Most Americans today are accustomed to seeing an NP or a PA as a physician for primary care. That’s because nurse practitioners (NPs) and physician associates (PAs) are at the center of a shifting healthcare workforce.
This wasn’t always the case, though. As little as 20 years ago, even physicians were sometimes unaware of the role that advanced practice providers play within the healthcare system.
Today, NP and PA roles are seeing explosive growth in both numbers and responsibilities. The jobs are consistently ranked among the top five fastest-growing careers in the U.S. With opportunity comes new challenges, especially as regulatory structures and liability risks evolve.
Nurse Practitioner and Physician Associate Career Outlook: Growth and Opportunities
Demand for PAs and NPs is climbing for several reasons:
- Lower entry barriers than physicians. With limited medical school spots and residency positions, many aspiring clinicians are opting for PA or NP tracks, which offer faster entry into practice.
- Strong professional pipeline. With over 4 million nurses in the U.S., the natural transition from RN to NP creates a steady flow of new practitioners. Today, there are about 450,000 nurse practitioners, a number expected to keep rising as more clinicians seek flexible, higher-paying roles.
- Flexibility and earning potential. Both PA and NP careers offer six-figure salaries with the ability to pivot into specialties like urgent care, orthopedics and aesthetics. Especially for working parents, these roles provide career growth without compromising flexibility.
“You can finish a PA program, be in your late 20s, and already be earning six figures with specialty experience. Compare that to a physician path that can take a decade or more, often with less autonomy, considering the number of physicians counted as W2s and the acquisition of physician practices by health systems and private equity firms,” says William Sullivan, Executive Vice President of CM&F Group.
NP vs PA Autonomy: How State Laws Are Shaping Practice Authority
As demand for more providers grows amidst healthcare shortages, state-level regulations are redrawing the boundaries of NP and PA practice authority. The American Academy of Physician Associates (AAPA) and the American Association of Nurse Practitioners (AANP) are now aligning their advocacy efforts, securing wins for both professions.
- Nurse practitioners are far ahead, with 42 states granting them near-full practice authority. In states like Wisconsin, NPs can now even own and operate their own practices. “Nurse practitioners are overwhelmingly operating at the top of their licensure in the majority of states now, and it’s still growing,” says Sullivan.
- Physician assistants are making progress, albeit at a slower pace. Eight states have adopted some form of “PA modernization,” including expanded scope and the ability to work more independently. Efforts include:
- Title change from “physician assistant” to “physician associate,” reflecting their growing autonomy.
- Interstate compacts allow PAs to practice across state lines.
“NPs and PAs are steadily moving into roles once dominated by physicians, and patients are benefiting most by having more access,” says Sullivan..
Liability Risks for Nurse Practitioners and Physician Associates with Greater Autonomy
Greater authority brings heightened responsibility and risks. As patients increasingly see NPs and PAs as their primary care providers, liability lands squarely on them when something goes wrong. You can’t point fingers anymore when you’re the person. Patients know they’re being treated by an NP or PA, and you become the natural target if care is questioned,” says Sullivan.
Another emerging risk is that some health systems are experimenting with shifting PAs and NPs to independent contractor status (1099), rather than W-2 employees. The Department of Labor laws make this complicated, but in cases where it’s possible, treating NPs and PAs like contractors reduces risks by pushing liability onto the clinician. A risk management move that is seen with businesses in certain states, like Florida.
The Future of NP and PA Careers: Balancing Growth, Autonomy, and Liability
For PAs and NPs, the evolution of their professions is both empowering and challenging. They’re building faster, more flexible career paths and are gaining practice autonomy that rivals physicians. With this shift comes the need for a business mindset. That means choosing jobs strategically, negotiating contracts wisely and carrying liability coverage that matches the reality of their work.
The question for PAs and NPs in 2025 and beyond isn’t whether these roles will expand. It’s how individual practitioners will balance opportunity with risk.
Frequently Asked Questions
- What is the career outlook for nurse practitioners (NPs) and physician associates (PAs)? The job outlook for NPs and PAs is among the fastest-growing in U.S. healthcare. With over 450,000 nurse practitioners and increasing PA programs, both roles are expected to continue expanding due to high demand, flexible career options, and strong earning potential.
- Do nurse practitioners and physician associates have full practice authority? Nurse practitioners have near-full practice authority in 42 states, allowing them to diagnose, prescribe, and even open their own practices. Physician associates are gaining ground, with several states adopting “PA modernization” laws to expand autonomy and scope of practice.
- Why do NPs and PAs need malpractice insurance? As patients increasingly rely on NPs and PAs as primary care providers, liability risk shifts directly to them. Greater autonomy means greater responsibility—making comprehensive malpractice insurance essential for protecting their careers and financial future.
Click here to learn more about getting covered as an NP or PA.
