Why Nurse Practitioners and Physician Assistants Are Already Thriving in Concierge Medicine

A Concierge Medicine Today analysis

Primary care in the United States is running short of the one resource it depends on most: physicians. The Association of American Medical Colleges (AAMC) projects a national shortage of between 13,500 and 86,000 physicians by 2036, including a shortfall of 20,200 to 40,400 primary care physicians specifically. The Health Resources and Services Administration (HRSA), using its own workforce simulation model, projects a national shortage that could reach 187,130 full-time equivalent physicians by 2037, with more than 8,300 federally designated primary care shortage areas already affecting nearly 101 million Americans (30 percent of the population), most of them rural.

That gap is not a distant hypothetical. It is already shaping who delivers frontline medicine in this country, and it is reshaping concierge and membership-based medicine specifically. This article makes a fact-based case, without disparaging physicians, for why nurse practitioners (NPs) and physician assistants (PAs) are positioned to play a growing and often excellent role in primary care generally, and in concierge and direct primary care (DPC) models in particular.

This is not an argument that NPs and PAs should replace physicians or that one model is superior to another. It is an argument, grounded in workforce data, quality-of-care research, and patient experience studies, that the profession-level distinction patients often assume (physician equals better care) does not hold up cleanly in the evidence, and that the structural realities of American healthcare are pushing more of the primary care and concierge landscape toward team-based and NP/PA-led delivery whether or not any individual physician prefers that outcome.

First Principles: What Problem Is Primary Care Actually Trying to Solve

Before evaluating who should deliver primary care, it helps to strip the question down to its fundamentals, a discipline central to how CMT approaches industry narratives.

Primary care exists to solve a small number of basic problems: continuity of trust between a patient and a clinician, timely access when something is wrong, accurate diagnosis and management of common and chronic conditions, and coordination when specialty care is needed. None of those four functions are, by definition, exclusive to a medical doctorate. They are functions of training depth, clinical judgment, time availability, and communication skill. A physician brings a longer and broader scientific and residency training pathway. An NP or PA brings, depending on the individual, extensive direct patient-care experience, a generalist or team-based clinical education, and, in many independent-practice states, full authority to diagnose and treat.

The honest first-principles observation is this: the shortage of primary care physicians is a supply problem, not a quality mandate that only physicians can meet those four functions. The workforce data below explains why the system is already responding accordingly.

The Supply Problem Is Real and Getting Worse

According to the AAMC’s most recent physician workforce report, published in March 2024, the United States will face a shortage of up to 86,000 physicians by 2036, including 20,200 to 40,400 in primary care specifically. The AAMC attributes this primarily to population growth (the U.S. population is projected to grow 8.4 percent by 2036) and population aging (Americans 65 and older are projected to grow by 34.1 percent, with the 75-and-older population growing 54.7 percent), combined with a physician workforce that is itself aging toward retirement: roughly 20 percent of practicing physicians are already 65 or older, and another 22 percent are between 55 and 64.

A 2025 analysis in the Journal of General Internal Medicine, reviewing both the HRSA and AAMC projections together, found that only about 24 percent of U.S. physicians practiced in primary care in 2024, and that HRSA projects a national primary care shortfall of roughly 68,020 full-time equivalent clinicians by 2036, a figure that represents more than 80 percent of the total projected physician shortage across all specialties combined.

Meanwhile, the supply of NPs and PAs is expanding rapidly in the opposite direction. According to the U.S. Bureau of Labor Statistics (BLS) Occupational Outlook Handbook, employment of physician assistants is projected to grow 20 percent from 2024 to 2034, and nurse practitioner employment is projected to grow even faster, placing NPs among the fastest-growing occupations in the entire U.S. economy across all sectors, not just healthcare. The BLS attributes this growth directly to the shift toward team-based healthcare models that use NPs, PAs, and other advanced practice clinicians to provide care that would otherwise fall to a physician, combined with the same aging-population dynamics driving physician demand.

This is the structural reality CMT’s audience is operating inside of: demand for primary care is rising, physician supply is not keeping pace, and NP/PA supply is growing several times faster. Whatever a given physician’s personal view of advanced practice clinicians, the workforce math is not optional.

The Evidence on Quality of Care Is More Reassuring Than Most Physicians Realize

The most persistent objection to NP- and PA-led primary care is a quality concern, and it deserves a direct, evidence-based answer rather than a dismissal.

