A new policy report from the Milbank Memorial Fund examines the rapid growth of the nurse practitioner (NP) workforce and what that growth may mean for the future of primary care access in the United States.
Rapid Growth, Uncertain Impact: Nurse Practitioners and the Future of Primary Care Access, published September 22, 2026, projects that the NP workforce will grow by nearly 11% annually from 2023 to 2030. While this growth presents significant opportunities to expand access to primary care, particularly in underserved communities, the authors note that workforce growth alone does not necessarily translate into increased primary care capacity.
The report examines several factors influencing the NP primary care workforce, including education and clinical preparation, availability of preceptors, workforce data, practice settings, and the movement of primary care-trained NPs into specialty care. Recent research cited in the report estimates that approximately 31%-45% of NPs currently practice in primary care.
Of particular relevance to the postgraduate advanced practice provider community, the report identifies investment in voluntary postgraduate NP residency and fellowship training as one of five policy recommendations for strengthening the primary care workforce.
The authors highlight postgraduate NP residency and fellowship programs in Federally Qualified Health Centers and other safety-net settings as a strategy for supporting newly graduated NPs as they transition into complex primary care environments. The report points to research associating postgraduate training with improved retention and job satisfaction and an increased likelihood of NPs remaining in primary care and serving underserved populations. It also calls for more stable federal and state investment in postgraduate training infrastructure.
The report’s recommendations also include greater transparency of NP program outcomes, strengthened oversight of NP education, expansion of the clinical preceptor pipeline, and improved workforce data collection. Together, the recommendations highlight the importance of education, transition-to-practice support, and continued investment in preparing the next generation of primary care providers.
Read the full report here.
Citation: O’Reilly-Jacob M, Auerbach D, Hoyt A, Barnes H, Croke BA, Winogora V, Kelly-Weeder S, Clarke S. Rapid Growth, Uncertain Impact: Nurse Practitioners and the Future of Primary Care Access. Milbank Memorial Fund. September 22, 2026.
