Forty-eight percent of medical groups added more nurse practitioners and physician assistants relative to physicians in 2025, according to MGMA. Only 11.0% moved their staffing ratio the other way, toward more physicians, and 40.0% held their mix steady.
The shift shows up in national supply counts too. The American Association of Nurse Practitioners (AANP) put the 2025 licensed nurse practitioner count at 461,000, up from roughly 431,000 two years earlier, a 7.0% increase. The National Commission on Certification of Physician Assistants (NCCPA) counted 189,907 board-certified PAs by the end of 2024, up 6.3% from 2023 and up 27.8% since 2020.
Physician workload is part of the reason groups are redrawing care teams. More than 40.0% of physicians reported at least one burnout symptom in the American Medical Association's most recent national physician survey, a figure MGMA cites alongside its staffing-ratio poll as part of the case for adding APP capacity instead of stretching physician schedules further.
How the staffing ratio is moving
MGMA fielded its poll on November 11, 2025, among 305 medical groups. The results split four ways: 48.0% of groups added more APPs relative to physicians, 40.0% kept the ratio about the same, 11.0% shifted toward more physicians, and 1.0% were unsure.
Recruiting timelines help explain the pattern. In a separate MGMA poll from April 2025, 38.0% of practice leaders said physician time-to-fill had grown longer year over year, while only 9.0% said it had gotten shorter. A national estimate from Kaufman Hall put roughly 2 in 5 of all U.S. providers, or 40.0%, as APPs as of the first quarter of 2025. Hiring plans point the same direction: MGMA found that nearly two-thirds of groups planned to add net-new APP roles in 2024, a pace it says carried into 2025 and 2026 budget cycles.
What care-team redesign looks like on the ground
The staffing-ratio numbers translate into scheduling changes inside practices. MGMA describes the 2026 model as physician-led, APP-enabled care teams, where APPs run protocoled visits and rapid consult pathways while physicians handle the more complex cases on the same panel. That structure is how a group with 48.0% more APP capacity than a year earlier can expand its patient panel without adding a physician role that can take months longer to hire than an APP.
Nearly 7 in 10 groups, or about 70.0%, told MGMA in a February 2025 poll that they met or exceeded their combined physician and APP productivity goals for the year. The redesigned teams delivered the visit volume practices had budgeted for.
Where the extra clinicians come from
National workforce data explains part of the pull toward APPs. AANP's 2025 count of 461,000 licensed nurse practitioners comes from state licensure records, cross-checked against Centers for Medicare and Medicaid Services data and deduplicated for NPs licensed in more than one state. NCCPA's 2024 Statistical Profile put PA density at 56 per 100,000 people nationally, up from 45 per 100,000 in 2020, and estimated that PAs saw 11.4 million patients a week in 2024.
The mix within the PA workforce is also changing. NCCPA reported that the primary care share of PA practice fell to 22.0% in 2024, down from 24.4% in 2020, as more PAs moved into surgical and other specialties. Surgical subspecialties accounted for 18.5% of the PA workforce in 2024, and family medicine or general practice accounted for 16.3%.
What APPs cost and produce
Pay for APPs is climbing faster than most other line items in a practice budget. Median total compensation for advanced practice providers rose 19.4% from 2020 to 2024, according to MGMA's 2025 Provider Compensation and Productivity Data Report. Among physician-owned practices in that same report, APP encounter volume rose 39.3% and APP work relative value units rose 21.9% in 2024 alone.
How practices pay for that output varies. A March 2025 MGMA Stat poll found 44.0% of organizations pay APPs salary plus incentive, another 44.0% use straight salary or hourly pay, 6.0% use RVU-only formulas, and 3.0% use volume-based pay. The near-even split between incentive pay and flat salary shows most groups have not settled on one formula for APP pay the way many have for physician wRVU-based plans.
The PA-specific numbers behind the trend
NCCPA's 2024 profile also tracked how the 189,907 board-certified PAs it counted work and how they feel about the job. Mean PA income reached $129,291 in 2024, up 12.0% from 2020. Career satisfaction stood at 87.1%, while 32.6% of respondents reported burnout symptoms.
Telehealth use among PAs rose to 43.5% of respondents in 2024, more than double the 20.7% who reported using it in 2020. More than half, 53.4%, had changed specialties at least once in their career, and 74.1% held two or more clinical positions at the same time.
The numbers side by side
| Metric | Figure | Source |
|---|---|---|
| Licensed nurse practitioners, 2025 count | 461,000, up 7.0% from about 431,000 | AANP |
| Board-certified physician assistants, end of 2024 | 189,907, up 6.3% year over year | NCCPA |
| Medical groups that added more APPs than physicians in 2025 | 48.0% of 305 groups polled | MGMA Stat |
| APP median total compensation growth, 2020-2024 | +19.4% | MGMA |
| APP encounter volume growth, physician-owned practices, 2024 | +39.3% | MGMA |
| APP work RVU growth, physician-owned practices, 2024 | +21.9% | MGMA |
A practice tracking its own APP-to-physician ratio has real numbers to weigh it against. NP supply grew 7.0% over two years and PA supply grew 6.3% in one. Where physician-owned practices leaned harder on that supply in 2024, APP encounter volume climbed 39.3%.
Sources
- MGMA, "APP utilization and how care team redesign continues into 2026," November 12, 2025
- NCCPA, "2024 Statistical Profile of Board Certified PAs," May 2025
- AANP, "A Behind-the-Scenes Look at the 2025 Nurse Practitioner Count," 2025
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