By Te-Ping Chen | Photography by Cornell Watson for WSJ
Becky Peterson graduated this month with a degree that paves the way for her to examine patients, prescribe medication and make diagnoses, just like a physician. But she won't be Dr. Peterson, and her graduate program took just two years.
Instead, she is becoming a nurse practitioner, a good-paying job that is also the fastest-growing field in healthcare.
"There is a place for medical-school doctors, and a place for nurse practitioners. And all of us are trying to do the same thing, which is meet the needs of people who need help," said Peterson, who graduated from a University of North Carolina at Chapel Hill program and lives in Morrisville, N.C. She is now preparing for a certification exam and will start a mental-health residency this fall.
These days, heading to the doctor's office often doesn't involve a doctor. At least not directly. Instead, nurse practitioners have become major gap fillers, growing their ranks by 60% to 461,000 between 2019 and 2025, data from the American Association of Nurse Practitioners show.
Physician assistants who can fill similar roles are also in high demand, as are other non-MD health providers. They are all part of a broader trend to push basic care beyond the doctor's office. In many states, for example, pharmacists now prescribe medications such as contraceptives and flu treatments.
This shift has sparked some controversy: Doctors' groups say there is danger in deploying people who don't undergo the rigor of medical school and residency to do unsupervised doctor-level work. These groups have tried to stop states from changing rules to widen the market for NPs and PAs, as the other professions are known.
But the graying population frequently demands more care than doctors can provide. The number of doctors the U.S. can add a year is limited by available residency slots, and many newly minted MDs often bypass primary care in favor of higher-paying specialties. The U.S. is currently facing a shortage of 16,000 primary-care physicians, according to an analysis by the nonprofit KFF, which researches healthcare policy, and projections show the shortage is likely to dramatically worsen.
Healthcare workers such as NPs and PAs often plug these holes. And they can be money-savers.
"Doctors cost a lot of money and nurse practitioners don't," said Brian McKillop, president of physician solutions at staffing company AMN Healthcare. He said employer appetite for healthcare workers whose abilities overlap with doctors -- but don't have an MD -- is at an all-time high.
Nurse practitioners make an average income of $132,000 a year, according to federal data. That is a lucrative step-up from registered nurses, who make an average $98,000, but also far below the $257,000 average for primary-care doctors.
Meanwhile, Peterson's two-year nurse practitioner program cost around $50,000, a fraction of what she would have spent on medical school. By contrast, the average medical-school graduate leaves with $207,000 in debt. The less-grueling training made it easier to plan and raise a family, said Peterson, who like most NPs received her bachelor of science in nursing before going on to get her advanced degree.
Patients in rural areas, in particular, have come to rely on nurse practitioners. According to federal data, 66% of rural Medicare recipients say they see a nurse practitioner or physician assistant for some or all of their medical care, compared with the 54% of urban residents who say the same.
Back when Danielle Howa Pendergrass founded her own women's health clinic in Price, Utah, in 2012, she says it was one of only two such clinics anywhere near her remote hometown. Today, Howa Pendergrass, a nurse practitioner, sees 100 patients a week, prescribes medication, orders tests and diagnoses everything from diabetes to cancer.
"We're excellent in what we do -- we have the skills, we have the training," she said. "I stepped in and filled a huge gap."
NPs got their start in the 1960s, but they have been in especially high demand much more recently. Over the past two decades, around 30 states have given nurse practitioners leeway to practice without physician oversight. In such states, their capabilities are very similar to many doctors, though they can't do more complex medical procedures.
Ten states let physician assistants -- who generally have a minimum of six or seven years of clinical training and higher education -- practice independently as well. And five states -- including Delaware, just this month -- have passed laws changing the title of physician assistant to physician associate.
"Truly, we are not just an assistant to a physician any longer," said Jim Earel, a physician associate and 18-year veteran of an orthopaedics group in Bettendorf, Iowa. He manages care for his own roster of patients and said the name is a better fit.
In many states, NPs and PAs still work under physician oversight. Those arrangements can involve everything from close, in-office collaboration to a more nominal agreement that exists mostly on paper, in which a physician is paid a fee of up to thousands of dollars a month.
Physician groups such as the American Academy of Family Physicians argue that healthcare workers who aren't medical doctors shouldn't be practicing without physician oversight. "If you see a young kid and they've got strep throat, it's easy to treat if that's what it is. But if not, what else could it possibly be that you're missing? That's where it gets scary," says Asim Jaffer, a primary-care physician in Peoria, Ill.
Walter Lapicki, an anesthesiologist at Hunterdon Health in Flemington, N.J., says that in some cases, allowing providers who aren't doctors to practice without supervision can put patients at risk. Though Lapicki works with plenty of certified registered nurse anesthetists -- who are able to administer anesthesia -- he or another anesthesiologist are always physically on hand, he said.
Researchers say the evidence shows nurse practitioners can offer care on par with general practitioners, though one study of emergency departments found they drove up costs, in part by ordering more testing. A 2023 study by a researcher at the University of Alabama School of Law found that letting nurse practitioners work without physician supervision -- thereby making it easier for them to see patients and open their own practices -- reduced deaths that could have been prevented through healthcare by 2%.
Healthcare visits are often routine, and for many patients, the biggest issue is simply lack of access that staffing shortages can make worse, researchers say.
"Physicians argue that if you're in an exam room, you'd rather be with a physician," said Benjamin McMichael, a University of Alabama School of Law economist who authored the paper.
"But that's not the whole story, because a lot of people never get to that exam room," he said.
Write to Te-Ping Chen at Te-ping.Chen@wsj.com
(END) Dow Jones Newswires
May 16, 2026 12:00 ET (16:00 GMT)
Copyright (c) 2026 Dow Jones & Company, Inc.
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