My original ambition was to become a nurse anesthetist. However, while working as a registered nurse on a cardiac step-down unit, I realized that I enjoyed the clinical aspect of patient care, and the wide variety of maladies kept my interest. Therefore, I reset my goal to become a nurse practitioner (NP). So in 1999, I completed the required coursework, joined a family practice group, and was proud to be one of the nation’s 68,300 NPs. Today, according to the American Association of Nurse Practitioners (AANP), there are more than 234,000 NPs in the United States.

The NP profession has evolved significantly during the past 20 years. These changes involve the growth of our profession, the way we practice, and the patients and conditions we diagnose and treat.

Changes in education, job growth, and salary

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Loretta Ford, EdD, RN, and Henry Silver, MD, established the first NP program in 1965 at the University of Colorado. A few years later, Boston College ushered in a master’s program for NPs. In 2004, the American Association of Colleges of Nursing sanctioned the Position Statement on the Doctorate of Nursing Practice (DNP). This document supported the transition of education from the master’s level to the doctorate level by 2015.

Merritt Hawkins, a national healthcare firm specializing in recruitment for physicians and advanced practitioners, stated in its 2017 annual report that NPs are third on the list of most requested recruiting assignments, their highest position ever. The average compensation offered was $123,000, up from $105,000 in 2013. Earlier this year, US News and World Report ranked NPs as #4 of the best 100 jobs. These rankings are based on work–life balance, salary, job growth, and job satisfaction. Just 8 years ago, our profession was not even listed among the top 10 in either of these publications.

The Bureau of Labor Statistics (2018) predicted a 31% job growth for NPs during the next 10 years, which would lead to 56,000 new positions. The impetus for this robust growth may be a 2017 report by the Association of American Medical Colleges (AAMC) that projected a physician shortage of between 40,800 and 104,900 by the year 2030. A primary cause for this alleged shortage is America’s aging population and physician retirement. Up to one-third of practicing physicians will be older than age 65 within the next 10 years.

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During the past decade, NP salaries have outpaced the rate of inflation. According to the AANP (2015), salaries have increased by 10% since 2011. The Bureau of Labor Statistics (2016) reported that NPs in all care settings earned a median annual salary of $100,910.