Survey: 92% of health care leaders now call APPs essential to staffing

Advanced practice providers (APPs) have stopped functioning as a staffing patch and become permanent infrastructure, according to a survey of 327 health care facility leaders released July 30 by CHG Healthcare. In the survey, 92% of leaders rated APPs very or extremely important to their organization's workforce strategy, up from 89% a year earlier. Only 1% said they expect to use APPs less in 2026 than in 2025.

For physicians, the more consequential finding is the one the survey did not go looking for. It asked employers how they intend to deploy APPs. It did not ask physicians what that deployment does to their patient panels, their measured productivity or the supervision and collaboration time that comes with a larger care team, which are the terms on which most physician compensation is still calculated.

CHG has a commercial stake in the findings: its locum tenens brands, CompHealth and Weatherby Healthcare, place nurse practitioners, physician assistants and CRNAs.

What does a bigger APP workforce do to physician productivity numbers?

It shows up first in the benchmarks physicians get paid against. The Medical Group Management Association's (MGMA’s) 2026 Provider Compensation and Productivity report, drawn from 2025 data on more than 245,900 physicians and APPs, found work relative value units fell in 16 of 23 common specialties and total encounters fell in all 23, while median compensation kept climbing between roughly 1.8% and 2.9% depending on specialty. Pay and productivity split for the first time in years.

Andy Swanson, M.P.A., FACMPE, chief customer success officer at MGMA, said the split is partly an artifact of where lower-acuity work is going. "While encounters are down, those patients that doctors are seeing actually have higher acuity and a little bit more complexity," he said. "Perhaps what's going on is that we are moving lower-acuity patients to our APPs, and so we're offloading some of the lower burdensome caseload to the right level of care."

That reallocation collides with a payment change already in effect. Under the CY 2026 Medicare Physician Fee Schedule final rule, CMS applied a 2.5% efficiency adjustment to the work RVUs and intraservice time of most non-time-based codes as of Jan. 1, exempting evaluation and management visits, behavioral health and maternity global codes. Procedural and imaging-heavy specialties absorb it; primary care largely does not.

Swanson's warning for groups is that the two pressures compound. Practices cannot offset the RVU cut by shifting more volume to APPs indiscriminately. "Make sure that the high-acuity patients find their way to those specialists, and they're not being seen by APPs," he said. He also cautioned against trimming starting salaries to match the adjustment in specialties that are already hard to recruit.

Do physician pay models credit the work of supervising APPs?

Largely not yet, and that gap is where APP expansion quietly becomes a physician compensation problem.

Tynan Kugler, M.P.H., MBA, CVA, a principal at PYA who specializes in provider compensation and valuation, told Medical Economics that APP strategy has become a core lever in compensation redesign for both employed and independent groups, because APPs "are just central to care delivery now." The models on both sides of the arrangement, she said, are lagging the reality.

"Advanced practice provider compensation models have not historically been tied to productivity, so there's kind of a little bit of a lag there," Kugler said. "And then sometimes physician compensation models have not taken into consideration the work effort related to [collaborating with] an APP."

The result is a structural mismatch she described as a push-pull: organizations want both the APP and the physician practicing at the top of their license, "but recognize there's some levers that need to be pulled to manage both compensation and overall professional satisfaction for both."

For physicians negotiating or renegotiating an employment agreement, that is a concrete item to raise, and whether the compensation model credits collaboration, chart review and oversight, or treats them as unbilled overhead, is worth settling before signing.

Which APP roles are hardest to fill?

Certified registered nurse anesthetists lead nationally, cited by 30% of facilities as the single most difficult APP position to fill.

The pressure is uneven by geography: 49% in rural facilities, compared with 29% suburban and 24% urban. Because many rural hospitals run CRNA-only or CRNA-led anesthesia models, one unfilled position can limit operating room capacity or shutter a surgical service line.

Surgical NPs and PAs come second at 22% nationally, peaking at 27% in suburban settings as surgical volume continues migrating to outpatient and ambulatory sites. Urban facilities report a different bottleneck entirely: 26% name emergency department and urgent care NP/PAs as their hardest hire, against 9% in suburban and 8% in rural markets.

Why are rural sites cutting locums coverage they say they need?

The sharpest staffing split in the data is geographic, and it runs against itself. In the survey, 58% of rural respondents called APPs "extremely important" to their strategy, the highest of any geography and above the 50% national figure.

At the same time, 25% plan to reduce APP locums use in 2026, again the highest of any geography, and 38% report using no APP locums at all. Urban facilities are moving the other way, with 23% planning increases against 12% planning reductions.

The rural numbers are small enough to read carefully. The survey was fielded in the fourth quarter of 2025 through CHG's own contact lists and third-party research panels, and its 327 respondents skew urban: 172 urban, 102 suburban and 53 rural. That puts every rural figure on a base of 53, meaning 25% represents roughly 13 facilities. The direction is worth more attention than the precision of the point estimate.

CHG frames the pullback as a budgeting error, arguing that locums coverage functions as access infrastructure rather than a discretionary line item. There is a separate reason for independent owners to take that framing seriously.

Kevin Baker, director of business development at Emergency Care Partners, said buyers price staffing fragility directly into practice valuations, weighing "how reliant are they on locums providers" alongside hospital subsidy dependence, payer mix trends and recruiting difficulty.

Coverage gaps that look like savings on this year's income statement can show up as a discount at the closing table.

Cost pressure is real regardless. Total direct expense per employed provider, a figure that includes physicians and APPs, rose 6% between the third quarter of 2023 and the third quarter of 2025, according to Kaufman Hall.

What separates an embedded APP program from a working one?

Scale is no longer the differentiator. APPs already account for more than 40% of employed clinicians, according to Vizient's 2026 State of the Industry Report, and the pipeline math points one direction. The Bureau of Labor Statistics projects nurse practitioner employment to grow 40% and physician assistant employment 20% between 2024 and 2034, against 3% for physicians and surgeons.

"Not only is it 40% today, it'll probably be half the workforce within the next decade," said Matthew Bates, M.P.H., managing director at Kaufman Hall. "Figuring out effective, efficient models is critical. It's not a nice to do. It's a must do."

What separates the groups getting it right, said Shannon Sims, M.D., Ph.D., chief product officer at Vizient, is caseload design rather than headcount. "I don't think there's a magic formula, but what we see is practices that have a blend of doing that see the most productivity out of both their APPs and their physicians," he said.

Sims also flagged a cost of top-of-license practice that rarely appears in workforce decks. Concentrating physicians exclusively on the most complex patients "does place an interesting increased cognitive load on them," he said. "That can be draining in an interesting way.

And so you do have to be thoughtful about that." That may help explain the softest number in the CHG data: alleviating staff burnout ranked near the bottom of the outcomes measured, at 80%, well behind patient access at 94% and throughput at 92%.

The same caution runs in the other direction. Sims said groups have to ensure APPs "are practicing at appropriate levels of complexity so that you don't introduce unfortunate, inadvertent risks" to the clinician or the organization.

Which raises the question of who is designing these models. CHG's own 2025 Physician Sentiment Survey, fielded by Hanover Research among 920 practicing physicians, found that 72% want input into decisions affecting their work while only 40% say they are asked for it.

"If you're going to do it, do it meaningfully," Bill Heller, chief operating officer at CHG Healthcare, told Medical Economics in December 2025. Too often, he said, physicians are consulted after the decision is effectively made. "It's this late-stage consultation, and it's pretty obvious the decision has been made."

The strategic question is settled. The operational one, meaning who sees which patients, who gets credit for the oversight and whose compensation model absorbs the difference, is still being decided, in most cases without the physicians it lands on.