The most rigorous single study remains a landmark randomized controlled trial published in the Journal of the American Medical Association in 2000 (Mundinger et al.), which randomly assigned over 1,300 patients to either a physician or a nurse practitioner for primary care and tracked outcomes for a year. The trial found that health status outcomes were statistically equivalent between the two groups after six months, that healthcare utilization was equivalent at six and twelve months, and that patients being treated for hypertension by NPs actually had lower diastolic blood pressure readings than those treated by physicians. Patient satisfaction was equivalent following the initial visit.

That finding has held up across a substantial and growing body of subsequent research. A 2013 systematic review in The Journal for Nurse Practitioners (Stanik-Hutt and Newhouse) analyzed 37 studies published between 1990 and 2009 comparing NP and physician outcomes across 11 aggregated quality measures and found NP care comparable or better on every measure reviewed. A 2015 systematic review of randomized controlled trials, published in the International Journal for Quality in Health Care (Swan et al.), found that of the studies meeting inclusion criteria, NP-treated patients showed better cholesterol and diastolic blood pressure control in some studies, higher patient satisfaction in several, lower cost of care in others, and longer consultation times compared with physicians, with no studies showing worse outcomes.

The American Academy of PAs cites comparable peer-reviewed findings for PAs specifically, including a 2017 study in Medical Care (Kurtzman and Barnow) comparing practice patterns and quality of care among NPs, PAs, and primary care physicians in community health centers, and a 2018 study in the American Journal of Medicine (Yang et al.) finding that NPs, PAs, and physicians were comparable in managing the first five years of a patient’s type 2 diabetes.

None of this research argues that training and experience do not matter, or that every NP or PA is interchangeable with every physician for every condition. Complex, multi-system, or diagnostically ambiguous cases are precisely where a physician’s longer and deeper training carries the most weight, and the collaborative and team-based models common in concierge practice exist in large part to route those cases appropriately. What the research does establish, consistently and across multiple independent bodies of literature over two decades, is that for the core functions of primary care, routine diagnosis, chronic disease management, preventive care, and patient education, NP- and PA-led care performs on par with physician-led care on most measured outcomes, and frequently ahead of it on patient satisfaction and time-related measures.

The Likability Factor: Why Patients Often Prefer the NP or PA Visit

This is where the CMT audience’s own instincts about relationship-driven medicine intersect directly with the data, and it is worth examining honestly rather than glossing over.

Multiple independent studies point to a consistent pattern: patients frequently rate their experience with NPs as equal to or better than their experience with physicians, particularly on the interpersonal dimensions of care. A 2019 national survey study published in Nursing Outlook found no significant difference in patient satisfaction between NPs and physicians measured six months after an initial visit, building on the original Mundinger trial’s findings two decades earlier. A 2025 pilot study in a direct-access endoscopy clinic setting, published on PubMed Central, found that patients who saw NPs rated their experience more positively on professionalism and friendliness specifically, with 90.3 percent of surveyed patients indicating they would be willing to see an NP again, despite many entering the study with a stated preference for physicians.

A review summarized by Nice Healthcare, drawing on a broad analysis of more than 4,000 studies, found that while NP patient health outcomes were similar to those of physicians, NPs scored higher on patient satisfaction specifically, spent more time with their patients, provided more information during visits, and were more likely to recall patient names, alongside being more likely to deliver preventive counseling such as smoking cessation guidance.

There is a plausible, non-disparaging explanation for this pattern, and it is largely structural rather than a reflection of physician skill or intent. NP and PA training pathways emphasize a strong grounding in patient education, holistic assessment, and communication as core competencies from the outset, and NPs in particular typically enter their training with substantial direct bedside nursing experience already logged before ever seeing a patient as a clinician. Physicians, by contrast, are trained first and foremost as diagnosticians and medical scientists, a body of training that is indispensable for complex and high-acuity cases but that historically has allocated less structured curricular time to the interpersonal and communication skills that patients tend to rate most heavily in satisfaction surveys. Combined with the reality that many NPs and PAs in traditional settings carry smaller patient panels or handle more of the preventive and routine visit volume, the result is a visit experience that a meaningful share of patients report finding warmer and more thorough, independent of clinical outcome.

Time Spent With Patients: The Data Behind the Perception

Time is the resource concierge and DPC medicine sells, and it is worth grounding this in hard numbers rather than industry folklore.

Research using timestamped electronic health record data from more than 21 million primary care visits, published in Medical Care in January 2021 (Neprash et al.), found that the average primary care visit in a conventional, insurance-based practice lasted 18.0 minutes and ran over its scheduled time by an average of 1.2 minutes. Other national estimates, drawn from National Ambulatory Medical Care Survey (NAMCS) data, place the average conventional primary care visit in a similar range, generally cited between 17 and 20 minutes.

