WSJ: Nurse Practitioner Is Now the Hottest Job in Healthcare Save

The Wall St. Journal has published a perspective on nurse practitioners (NP) and their very promising careers.

The U.S. healthcare system is undergoing a significant workforce shift, with nurse practitioners (NPs) emerging as the fastest-growing profession in healthcare.  Between 2019 and 2025, NP numbers grew 60% to 461,000; driven by physician shortages, healthcare cost containment efforts, and expanding scope-of-practice legislation.

The need for NPs is driven by the current shortage of 16,000 primary-care physicians — projected to worsen significantly. NPs and physician assistants (PAs) have become leading healthcare providers, especially in rural settings where 66% of Medicare recipients rely on APPs for some or all of their care. Recruitment for NPs and PAs is "at an all-time high."

The financial calculus is compelling for both providers and employers. NPs earn an average of $132,000 annually — well above RN salaries ($98,000) but substantially below primary care physicians ($257,000). A two-year NP graduate program costs roughly $50,000, compared to $207,000 in average medical school debt. For health systems, the cost differential is a major draw.

Approximately 30 states now permit NPs to practice without physician oversight, with 10 states extending similar independence to PAs. Five states have even rebranded "physician assistant" to "physician associate," reflecting evolving professional identity and responsibility.

Not all physicians, societies and organizations are on board, many arguing against equating 2 years of APP training against 7+ years of MD training; and citing occasional incidents of higher care costs, more testing, etc by NPs and PAs. 

Yet, there is ample evidence base suggesting NPs deliver care comparable to general practitioners for routine conditions, and one study found independent NP practice reduced preventable deaths by 2% by improving access.

For rheumatology practices, especially those with manpower needs, NPs and PAs have become indispensable rheumatology providers. Many rheumatology practices rely on them for consults, screening, infusion monitoring, follow-up visits, and specialty clinics. The APP debate centers around appropriate supervision, onboarding, training, independence (especially with complex autoimmune conditions), and how best to leverage mid-level providers without compromising diagnostic rigor for patients with nuanced, multisystem disease.

The bottom line: NPs are filling a genuine and growing need; are you employing APPs in rheumatology?