Changing Roles for NPs and PAs

Changing Roles for NPs and PAs

“NPs and PAs have a strong legacy of delivering quality patient care,” says Ashlyn Smith, PA who specializes in Endocrinology. “I am seeing patient preference for NPs and PAs as their primary care providers—in contrast to ‘the NP/PA I see at my doctor’s office.’ We need to support our professional organizations that are representing us before the legislature so we can have the option of personally owning clinics.”

NPs and PAs play integral roles in managing disease states that range from diabetes to oncology—often working as part of a team. However, an increasing number of clinicians are finding new ways to make meaningful contributions to healthcare in the US.

There is no established “best” role for NPs and PAs who work in healthcare teams; many options are available. Here are trends to help you discover (or create) the place on the team that is right for you.

The shortage of primary care physicians creates opportunity for NPs and PAs. Expect that, in the future, you are likely to be the key health provider who orders tests, prescribes medication, and makes critical decisions in both patient care and implementation of policies in your practice.1 “In underserved areas, we are more likely to provide care…which could only be performed with prescriptive authority,” says Tina Copple, DNP.

Look for opportunities in research. “The world of diabetes research is expanding to include studies in renal disease, cardiovascular disease, and heart failure. Motivated PAs and NPs have opportunities outside the clinic, from participating in clinical trials, working on diabetes care initiatives, and shaping practice guidelines,” says Ashlyn Smith, PA, who specializes in endocrinology.

Already, NPs are key drivers in providing ongoing care for patients with chronic illnesses, such as diabetes.NPs and PAs are able to provide 85%-90% of the care for these patients, who experience the same degree of disease control whether treated by physicians or by NPs/PAs.

Roles in typical practice setting are often determined by 1) whether the NP or PA provides regular or supplemental care for the individual patient, 2) the type of care provided (acute or chronic), and 3) the complexity of the individual patient. The goals of the practice may determine the roles of each team member. Is the practice working to improve performance measures?2  Or meet the needs of a growing patient population?

Additionally, “many NPs work with community organizations, such as the American Heart Association,” says Mimi Secor a specialist in women’s health and fitness. She adds that “the aging population will increase demand for more NPs and PAs in both managing heart disease and/or obesity. We will need more NPs and PAs to meet the demand of this burgeoning population. This is a good time for NPs and PAs as job opportunities are expanding all over the country.”

Oncology too represents a growing field for NPs and PAs. In one study, 3,055 NPs and PAs were surveyed to assess their roles within practice settings. A total of 577 (19%) clinicians completed the survey. Ninety percent were satisfied with their choice of career. They spent approximately 80% of their time providing direct patient care, predominantly patient counseling, prescribing, managing treatment, and providing follow-up visits, both independent and shared. Salaries averaged $113,000 to $115,000, about $10,000 more than the typical compensation for clinicians in other fields. The authors note that, as cancer survival increases, these clinicians will play increasingly important roles.3

The 2016 American Society of Clinical Oncology Practice Census Survey reveals that NP and PA duties currently include ordering/administering chemotherapy, managing pain and other adverse effects, and providing primary care. Practices often experience an increased patient volume, expanding services, and seeking to reduce physician workload—and seek to hire NPs and PAs to address these shortages.4

As more states allow independent prescribing for clinicians with advanced practice licensing and academic centers place restrictions on the number of hours for which residents can work, NPs and PAs may be expected to take on a significant portion of that responsibility. And, increasingly, PAs, NPs, and physicians often train side by side in their course work and clinical rotations.

To meet these future needs, a new society, the Advanced Practitioner Society for Hematology and Oncology (APSHO), has been launched.


  1. 7 future job trends for nurse practitioners. Nurse Journal. Accessed December 7, 2018.
  2. Everett C,Thorpe C, Palta M, Carayon P, Bartles C, Smith MA. Physician assistants and nurse practitioners perform effective roles on teams caring for medicare patients with diabetes;  Health Aff (Millwood). 2013;32:1942-1948.
  3. Bruinooge SS, Pickard TA, Vogel W, et al. Understanding the role of advanced practice providers in oncology in the United States. J Oncol Pract. 2018; 14:9:3518-e532.
  4. Baileys K. How nurse practitioners are enhancing the oncology workforce. ONS Voice. January 11, 2018. December 7, 2018.