—we have the skills, we have the training," she said. "I stepped in and filled a huge gap."
Expanding Scope, Evolving Titles
Though nurse practitioners emerged in the 1960s, their prominence has surged in recent decades. Over the past 20 years, roughly 30 states have granted NPs authority to practice without physician oversight. In these states, their scope closely mirrors that of many primary-care doctors—though they typically do not perform highly complex procedures.
Ten states allow physician assistants—who generally complete six to seven years of combined education and clinical training—to practice independently as well. And five states, including Delaware, just this month, have passed legislation renaming "physician assistant" to "physician associate."
"Truly, we are not just an assistant to a physician any longer," said Jim Earel, a physician associate and 18-year veteran of an orthopaedics group in Bettendorf, Iowa. He manages his own patient roster and believes the updated title better reflects modern practice.
In many states, however, NPs and PAs still operate under physician supervision. These arrangements vary widely: some involve close, in-person collaboration; others are largely nominal, with physicians receiving monthly fees—sometimes thousands of dollars—for oversight that exists mostly on paper.
The Debate Over Independence
Organizations like the American Academy of Family Physicians contend that non-physician clinicians should not practice without direct physician oversight.
"If you see a young kid and they've got strep throat, it's easy to treat if that's what it is," said Asim Jaffer, a primary-care physician in Peoria, Ill. "But if not, what else could it possibly be that you're missing? That's where it gets scary."
Walter Lapicki, an anesthesiologist at Hunterdon Health in Flemington, N.J., echoes this caution. Though he regularly collaborates with certified registered nurse anesthetists—who can administer anesthesia—he emphasizes that a physician anesthesiologist is always physically present during procedures.
Research offers nuanced insights. Multiple studies suggest NPs deliver primary care comparable to physicians. However, one emergency department study found NP-led care sometimes increased costs, partly due to higher rates of diagnostic testing. Conversely, a 2023 analysis by a University of Alabama School of Law researcher found that allowing NPs to practice without supervision—enabling them to see more patients and open independent practices—reduced preventable, healthcare-related deaths by 2%.
For many patients, especially in underserved areas, access remains the paramount concern.
"Physicians argue that if you're in an exam room, you'd rather be with a physician," said Benjamin McMichael, the University of Alabama economist who authored the 2023 study. "But that's not the whole story, because a lot of people never get to that exam room."
As healthcare systems grapple with rising demand, workforce shortages, and cost pressures, nurse practitioners and physician associates are no longer just supplements to physician care—they are becoming central pillars of a reimagined delivery model. The question is no longer whether they can fill the gap, but how best to integrate their expanding roles into a system striving to serve everyone who needs care.