Our Nov. 11, 2025, MGMA Stat poll finds that most medical group practices (48%) have added more advanced practice providers (APPs) relative to physicians in 2025, while nearly as many (40%) have kept this ratio steady and only a few (11%) have seen the ratio trend toward the MD side. Another 1% were unsure. The poll had 305 applicable responses. 

These results land at a moment when access pressures, recruiting realities, and rising costs are forcing medical groups to recalibrate how work gets done. 

What you told us

Leaders who reported an increase in their APP-to-MD ratio mostly described two things happening at once: demand keeps climbing (service growth, bigger panels) while physicians are harder to recruit or retain. Many added new APP roles (or converted vacant MD slots) to preserve access. A few even cited targets like two APPs per each physician, especially in walk-in or same-day care, framing the shift as a practical way to maintain continuity rather than a debate over who should deliver care. 

Those saying “about the same” often pointed to offsetting moves — physician and APP hires or departures that netted out — or intentional caps driven by budgets, hiring freezes, or simple space limits. Where change was on the table, groups were waiting on a physician hire, struggling to find qualified APPs (including specialty roles such as GI), or keeping physician-heavy mixes for call coverage. Governance and market realities also held ratios steady: owner or mission preferences for physician-led care, scope rules, patient preference to see doctors, and, in some cases, not employing APPs at all. 

For decreases, the most common story was APP attrition that wasn’t backfilled because of tight budgets or a thin recruiting pipeline. Others described a conscious reset: leaning back toward physician-led care, citing value or quality concerns, or shifting their service mix (e.g., private-pay models), which reduced the need for APP roles even as physician hiring continued. 

The supply-demand math is driving experimentation 

While the specific dynamics in your practice depend on many factors, we need to start with a shared understanding of how care teams are being redesigned to meet patient demand and keep the enterprise solvent. 

For example: Physician vacancies are taking longer for many groups to fill — 38% of leaders reported time-to-fill increased year over year as of April 2025 — while only 9% said they shortened it. That throughput bottleneck keeps clinics under capacity even when schedules are “full.” 

Meanwhile, the national physician shortfall is still projected to reach up to 86,000 doctors by 2036, concentrating pain in primary care and select specialties. In contrast, the APP pipeline continues to expand: the number of licensed NPs grew nearly 12% in 2024 to 431,410, and board-certified PAs reached 189,907 by the end of 2024 (up 28% since 2020). Many groups have leaned on APP hiring to protect access; nearly two-thirds planned to add net-new APP roles in 2024, a trend that has carried forward into 2025 planning. 

What MGMA data says about APP utilization and pay 

The 2025 MGMA Provider Compensation and Productivity data report points to sizable five-year gains for APPs: median total compensation rose 19.4% from 2020 to 2024. In physician-owned practices specifically, APP productivity climbed sharply in 2024 (+39.3% encounters; +21.9% wRVUs), suggesting practices are getting more deliberate about putting APPs at the top of license with clearer visit types, templates and handoffs. This helped confirm our February 2025 polling that found nearly seven in 10 groups reported meeting or exceeding their physician and APP productivity goals in 2024. 

Compensation models, however, remain mixed: In our March 2025 polling, 44% of organizations paid APPs salary-plus-incentive, 44% used straight salary/hourly, and relatively small shares used RVU-only (6%) or volume-based (3%) models — evidence that leaders are still tuning how to reward APP contribution without overmedicalizing roles or creating perverse incentives. However, signing and starting bonuses — once largely physician-focused — are now commonly extended to APPs, often with payback clauses. 

• MGMA members enjoy exclusive access to a recap from the 2025 Leaders Conference on rebuilding APP compensation in the shift toward quality incentives.  

Care team models are evolving, not converging 

Across primary and specialty care, organizations are widening their front doors with APP-led chronic-stable visit blocks, improved triage, and co-visits that reserve physician time for higher-complexity issues.  

In our February polling on productivity, leaders credited better scheduling, expanded hours/staffing and targeted tech such as AI scribes and e-visits. Access data underscore the need: average new-patient waits hit 31 days in 2025 across 15 metros, up 19% since 2022, prompting many groups to add clinicians (physicians and APPs) and rework templates and centralized scheduling. 

Importantly, scope-of-practice rules still vary widely by state; your latitude for NP-led or PA-led panels and supervision ratios hinges on local regulation. 

Right-sizing the mix for finance and risk 

APPs are not a one-for-one substitute for physicians, nor are they a universal cost fix; outcomes and economics depend on role clarity, physician availability for consults/escalations, and smart panel segmentation. Still, several signals point to sustained APP presence in ambulatory teams:  

• By Q1 2025, roughly two out of every five U.S. providers were APPs, and many recruitment groups report shorter search cycles for APPs than for physicians.  
• Burnout remains a constraint on all sides — the latest AMA survey saw a slight decrease in 2023 from 2021 but still found more than 40% of physicians reported at least one symptom — even as organizations add well-being tactics. 

A look ahead to 2026 

Whether your organization is all-in or wary on team-based care, all medical practices face the challenge of expanding access and preserving margin without overwhelming clinicians. The prevailing pattern is physician-led, APP-enabled pods that expand panel capacity and smooth patient throughput via protocoled visit types, standing orders, and rapid consult pathways.  

Our latest benchmarks show APP compensation rose nearly 20% over five years, and APP productivity jumped in physician-owned groups, suggesting utilization is increasing in settings where workflows and scheduling are more malleable. At the same time, compensation models for APPs remain split between salary-only and salary-plus-incentive, signaling that leaders are still testing how to tie quality, access and wRVUs together. 

Expect 2026 budgets to keep prioritizing workforce (more roles, better retention and upskilling) along with health IT that supports templated scheduling, centralized access and documentation relief. Against a backdrop of longer wait times, persistent physician shortages, and a growing APP supply, most medical groups will continue to rebalance the APP-to-physician ratio while watching patient experience, care quality, and clinician well-being closely.  

In short: more intentional APP deployment, smarter scheduling, and tighter physician-APP collaboration — not a wholesale shift to any single model — are the near-term realities to expect in 2026. 

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