Most healthcare organizations still build their APP recruiting strategy around a physician-first instinct. A role opens, and the first question is, “where do we find our next doctor”? That instinct made sense for a long time, but it may be starting to work against you.
The math has shifted. The Association of American Medical Colleges projects physician workforce growth of roughly 1% a year over the next decade, while nurse practitioner supply is expected to climb 66% and physician associate supply 37% between 2024 and 2034. A newer Health Affairs study from researchers at Columbia School of Nursing puts it even more starkly: NP growth at 11% annually through 2030, compared to about 1% for physicians. Different models, same direction. The physician pipeline is basically flat, and the advanced practice pipeline is not.
At the same time, AAMC projects a primary care physician shortfall of 17,800 to 48,000 by 2036, with more than 83 million Americans already living in a primary care shortage area. Put those two trends together and the conclusion is obvious. The people who are going to fill your primary care and a growing share of your specialty gaps are increasingly NPs and PAs, whether your org chart has caught up to that or not.
The recruiting habit that needs to change
Most CHROs aren’t ignoring APPs. They’re posting for them. What’s slower to change is the sequencing: post the physician role, let it sit for months, eventually open it up to APPs as a fallback once the search stalls.
That order should probably be reversed for a lot of roles. If a nurse practitioner or physician associate can deliver the care a position requires, and increasingly they can across primary care, psychiatry, and a widening list of specialties, building the search around that candidate pool first gets a seat filled faster and with less strain on the team covering the gap in the meantime.
What this changes about the job description
Writing an APP-first job posting is a different exercise than writing a downgraded physician posting. A few things worth rethinking:
Scope of practice by state.
Full practice authority states let NPs practice independently. Reduced or restricted practice states require physician oversight arrangements that need to be built into the role from day one, not figured out after an offer is signed.
Supervision and collaboration structure.
If a collaborating physician relationship is required, that physician’s availability and bandwidth needs to become part of the hiring plan.
Compensation benchmarks.
APP compensation data moves fast as demand grows. A comp package built on numbers from two years ago will lose candidates to organizations that priced the role correctly.
Growth path.
NPs and PAs weighing offers are increasingly comparing autonomy, mentorship, and long-term role development. It’s not just about base pay anymore. Organizations that share some of the softer benefits in the posting are working from a stronger position.
The rural healthcare model
Rural and underserved systems have been working this model for a while, as they’ve needed to rely on APPs sooner. But the pressure is moving into suburban and urban systems too, particularly in primary care, psychiatry, and geriatrics, where AAMC has flagged shortages of over 30,000 geriatricians by 2030.
Systems that build APP-inclusive search strategies now, rather than treating them as a physician substitute when a search stalls, are going to have an easier time keeping service lines staffed as this trend continues.
Setting up for success
There’s no question that most of the time, APPs can do the job. You might even have internal data that demonstrates equal or higher patient satisfaction scores. But is your recruiting process set up to find them as a first choice, with the right scope-of-practice groundwork, comp benchmarking, and growth path already built in, rather than scrambling to retrofit a physician search after months of no traction?
If your team is still writing job descriptions around a physician-first default, that’s worth a second look before the next search opens.
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