APP roles — certified registered nurse anesthetists (CRNAs), nurse practitioners (NPs), physician assistants (PAs), and certified nurse midwives (CNMs) — all are projected to experience outsized growth through 2031, per the Bureau of Labor Statistics (BLS) Occupational Outlook Handbook:
PA jobs are expected to grow by 28% (much faster than average) through 2031, with 38,400 new positions estimated to be added.
Nurse anesthetist, nurse midwife and NP jobs are expected to grow by 40% in that same period, with 118,600 new positions created through 2031.
Additionally, nearly one in five (19%) of search engagements for healthcare search and consulting firm Merritt Hawkins in 2021 were for APPs, up from only 13% two years earlier, with NPs topping the list of most-requested search engagement. Per a 2022 AMN Healthcare review of physician and APP recruiting incentives (PDF), this was driven in large part by a shift toward “convenient care” settings (e.g., retail, telehealth, urgent care centers) that are largely staffed by APPs.
An April 11, 2023, MGMA Stat poll found that these projections are right on track, as nearly two out of three (65%) medical groups plan to add new APP roles in 2023, versus only 35% that do not. The poll had 556 applicable responses.
As Allison Dimsdale, DNP, NP-C, AACC, FAANP, associate vice president for advanced practice for the Private Diagnostic Clinic at Duke University Health System, recently told HealthLeaders: “It makes sense that if our absolute top goal is to take care of lives, then we have to optimize our clinical workforce” by finding ways to incorporate more NPs and PAs while the search continues for hard-to-recruit physician and nurse roles — a process she calls “practice redesign.”
That redesign seems well underway for many healthcare organizations: Among the one-third of poll respondents who said “no,” a significant number of them told MGMA that the reason they aren’t adding APP roles is because they’ve already successfully recruited for their needs, often finding “top-performing” candidates to help cover many different specialties, and engaging them with monthly lunch-and-learn sessions alongside the compensation packages of pay and benefits offered.
Despite those successes, several medical group leaders said there are challenges, especially in creating physician buy-in for broader use of APPs, as well as recruitment challenges in some underserved areas.
Additionally, the overall cost of hiring new APPs — while not as high as hiring new physicians — has been on the rise: The 2022 MGMA DataDive Provider Compensation survey found a 3.98% increase in APP total compensation from 2020 to 2021. Looking beyond the changes driven largely by demand for APPs during the COVID-19 pandemic, last year’s data summary report (Provider Pay and the Pandemic: Realizing Recovery) gave us three- and five-year looks at the shifts in NP and PA compensation by specialty area.
Did you know?
The 2022 MGMA DataDive Provider Compensation data set identified the top five highest-paying states for APPs’ median total compensation?
For more insights around APP productivity and compensation, watch for the release of the 2023 MGMA DataDive Provider Compensation and Productivity survey results in May. Preorder MGMA DataDive today.
Where APPs are being added — and why
The most common specialties where APP utilization was reported in our poll were primary care (especially family medicine and pediatrics), pulmonology, urology, GI, urgent care, cardiology and surgical specialties.
The most common reasons for increased APP use involved normal practice growth or the need to update staffing models amid difficulties attracting physicians — especially in rural care settings — amid higher rates of doctors retiring. Several medical group leaders pointed to PAs and NPs playing a significant role in helping clinical teams to stay on track and mitigate concerns around patient wait times.
Having more APPs for office and hospital work (e.g., rounding and on-call) were frequently cited rationales, as well as the desire for many medical groups to reinforce a shift to team-based care.
As Dimsdale explained in her Q&A with HealthLeaders, Duke Health began redesigning teams in 2020 to address issues with access in cardiology and working to get NPs and PAs working to the top of their scope on an interprofessional team of four physicians, one APP and four nurse clinicians. That model allowed the APP to see returning patients, acutely triaged patients, and hospital follow-up patients. “This freed up the physicians to see complex patients new to our practice and establish a plan of care,” Dimsdale said. “This met our aim of all members of the team working to the top of their scope of practice, while increasing access for our patients.”
Respondents to the MGMA Stat poll noted they found specific uses for new APPs in areas such as:
NP parent management training specialty for pediatrics alongside nutrition and wellness, COPE training, autism testing, and lactation services
Expanded weekend availability for sick child visits.
APP turnover trends
The 2023 NSI National Health Care Retention & RN Staffing Report (PDF) highlighted that APPs and allied health professionals recorded turnover rates below the average for all hospital staff turnover (22.7%) in 2022, and many positions saw year-over-year decreases in turnover:
Certified registered nurse anesthetist (CRNA) turnover dropped by nearly half, from 22.9% in 2021 to 12.0% in 2022.
NP turnover ebbed from 15.3% in 2021 to 12.4% in 2022.
One exception to this was seen among PAs, which saw turnover increase from 10.7% in 2021 to 18.5% in 2022.
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