Sam Robinson
Despite the exponential growth of American healthcare utilization, the availability of primary care physicians has become increasingly limited. In a 2024 report, the Health Resources and Services Administration projected a national shortage of over 87,000 primary care physicians by the year 2037, projected to disproportionately impact rural and less affluent areas.
The lack of primary care physicians can be attributed to a number of factors. Primary care providers are an aging workforce that’s retiring faster than they’re being replaced, reporting higher levels of burnout compared to their specialist counterparts. Further, reimbursement levels for primary care doctors are comparatively inadequate—pediatricians earned an average of about $250,000 in 2024, falling far short of other specialties that earn almost double. This difference in income is especially motivating when considering the increasing cost of attending medical school.
The inability of American medical colleges to produce enough primary care physicians has prompted alternatives. Clinicians, namely Nurse Practitioners (NPs) and Physician Assistants (PAs), have grown in popularity as the demand for healthcare personnel increases. Clinicians are providers that make up the middle ground between nurses and physicians—they are trained to perform many of the same functions as doctors, including diagnosing conditions, prescribing treatments, and managing patient care, but often do so under physician supervision.
Clinicians serving as the solution to primary care shortcomings is nothing new—they are often cited as a bridge between supply shortages and increased demand for healthcare personnel. There is a projected surplus of over 65,000 NPs by 2037, which could indicate greater primary care access for thousands of Americans. Already, are delivered by non-physicians, with their services being provided predominantly to lower income individuals, rural residents, and people with disabilities.
Compared to physicians, clinicians spend less time in school (5.5-7 years for NPs vs at least 11 years for doctors), have to incur lower educational costs, and demand lower levels of reimbursement. All of these traits contribute to their accessibility, which means rural and less fortunate areas can receive needed primary care.
Although clinicians increase the accessibility of healthcare, one important concern remains—can they provide the same level of care as physicians, or do marginalized populations that depend on clinicians receive a lower standard of care?
Research exists to back either viewpoint. For example, in defending physicians’ territory and scope of practice, the AMA frequently advertises data undermining the idea that clinicians can function independently. This 2022 AMA article publicized a study highlighting clinicians as being higher cost—ordering more tests, referrals, and visits to the ED—and underperforming on quality measures. It is important to note that the AMA’s stance is influenced by professional self-interest, often portraying clinicians in a negative light to preserve physician dominance in healthcare.
Despite similar findings, substantial research supports the ability of clinicians to provide an adequate level of care. Large systematic reviews have found that clinicians provide the same quality of care as physicians across multiple backdrops, such as primary care, office visits, and emergency settings. This study from 2000 found that, when compared to physicians, the quality of care delivered by nurse practitioners was not significantly different across several common health markers, including asthma, diabetes, and systolic blood pressure. While specific examples of their shortcomings can be selectively amplified, an overwhelming body of research indicates that clinicians are effective in their provision of care.
A common criticism of clinicians is that they are licensed to provide a broad scope of care with much less training. However, there have been many instances of professionals with less training stepping up to help meet workforce demands in areas that need it the most. For example, the licensing of behavioral health paraprofessionals (BHPs) by state governments has been instrumental in addressing the shortage of behavioral health workers needed to address issues like mental health and substance abuse. Removing the paper ceiling is an important step in utilizing this untapped pool of workers—instead of requiring a masters or doctorate degree, BHPs are specifically trained in behavioral health issues and require less university education.
One of the most stark examples of individuals with less education filling healthcare shortages is that of Dental Health Aide Therapists in Alaska. Because of low population densities and the prevalence of scattered, rural communities, it can be difficult for Alaskan natives to receive the dental care they need. However, since 2004, therapists have been able to provide the same standard of care as dentists. Following just two years of training, they are adequately trained in cleaning, drilling, filling, and tooth extraction, while also understanding what dental issues they can and cannot handle. They access to preventive dental care, and provide living-wage jobs for isolated tribal communities.
The shortage of primary care physicians poses a serious challenge to the American healthcare system and the integration of clinicians as providers into our healthcare system offers a promising solution. Despite having less formal training, clinicians consistently demonstrate their ability to deliver more accessible, high-quality care to patients who need it most. Rather than viewing them as substitutes or competition, the U.S. healthcare system should embrace their role as complementary providers that may be key to bridging gaps in care delivery and ensuring health equity for all communities.
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