Direct primary care and concierge visits look structurally different. Industry data commonly cited in the DPC and concierge sector places typical visit lengths between 30 and 90 minutes, roughly two to five times the length of a conventional primary care visit, a difference made possible by the membership-based model’s removal of insurance billing volume pressure and its dramatically smaller patient panels. A conventional primary care physician may carry a panel of 3,000 to 4,000 patients; a concierge physician’s panel is often a few hundred.

A 2015 study cited by the American Association of Nurse Practitioners (Swan et al., in the systematic review referenced above) specifically found that, across the studies reviewed, patient consultation times with NPs were longer than consultation times with physicians in comparable settings. This finding is directly relevant to concierge and membership medicine: if longer visit time is one of the two or three attributes patients value most (a 2007 study published in BMC Health Services Research found that time spent with the clinician correlated with overall satisfaction at r = 0.51, a stronger relationship than the correlation between satisfaction and waiting-room time), then a clinician type whose training and typical practice pattern already lean toward longer, more conversational encounters is well matched to a business model built entirely around selling more time.

Why NPs and PAs Are Already Succeeding Inside Concierge and Membership Medicine

This is not a speculative fit. It is already happening at scale, and the data shows it accelerating.

A study published in Health Affairs in late 2025, using a national sample of concierge and direct primary care practices built from linked directory and claims data, found that the number of concierge and DPC practice sites in the United States grew by 83.1 percent between 2018 and 2023, and the number of clinicians participating in these models grew by 78.4 percent over the same period. Within that growth, the composition of the clinician workforce shifted meaningfully: the share of concierge and DPC clinicians who were physicians declined from 67.3 percent to 59.7 percent between 2018 and 2023, while the share who were advanced practice clinicians (NPs and PAs) rose correspondingly, to roughly 40 percent of the total clinician base in these models by 2023.

In an interview with Physicians Practice discussing that research, Oregon Health & Science University physician-researcher Dr. Jane Zhu described the same trend she is observing in academic medical centers and hospital-owned primary care: “we’re seeing similar things… where a lot of frontline clinicians are increasingly comprised of advanced practice providers like nurse practitioners and physician associates.” That is a physician making this observation about her own field, not an outside critique of it.

The mechanism showing up most often in the concierge industry itself is the segmented or blended practice model, in which a physician converting a traditional practice to concierge retains a nurse practitioner or physician assistant to continue seeing the larger non-membership patient panel, allowing the physician to focus on a smaller retainer-based group without abandoning existing patients. Firms that specialize in concierge practice conversions describe this as a standard option physicians consider specifically to preserve patient relationships during a transition. In direct primary care specifically, NPs and PAs also increasingly own and lead their own membership practices outright, a legal option that is expanding as more states grant full or near-full independent practice authority.

The Regulatory Trendline Matters

Scope-of-practice law is a meaningful variable here, and it is moving in one direction. According to the American Association of Nurse Practitioners’ State Practice Environment data, more than half of U.S. states plus the District of Columbia now grant nurse practitioners full practice authority, meaning NPs may evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatment, including prescribing, without a mandated collaborative agreement with a physician. That count has risen steadily; industry trackers reported 22 full-practice-authority states in 2020, and reporting from mid-2026 puts the current figure at roughly 30 states and D.C., with New Jersey’s legislature eliminating its joint protocol requirement as recently as March 2026 and additional states actively considering similar legislation. Because this is a fast-moving legal landscape, readers should confirm current status for any specific state directly through AANP’s interactive map rather than relying on any single point-in-time count, including this one.

Physician assistant independent practice authority is more limited and more state-dependent, generally requiring some form of collaborative agreement, though a growing number of states have relaxed direct supervision requirements in favor of more flexible collaborative arrangements. Either way, the regulatory direction of travel over the past decade has consistently expanded, not contracted, the scope within which NPs and PAs can independently deliver primary care, including within membership-based models.

Where the Physician’s Role Remains Irreplaceable

None of this argument should be read as minimizing physicians’ value, and CMT’s editorial position is explicit on this point: this is not about one model being superior to another. The evidence base above concerns average outcomes across large populations of routine and chronic-condition visits. It does not extend to undifferentiated or high-acuity diagnostic complexity, multi-system disease, surgical and procedural care, or the deep pattern-recognition physicians develop over a longer residency and, often, subspecialty training. Every study cited above that found comparable NP or PA outcomes was conducted within scope-appropriate, typically team-based or collaborative settings, not as a case for physicians being unnecessary.

