In just 7 years, the number of nurse practitioners more than doubled. Here's why that's a problem for hospitals

The number of nurse practitioners (NPs) in the U.S. more than doubled in just seven years—an unprecedented rate of growth for a major profession, according to a new Health Affairs study.

The number of nurse practitioners grew from about 91,000 to 190,000 from 2010 to 2017, according to the study.

While those nurse practitioners have helped fill critical gaps in healthcare delivery nationwide, it’s created a potential problem for hospitals. Most nurse practitioners practice as registered nurses (RNs) before completing their education to become an NP.

The growth in NPs has reduced the size of the RN workforce by up to 80,000 RNs nationwide, the study authors said, at the same time the more than one million baby-boom RNs are well on their way to retirement.

The authors concluded that hospitals must devise creative strategies to replace those RNs who left their jobs to become NPs and who earned an average salary of just under $95,000 in 2017.

“One implication that has been relatively unexplored in the literature, but that is a frequent topic among hospital chief nursing executives, has to do with the fact that new RN graduates seem to be increasingly leaving hospital positions after only one or two years,” the authors wrote. During their time working at hospitals, they acquire clinical experience and then go on to begin a master’s degree or a doctor of nursing practice program.

The growth in NPs was driven by the rapid expansion of education programs that have attracted Millennial nurses. The number of programs to educate NPs grew from 356 in 2010 to 467 in 2017. Collectively, they now graduate nearly as many new NPs as medical schools do physicians each year, the study said.

Employment for NPs grew the fastest in outpatient care clinics, where growth in earnings was also highest.

The study, which used data from the Census Bureau’s American Community Survey for the period 2010–2017, found the following:

  • Employment for NPs was concentrated in hospitals, physician offices and outpatient care centers.
  • Growth occurred in every region of the country but was particularly rapid in the east south-central region of the country, which includes Alabama, Kentucky, Mississippi and Tennessee.
  • The growth of NPs was accompanied by a modest 5.5% aggregate real earnings growth from 2010 to 2017.
  • More care will be provided by nurse practitioners as there are projected to be two NPs for every five physicians in 2030, compared to less than one NP per five physicians in 2016. 
  • Overall growth in the numbers of NPs has been particularly rapid in outpatient clinics, a growing locus of healthcare delivery.

Concerns about physician shortages have encouraged the greater use of NPs to provide primary care and fill gaps in rural areas.

In addition to the growing number of nurse practitioners, the physician assistant workforce is also one of the fastest-growing professions in healthcare—with an increase in both numbers and salaries.

The number of certified PAs grew over 6% in 2018 and the average salary increased by more than 12% in a four-year span, according to a just-released report from the National Commission on Certification of Physician Assistants.