Specialization of Physician Associates and Nurse Practitioners as Reflected in Workforce Projections

Introduction The utilization of physician associates (PAs) and nurse practitioners (NPs) within the United States healthcare system has increased substantially since their inception in the 1960s. While many PAs and NPs are educated and work within specialty areas in their clinical practice, the federal government does not identify PAs and NPs by specialty in its workforce projections. Methods We obtained data from publicly available sources as well as professional organizations. Employment status, specialty, and location information for NPs and PAs were drawn from association census surveys. Results Outpatient or ambulatory care employment sites employ 46.6% of NPs and 55.3% of PAs, while almost a quarter of each group (22.1% and 23.9%, respectively) work in general and surgical hospitals. About 9% of providers who are PAs and NPs are employed in Federally Qualified Health Centers, many of which are in health professional shortage areas (HPSAs). The number of PAs and NPs working in HPSAs has significantly increased from 72,000 PAs and NPs in 2011 to 110,000 in 2023. There has been no growth of physicians in HPSAs during this same time. The Health Resources and Services Administration (HRSA) does not identify NPs and PAs by their specialty practice area so the extent to which they provide care in specialty areas is unknown based on HRSA data. Conclusion It is essential to provide detailed information inclusive of PAs and NPs as well as physicians in planning for healthcare workforce needs. The accurate projection of potential healthcare provider shortages requires knowledge of each type of provider along with their role and specialization to determine gaps in healthcare service delivery.