Amid a Physician Shortage, 51% of Primary Care Providers Are Nurse Practitioners and Physician Assistants

The COVID-19 pandemic spotlighted America’s health care workers, as well as staffing shortages in an industry where people are increasingly overworked. Although the pandemic caused significant health care staff shortages, it also exacerbated those developing before the crisis struck — namely, an increasing lack of physicians in the U.S.

There’s an increasing demand for health care professionals. America is an ever-growing and aging nation — the U.S. Census Bureau even projects that the number of older adults will be higher than the number of children for the first time in 2034. Older adults need regular health care, particularly with 6 in 10 adult Americans having a chronic disease.

However, other health care professionals are stepping in to provide primary care. According to ValuePenguin health insurance expert Robin Townsend, the emergence of these professionals in primary care has benefits.

"Nurse practitioners and physician assistants are (at least partially) filling the primary care provider gap left by physicians," Townsend says. "That’s good for patients across the U.S. — especially those without insurance — as it gives them better access to affordable care."

Key findings

Rate of primary care providers varies widely by state

For every 100,000 Americans, there are 168.7 primary care providers (PCPs), but those figures vary extensively by state. Washington state ranks lowest, at 107.9 PCPs per 100,000 residents.

Following that, the states with the lowest rates include:

On the other hand, the District of Columbia has the highest rate of PCPs at 464.1 per 100,000 residents. That’s followed by:

Many states with the lowest rate of PCP providers have more countywide primary care shortages than the states with the highest rates. An earlier ValuePenguin study on health care workforce shortages found that 41% of counties within Washington state have a lack of PCPs — the third-highest. Meanwhile, Nevada ranked first, with 63% of counties in the state facing a shortage of PCPs.

On the opposite end of the list, just 8% of counties in Tennessee have a PCP shortage. And while the District of Columbia wasn’t included in the original study, three of the next four states with the highest rate of PCPs had deficiencies in 20% or less of their counties.

Still, there are some exceptions. Oregon (third-lowest PCP rate) had a notably smaller shortage of PCPs — affecting just 25% of counties in the state — while Alaska (second-highest PCP rate) ranked notably higher, with 79% of counties facing a PCP shortage.

Full rankings: States with the fewest primary care providers per capita

51.1% of PCPs are nurse practitioners and physician assistants

When thinking about primary care, a doctor likely comes to mind. And that may be the case for some Americans — internal medicine, family medicine and pediatrics are primary care specialties in which physicians practice.

But a PCP doesn’t necessarily need to be a physician — in fact, more than half of PCP providers aren’t physicians at all. Rather, when comparing the number of physicians specializing in PCP roles with the number of nurse practitioners (NPs) and physician assistants (PAs) in the U.S., ValuePenguin researchers found:

Townsend believes that varying levels of education likely play a role in the difference between the type of providers in PCP roles.

Only 29.2% of U.S. physicians practice in a primary care specialty, according to a ValuePenguin analysis of a 2019 report from the Association of American Medical Colleges (AAMC). This rate has been declining over the past decade. Though many factors may contribute to the decline in physicians in primary care specialties, pay, burnout and an increasing number of physicians leaving likely contribute.

Primary care is among the lowest-paid specialties at an average of $255,000 annually, according to a 2022 Medscape report. In comparison, those in plastic surgery earn an average of $576,000 — the highest among those examined. Although primary care physician salaries are still well above the national median salary of $45,760, many physicians may prefer working within a higher-earning specialty — particularly those with hefty medical school debt.

Meanwhile, an analysis of studies on PCP burnout — emotional exhaustion and reduced feelings of accomplishment at work — found that the prevalence of self-reported burnout among PCPs range from 13.5% to 60%, according to a study published in the Medical Care Research and Review journal. Coupled with that, 1 in 3 primary care clinicians reported in March 2021 that they expected to leave primary care within five years, according to a survey from the Larry A. Green Center, a Richmond, Va.-based research, development and advocacy firm.

Which states have the lowest percentage of physicians in primary care roles?

The percentage of physicians in PCP roles varies by state, too. Overall, Kansas has the lowest percentage of physicians in PCP roles. Of the PCP providers in the state, just 19.1% are physicians, while 72.0% are NPs and 8.9% are PAs. That’s followed by:

Meanwhile, the District of Columbia has the highest percentage of physicians in PCP roles (76.3%), followed by:

With NPs and PAs earning significantly less than physicians, cost of living may have something to do with the varying percentages of physicians in primary care. The states with the lowest percentage of physicians in PCP roles generally have a lower cost of living. In comparison, those with the highest percentage of physicians in PCP roles generally have a higher cost of living.

Full rankings: States with the lowest percentage of physicians in PCP roles

While NP and PA roles are growing, physician roles are shrinking

Since 2016, the number of people employed as nurse practitioners has jumped from 150,230 to 234,690 — an increase of 56.2%. PA roles have grown, too: The number of PAs has risen 27.8%, jumping from 104,050 in 2016 to 132,940 in 2021.

Meanwhile, the number of physicians in primary care specialties has dropped 0.21% in the same period.

Growth rate of U.S. physicians, NPs and PAs (2016 to 2021)

However, the demand for physicians is growing. The BLS predicts that the U.S. will need 91,400 physicians by 2026, according to a 2020 report from Human Resources for Health — a 13% increase from 2016. And as the physician shortage worsens, some areas in the U.S. will be more impacted than others. By 2030, the regions with the largest estimated shortage ratios — according to the same report — will be:

On the other hand, the Northeast will have a surplus of 50 physicians per 100,000 people.

In light of this, Townsend says NPs and PAs will play an increasingly vital role in primary care — but that’s not necessarily a bad thing.

"More and more NPs and PAs are caring for patients in all stages of life, including older Americans, and this trend will continue," Townsend says. "NPs and PAs are well-equipped to manage chronic diseases with outcomes similar to medical doctors. In fact, NPs and PAs provide health care at a lower cost than medical doctors and are more likely to treat patients directly, rather than refer them for unnecessary follow-up health services. This is good for the patient and saves on health care costs, especially for Medicare."

Plus, notably, a study published in 2020 in the journal Medical Care suggests that patients of NPs and PAs have lower odds of inpatient hospital admissions and require less frequent emergency department visits. Not only does that indicate a higher level of care, but it suggests millions of dollars saved in patient care.

NP and PA jobs are among the 10 fastest-growing professions

While there’s a stark discrepancy between the growth rates of NPs and PAs compared to physicians, it’s only projected to get wider. In fact, NP and PA jobs are among the 10 fastest-growing jobs in the U.S. From 2020 to 2030, the BLS predicts that NP jobs will grow by 52.2%, while PA roles will grow by 31.0%.

Meanwhile, all physicians and surgeon jobs are projected to grow just 3.0% from 2020 to 2030, slower than the average of 7.7% for all occupations. Notably, it’s also slower than the predictions for employment in health care occupations overall, which are projected to grow by 16.0%.

With physicians growing at a much slower rate, Townsend says NPs and PAs will play a vital role in preventing a shortage of PCPs.

Top factors to consider when choosing a new provider

Whether you visit a physician, NP or PA, having a PCP is vital to your long-term health. To determine the PCP that’s right for you, Townsend offers the following advice: