Number of NPs/PAs in Specialty Care Rises 22% Over a Decade

Marcia Frellick

April 30, 2018

The number of nurse practitioners (NPs) and physician assistants (PAs) hired in specialty practices rose 22% from 2008 to 2016, according to a research letter published online today in JAMA Internal Medicine.

The numbers of advanced practice providers (APPs) grew even more in primary care (24%), report Grant R. Martsolf, PhD, MPH, from the School of Nursing at University of Pittsburgh in Pennsylvania,, and colleagues. However, they focused the study on specialty practices because growing use in primary care is well documented.

Overall, about 28% of all specialty practices employed APPs, including 49% of multispecialty practices and 21% of surgical practices. Employment of NPs in specialty practices grew at a faster rate than did employment of PAs (33% vs 20%).

In 5 of the top 10 specialties included in the report, APPs were employed in at least 25% of the practices. Dermatology had the largest growth.

Table. Top Specialties in Which at Least 25% of Practices Employ NPs/PAs

Specialty Practices That Employ APPs (2016) (%) Change From 2008 (%)
Cardiology 31.0 2.4
Obstetrics/gynecology 29.3 –0.7
Orthopedic surgery 29.1 3.9
Dermatology 36.3 32.5
Gastroenterology 28.7 14.2


Geographically, the states with the highest use of APPs in specialties were clustered in the Mountain regions and West North Central, including states such as Montana, North Dakota, South Dakota, Minnesota, and Iowa.

Among the reasons for overall growth in APP hiring, the authors point to the emergence of value-based care models, incentives for team-based care, and pressure to reduce costs.

Specialist practices may also be building new roles for APPs, they write.

Martsolf and colleagues used the 2008 and 2016 SK&A outpatient provider files to determine the prevalence of advance practice providers in specialties. The SK&A is a proprietary data set that includes information on 90% of physician practices in the United States.

The authors acknowledge limitations of the study: For example, they did not study specific duties of the APPs, and the data include only outpatient providers.

The authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online April 30, 2018. Abstract

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