About 44.0% of medical groups pay nurse practitioners and physician assistants a flat salary or hourly rate, and another 44.0% add incentives on top. That split comes from MGMA's March 2025 poll of 488 groups, and base salary made up about 84.0% of mean advanced practice provider (APP) pay in MGMA's 2023 data.
In this article, APPs means nurse practitioners (NPs) and physician assistants (PAs). The figures below cover how groups structure the pay, where the dollars go, how fast pay is rising, and how many groups are still hiring.
How practices structure APP pay
MGMA asked medical group leaders in March 2025 which model they use for APPs. Salary plus incentives and straight salary or hourly pay tied at 44.0% each. RVU-based pay covered 6.0% of groups, volume-based pay covered 3.0%, and 3.0% used something else.
| Pay model | March 2025 (n=488) | August 2023 |
|---|---|---|
| Salary plus incentives | 44.0% | 51.0% |
| Salary or hourly only | 44.0% | Not reported |
| RVU-based | 6.0% | 6.0% |
| Volume-based | 3.0% | 2.0% |
| Other | 3.0% | Not reported |
Source: MGMA Stat poll, March 25, 2025, with the August 2023 comparison given in the same MGMA article.
Salary plus incentives fell 7.0 points, from 51.0% in August 2023 to 44.0% in March 2025. MGMA wrote that momentum behind incentive pay was slowing. Leaders said they liked the idea of incentives but were unsure how to set them up, and some preferred fixed salaries because the cost is easier to predict while operating expenses climb.
A second MGMA poll, fielded May 5, 2026 with 261 responses, asked a related question. It found that 43.0% of groups had updated their APP compensation method in the past two years to add value or incentives. Another 50.0% had not, and 7.0% were unsure.
Where the pay dollars go
MGMA's 2023 provider compensation data shows how little of APP pay moves with performance. Base salary was about 84.0% of mean reported APP pay. Productivity was roughly 10.5%, and quality and patient experience together were just over 1.0%.
Productivity pay is about ten times the size of quality pay in that data. Only 9.0% of groups in the March 2025 poll used an RVU-based or volume-based model, so most productivity dollars reach APPs as a bonus layer on a salary.
A practice can run the same split on its own payroll. Take each APP's base pay, productivity bonus, and quality bonus for the last full year, then divide each by total APP pay. If the quality share sits near 1.0%, the plan pays almost nothing for the measures that drive MIPS scores and payer bonuses.
How fast APP pay is rising
MGMA's 2025 Provider Compensation and Productivity report covers 2024 data from more than 220,000 providers. Median total compensation for APPs rose 3.17% in one year and 19.39% over five years. Primary care PAs gained 8.27% in one year and about 30.0% from 2020 to 2024. Primary care NPs gained 3.62% in one year and 20.0% over five years.
The 3.17% one-year figure for all APPs sits well below the 8.27% gain for primary care PAs. An average across roles hides large gaps, so a pay review works better when it compares NPs and PAs separately by specialty.
MGMA's 2026 report draws on more than 245,900 providers. It shows primary care NP pay up about 22.0% over five years and primary care PA pay up about 27.0%.
The Bureau of Labor Statistics (BLS) gives a national median for May 2025. NPs earned $132,300 and PAs earned $135,880, a gap of $3,580.
| Occupation | Median pay, May 2025 | Jobs, 2025 | Projected growth, 2025 to 2035 |
|---|---|---|---|
| Nurse practitioners | $132,300 | 336,300 | 41.0% |
| Physician assistants | $135,880 | 168,900 | 21.0% |
Source: BLS Occupational Outlook Handbook, nurse practitioner and physician assistant pages.
How many groups are still adding APPs
MGMA's poll of 288 groups, fielded August 18, 2026, found that 51.0% added net-new APP positions beyond backfills in the past 12 months. Another 45.0% did not, 1.0% were unsure, and 2.0% employ no APPs. Groups that added roles named service-line expansion, higher patient volume, new locations, longer hours, and referral growth. Retirements and physician recruiting gaps came next.
Among groups that did not add roles, the most common reason was steady demand and enough staff. Budget limits and productivity worries came second. Others named lack of space, hiring difficulty, and owner or physician preferences.
An earlier MGMA poll of 305 groups, fielded November 11, 2025, looked at the APP-to-physician ratio. Some 48.0% of groups added more APPs relative to physicians, 40.0% held the ratio steady, and 11.0% moved toward more physicians.
Groups that plan to add APPs in 2027 can set a pay model before the first offer goes out. A group with no APP incentive plan can pick one metric, such as visits per day, and set its share of pay before it posts the job.
The supply side supports the hiring. MGMA cites 431,410 licensed NPs in 2024, a rise of nearly 12.0% in one year. It also cites 189,907 board-certified PAs, up about 28.0% since 2020. BLS projects 35,700 more PA jobs between 2025 and 2035, which would bring the total to 204,600.
Sources
- MGMA Stat, Has the trend toward incentives in advanced practice provider compensation lost steam, March 26, 2025
- MGMA Stat, Is it time for your practice to rethink how it pays APPs, 2026 (poll fielded May 5, 2026)
- MGMA Stat, Beyond backfills: More than half of practices adding net-new APP roles, August 19, 2026
- MGMA Stat, APP utilization and care team redesign in 2026, November 12, 2025
- Bureau of Labor Statistics, Occupational Outlook Handbook: Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners, accessed October 1, 2026
- Bureau of Labor Statistics, Occupational Outlook Handbook: Physician Assistants, accessed October 1, 2026
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