Our Aug. 18, 2026, MGMA Stat poll asked medical practice leaders whether their practice has added advanced practice provider (APP) positions beyond backfills in the past 12 months. More than half (51%) said yes, 45% said no, 1% were unsure and 2% said the question did not apply because they do not employ APPs. The poll had 288 applicable responses.
The distinction matters. A practice can hire two nurse practitioners and end the year with the same APP headcount if both hires replaced people who left. A net-new position is different. Leaders approved a new salary and benefits line, found room on the schedule and in the clinic, assigned physician oversight where required, and decided the added access or service capacity justified the cost.
What you told us
Among respondents reporting net-new APP positions, the primary driver was practice growth. Leaders linked additions to service-line expansion, increased patient volumes, new locations, extended hours, growing referrals, and efforts to improve patient access. Many also described APPs as central to expanding team-based care models, helping extend physician capacity and reduce wait times.
A separate theme was physician substitution rather than pure growth. Respondents cited physician retirements, departures, recruitment challenges, loss of physician resources, and difficulty hiring family medicine physicians. In these cases, APPs were added to maintain access or replace hard-to-fill physician capacity. A smaller group pointed to operational and coverage needs, including hospital coverage, discharge planning, regulatory changes, or profitability initiatives.
Among practices that did not add net-new APP positions, the most common explanation was no current need. Respondents reported stable demand, adequate APP staffing, sufficient coverage for existing volumes, or patient counts that did not justify expansion.
Financial constraints were the next most common factor, including budget pressures, hiring freezes, productivity concerns, and decisions to optimize existing resources before adding staff. Others cited space limitations, recruitment difficulties, or a focus on filling existing vacancies rather than creating new positions.
Several comments reflected physician or ownership preferences, particularly in specialty settings where groups prioritize physician-only care or believe patients and referring providers prefer physicians. A small number also pointed to scope-of-practice or specialty restrictions that limit APP use.
Looking ahead, some organizations expect to add APPs to meet future volume growth, while others anticipate maintaining current staffing levels because demand, budget, or facility capacity does not support expansion. Practices without APPs generally indicated they do not see a need for them or operate in settings where APP utilization remains limited.
What changed since last November
Our Nov. 11, 2025, poll asked a slightly different question and found that 48% of practices shifted their APP-to-physician ratio toward APPs during 2025, 40% held it steady and 11% moved toward physicians.² It’s important to not trend this week’s results against the earlier poll as the 2025 poll measured a ratio, which can change because a practice adds APPs, loses physicians without replacing them, or both. With a majority answering “yes” this week, it points to a similar trend that signals stronger APP demand rather than just reflecting physician attrition.
What the 2026 benchmarks show
The 2026 MGMA DataDive Provider Compensation and Productivity data report, based on 2025 data from more than 245,900 physicians and APPs, helps explain the budget and staffing pressures behind the poll results.¹
Old salary assumptions can understate the cost. One-year APP compensation growth exceeded the 2.7% rise in consumer prices in every grouping except primary care physician assistants, at 2.10%. Over five years, primary care nurse practitioner pay rose about 22% and primary care physician assistant pay about 27%, compared with about 15% for primary care physicians. Nonsurgical/nonprimary care NPs and PAs posted the largest one-year gains, at 8.46% and 7.43%.¹
APPs may still cost less than physicians in absolute dollars, but practices should not carry old salary ratios into a 2027 budget.
Physician oversight has to be priced. Physicians with supervisory duties reported 15% to 21% more total compensation than peers without them — 18.7% in primary care, 15.2% among surgical specialists and 20.7% among nonsurgical specialists.¹ The benchmark does not isolate APP oversight or prove that supervision caused the pay difference. It does show why a new APP role should not treat physician time as free.
Measure APP output separately. The 2026 report documents a broad physician productivity reset: Work RVUs fell in 16 of 23 common specialties, and total physician encounters fell in all 23.¹ MGMA polling also found fewer groups meeting or exceeding clinician productivity goals than a year earlier.¹
APP work RVUs increased while physician productivity softened. In primary care, NP work RVUs rose about 8.8% in 2025 and PA work RVUs rose about 8.7%, with five-year APP gains ranging from roughly 34% to 55%. That supports the idea that some clinical work is shifting across the care team. However, it does not prove that APPs replaced every physician visit that disappeared from the benchmarks.