The most credible reading of the evidence, and the one most consistent with CMT’s Learn, Build, Lead framework, is that physicians who lead sustainable, patient-centered practices increasingly do so as the senior clinical and business leader of a team, not as the sole clinician for every visit type. Physicians who build a practice around that team-based structure, whether a hybrid concierge model with a segmented panel, a larger membership practice with NP or PA colleagues handling preventive and chronic-stable visits, or a supervisory and mentorship role for advanced practice clinicians, are positioning themselves to meet rising patient demand without personally absorbing an unsustainable panel size. That is a leadership decision, not a concession.

The Bottom Line

The data supports a specific, bounded claim, not a sweeping one: nurse practitioners and physician assistants are a fast-growing, increasingly well-credentialed, and increasingly independently licensed segment of the American primary care workforce, entering a system with a well-documented and worsening physician shortage, delivering outcomes that a substantial body of peer-reviewed research finds comparable to physician-delivered care for the majority of primary care functions, often with higher patient satisfaction and materially longer visit times, both of which align closely with what concierge and membership medicine already sells as its core value proposition. Their footprint inside concierge and direct primary care is already measurably growing, not hypothetically emerging. Physicians who understand and plan around that trend, rather than treating it as a threat to resist, are the ones most likely to build the sustainable, patient-centered practices this platform exists to help them build.

Sources Cited

• Association of American Medical Colleges, The Complexities of Physician Supply and Demand: Projections From 2021 to 2036 (March 2024); AAMC press release, “New AAMC Report Shows Continuing Projected Physician Shortage” (March 2024); AAMC, “Addressing the Physician Workforce Shortage.”
• Health Resources and Services Administration workforce projections, as reviewed in: “The National Physician Shortage: Disconcerting HRSA and AAMC Reports,” Journal of General Internal Medicine (2025), via PubMed and Springer Nature Link.
• U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: “Physician Assistants” and “Nurse Practitioners” entries, Employment Projections 2024-2034 (bls.gov/ooh).
• Mundinger MO, et al. “Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A Randomized Trial.” JAMA, 2000;283(1):59-68.
• Stanik-Hutt J, Newhouse R, et al. “The Quality and Effectiveness of Care Provided by Nurse Practitioners.” The Journal for Nurse Practitioners, 2013;9(8).
• Swan M, Ferguson S, Chang A, Larson E, Smaldone A. “Quality of Primary Care by Advanced Practice Nurses: A Systematic Review.” International Journal for Quality in Health Care, 2015;27(5):396-404.
• American Association of Nurse Practitioners, “Quality of Nurse Practitioner Practice” (position statement, aanp.org) and “State Practice Environment” map.
• Kurtzman E, Barnow BS. “A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians’ Patterns of Practice and Quality of Care in Health Centers.” Medical Care, 2017;55(6):615-622.
• Yang Y, Long Q, Jackson SL, et al. “Nurse Practitioners, Physician Assistants, and Physicians Are Comparable in Managing the First Five Years of Diabetes.” American Journal of Medicine, 2018;131(3):276-283, as cited in American Academy of PAs, “PA Education: Preparation for Excellence.”
• National survey study on NP patient satisfaction outcomes, Nursing Outlook (ScienceDirect, 2019).
• Pilot trial on patient satisfaction with NP-led vs. physician-led care in direct-access endoscopy clinics, PubMed Central (PMC11992543, 2025).
• Nice Healthcare, “38 Studies Show Nurse Practitioners Keep Patients Safe,” summarizing broader literature review findings.
• Neprash HT, et al. “EHR Review Sheds Light on Planned, Actual Durations of Doctor Visits.” Medical Care, January 2021, as reported by HealthExec.
• Study on patient satisfaction and wait/visit time correlation, BMC Health Services Research (PubMed Central, PMC1810532).
• Study on concierge and DPC practice and clinician growth, Health Affairs (2025), as reported via PubMed (41329882) and Physicians Practice, including interview with Dr. Jane Zhu, Oregon Health & Science University.
• SignatureMD, “Segmented Practice: Working with a Nurse Practitioner or Physician Assistant in Concierge Medicine.”
• American Academy of PAs, “PA Education: Preparation for Excellence” (issue brief, aapa.org).

This article is intended for educational and informational purposes for physicians and healthcare leaders. It does not constitute medical, legal, financial, or accounting advice. Workforce projections and state scope-of-practice laws change over time; readers should confirm current figures with the primary sources cited before relying on them for practice or policy decisions.