The facilitators and barriers of nurse practitioner primary care practice ownership: A qualitative analysis

The United States faces a growing primary care shortage driven by an aging population, rising chronic disease burden and a physician supply that is lagging behind demand. Nurse practitioners (NPs) are playing an increasingly central role in primary care delivery, and a small but growing number are opening independent practices. Despite their potential to strengthen the primary care safety net, empirical research on NP practice ownership remains limited.

Examine the facilitators and barriers to opening and sustaining NP-owned practices, particularly the structural factors that shape long-term sustainability.

We conducted a descriptive qualitative study using conventional content analysis of transcripts from two concurrent in-person focus groups with NP primary care practice owners (n=14). Focus groups were held in Boston, Massachusetts in March 2025. Participants were recruited through the National Nurse Practitioner Entrepreneur Network and a larger grant-funded learning collaborative on value-based payment. Analysis was conducted by a multidisciplinary team with rigor supported through peer debriefing, reflexive team discussion, and consensus-based interpretation.

Four themes emerged: (1) motivation to open a practice driven by unmet community needs and a commitment to patient-centered care; (2) policy and payer barriers including reimbursement differentials, prolonged credentialing and denied claims; (3) financial fragility and limited business capacity and, (4) sustainability facilitated by service innovation, revenue diversification, job satisfaction and peer networks.

NP-owned primary care practices face compounding structural barriers that threaten long-term viability, including reduced reimbursement, supervision costs, credentialing delays, and limited access to capital. As primary care demand rises and the NP workforce continues to expand, supporting the growth and sustainability of NP-owned practices is a critically needed investment in the US primary care infrastructure. Coordinated action by federal and state policymakers, payers, financial institutions, and health systems is needed, particularly to strengthen access in rural and underserved communities.