A growing workforce will not solve every local hiring problem
National APP supply is growing quickly. Federal projections cited by the AAMC have nurse practitioner supply increasing 66% and physician associate supply 37% between 2024 and 2034.³
Supply also does not guarantee a candidate in the specialty or market where you need one. KFF Health News reported that nearly 90% of NPs are certified to work in primary care, but only about a third choose it, as more move into better-paying specialties.4 A growing national pipeline does not mean the primary care opening you posted in March will be easy to fill.
Patient communication and state rules still matter. Scope rules are state-specific. The AMA reported that 2026 bills to remove physician supervision or collaboration for PAs were defeated in Idaho, New Mexico, Tennessee, Wisconsin and West Virginia, while similar NP independence efforts faced resistance.5
Before posting a role, confirm the rules that apply to the license and specialty, define who reviews or signs what.
Three things to check in your own numbers
- Report APP productivity separately from physician productivity. Track the measures that match the job: visits, wRVUs, panel growth, access, procedures or work taken out of the physician inbox.
- Price physician oversight and the ramp-up period. Include physician onboarding and supervision time, and any compensation tied to it. Also model how long it will take the APP to reach the expected visit mix and volume.
- Check for role drift at 90 and 180 days. Compare the APP's actual template, visit types, refill and inbox work, and panel growth with what leaders approved. A role hired to expand same-day access can quietly become general coverage unless someone checks.
Join MGMA Stat
Our ability at MGMA to provide useful resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To take part, sign up for MGMA Stat and make your voice heard in our weekly polls. Text "STAT" to 33550 or visit mgma.com/mgma-stat. Polls will be sent to your phone by text message.
Additional reading
- APP utilization and how care team redesign continues into 2026 — MGMA Stat, Nov. 12, 2025
- Is it time for your practice to rethink how it pays APPs? — MGMA Stat, May 6, 2026
- Has the trend toward incentives in advanced practice provider compensation lost steam? — MGMA Stat, March 2025
- Stable staff-to-physician ratios might conceal real strain in your practice — MGMA Stat, July 8, 2026
- New-patient wait times largely hold flat in 2026 as some groups add providers in bid to meet demand — MGMA Stat, July 15, 2026
- Keeping your clinician productivity on track throughout 2026 — MGMA Stat, March 4, 2026
- Clawbacks on clinician sign-on bonuses are more common — and not a retention strategy — MGMA Stat, Feb. 5, 2026
- Rebuilding APP compensation in the shift toward quality incentives — member-exclusive Leaders Conference recap
- Finding hidden capacity and optimizing recruitment for your next physician hire — Dec. 29, 2025
- Advanced Practice Provider (APP) Compensation Model Contract Outline — member tool
- Provider Compensation and Productivity 2026: Benchmarks, Shifts and Strategic Takeaways — member-exclusive webinar, on demand
Notes
1. Medical Group Management Association. 2026 Provider Compensation and Productivity Data Report. Englewood, CO: MGMA; 2026.
2. Harrop C. APP utilization and how care team redesign continues into 2026. MGMA Stat. November 12, 2025. https://www.mgma.com/mgma-stat/app-utilization-and-care-team-redesign-in-2026
3. Forte G. How improved health workforce projection models could support policy. Association of American Medical Colleges. July 9, 2024. Accessed August 2026. https://www.aamc.org/data-reports/workforce/how-improved-health-workforce-projection-models-could-support-policy
4. Andrews M. Like doctors, more nurse practitioners are heading into specialty care. KFF Health News. June 17, 2024. https://kffhealthnews.org/health-industry/health-brief-nurse-practitioners-leaving-primary-care/
5. American Medical Association. April 24, 2026 state advocacy update. April 24, 2026. https://www.ama-assn.org/health-care-advocacy/advocacy-update/april-24-2026-state-advocacy-update
