The changing employment of physicians, NPs, and PAs
- Sep 15
- 2 min read
Hooker RS, Christian RL.
JAAPA. 2023;36(8):32-37. doi:10.1097/01.JAA.0000944616.43802.f6
Executive Summary: Shifting Dynamics in U.S. Clinician Employment
The employment of US physicians, NPs, and PAs is changing, and the forecast is that the transformation will continue well into the next decade of this century. The shortage of physicians, when matched with a growing and aging population, is worsening; at the same time, NPs and PAs are extending the healthcare provider base and making care more accessible. Based on the BLS analysis, more than 24,000 NPs and 11,000 PAs are needed to fill new positions where physicians will be unavailable by 2032. Physician employment growth of 3% from 2021 to 2031 lags behind the growth of NPs (46%) and PAs (28%) over the same time period. Clinician shortages are likely to continue across many healthcare service delivery systems well into the 2030s. Major disrupters, such as the COVID-19 pandemic, are likely to affect these predictions.
Purpose & Scope
The article analyzes 2021 U.S. Bureau of Labor Statistics (BLS) data to understand employment trends among physicians, nurse practitioners (NPs), and physician associates/assistants (PAs).
It aims to inform policy makers and healthcare leaders about workforce composition, growth projections, and implications for care delivery.
Key Findings
In 2021, the U.S. employed:
698,700 physicians
246,690 NPs + 139,100 PAs (Total 385,790)
47,000 new NPs and PAs per year (2021-2025) indicates 188,000 new providers for a total of 434,690 by 2025.
These clinicians served a population of 331.5 million, with notable differences in age, gender, and wages:
Physicians: Median age 45.1, 43.8% female, $208K median wage
NPs: Median age 43.3, 88.7% female, $118K median wage
PAs: Median age 39, 67.7% female, $121K median wage
Growth Projections (2021–2031)
Physicians: 3% growth
NPs: 46% growth
PAs: 28% growth
NP and PA expansion is driven by:
Lower educational costs and faster program growth
Limited funding for physician postgraduate training
Increased demand for team-based and cost-effective care
Policy & System Implications
The constrained growth of physicians is linked to stagnant Direct Graduate Medical Education (DGME) funding.
Federal initiatives are slowly increasing residency slots, but not fast enough to meet demand.
NPs and PAs are increasingly filling roles traditionally held by physicians, especially in hospitals and underserved areas.
Conclusion
The U.S. healthcare system is undergoing a workforce transformation.
NPs and PAs are critical to expanding access and offsetting physician shortages.
Strategic planning must account for all three clinician types to ensure sustainable care delivery into the 2030s.