The rate of growth of the nurse practitioner (NP) and physician assistant (PA) workforce in North Carolina has sped past that of the physician workforce, leading to added health professional education programs and expanded enrollment in existing programs to keep up with statewide demands, according to study results published in the North Carolina Medical Journal. 

Investigators collected data from 2000 to 2017 on active NPs, PAs, and physicians with practice addresses in North Carolina to assess trends in demographics, practice location, and primary vs specialty care practice characteristics statewide.

Practice locations were sorted into rural (46) and non-rural areas (54) based on population density and commuting patterns.

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Physicians and PAs were categorized as primary care providers if they selected at least one of the following areas of primary practice when obtaining initial licensure or re-registering: family medicine, general practice, pediatrics, adolescent medicine, or obstetrics and gynecology. Since NPs do not select a primary specialty during their North Carolina Board of Nursing licensure process, NPs were categorized as primary care providers if they had a primary care certification and practiced in a primary care setting.

In 2017, the North Carolina workforce included 6026 PAs, 6644 NPs, and 24,432 physicians; 27.2% of PAs, 50.7% of NPs, and 29.3% of physicians practiced primary care.

Compared with 21.5% of the state’s population living in a rural location, 15.3% of NPs, 14.9% of PAs, and 12.6% of physicians reported working in a primary practice located in a rural county; 18.5% of NPs, 23.3% of PAs, and 16.1% of physicians in these rural counties practiced primary care.

From 2000 to 2017, North Carolina’s combined NP and PA workforce increased in size from 22% of the state’s physician workforce to nearly 50% of the state’s physician workforce. In rural counties, NPs and PAs made up 62% of the size of the state’s physician workforce.

With only 2.1 NPs per 10,000 population, NPs were the smallest of the 3 workforces in 2000. By 2017, the NP workforce  increased by 215.9% in metropolitan counties and 187.3% in rural counties, with a statewide and rural county NP growth per capita that outpaced that of PAs and physicians.

“The rapid growth of the NP and PA workforce shows no signs of slowing, particularly given expansion of educational programs,” the authors noted.

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“Like the national market, the North Carolina market is weighted toward PA employment in specialty fields. Unlike physicians, many NPs and PAs change specialties over the course of their careers. Ultimately, those with the most influence on NP and PA specialty choice are not educational institutions but employers.”

Reference Spero CJ, Galloway EM. The rapid expansion of nurse practitioners and physician assistants in North Carolina. N C Med J. 2019;80(3):186-190.