More than one-third of both nurse practitioners (NPs) and physician assistants (PAs) said in surveys conducted on behalf of the AMA that they have switched the specialty in which they provide care at some point during their career.
While most nurse practitioners and physician assistants are trained to practice primary care, overwhelming majorities said additional formal training to gain the knowledge, acumen and skills needed to help provide care in the new specialty area was rarely pursued.
The findings—published last week in conjunction with the 2026 AMA State Advocacy Summit held in Southern California—shed light on a rising trend in U.S. health care that stands in stark relief with the rhetoric often advanced by nonphysician providers in their push to expand their scope of practice in ways that can undermine the physician-led care team.
Notably, the survey data confirms that both nurse practitioners and physician assistants “depend on physicians for guidance, mentorship and training, especially when transitioning to new specialties where they have limited or no formal preparation,” says an AMA issue brief. “Removing physician supervision or collaboration requirements” for these nonphysician providers carries with it the risk of “undermining the quality of care and patient safety.”
That is especially the case as nurse practitioners and physician assistants “move into specialties without formal preparation.”
According to separate AMA survey results released last week, 89% of the state medical association and national medical associates government affairs staff surveyed named scope of practice as their No. 1 priority this year.
More than 150 scope bills were defeated in 2025, and there are no signs of letup for 2026 in nonphysicians’ perennial push to inappropriately expand scope of practice.
Through its Advocacy Resource Center, the AMA works directly with national, state and specialty medical
societies to enact state laws and regulations that protect patients and support physicians—and fight back against those that do not.
As part of its long-running efforts to fight scope expansions, the AMA defends the practice of medicine against scope of practice expansions that threaten patient safety and undermine physician-led, team-based care.
Specialty switching among NPs
Among the nurse practitioners surveyed, 35% said they changed specialties at least once in their careers, with 13% saying they did so twice or more.
Nearly 80% said switching specialties was common among nurse practitioners, and 65% said it was “easy,” according to the AMA issue brief on specialty switching by NPs (PDF). Those who switched typically spent about four years in one specialty before doing so, the survey said.
And while two-thirds said additional training or certifications should be required when nurse practitioners switch specialties, 65% said on-the-job training is good enough, instead of getting more formal training. Asked whether they personally would get more training when switching specialties, the respondents were split roughly in half, with 47% saying they would get more schooling and 50% preferring to learn on the job.
About 60% of the nurse practitioners surveyed said they got additional on-the-job training from a physician to practice their current specialty. That included learning how to:
- Assess, evaluate and diagnose patients.
- Order and interpret diagnostic tests.
- Develop treatment plans.
- Prescribe medications.
- Perform in-office diagnostic or surgical procedures.
“Despite the heavy reliance on physicians for on-the-job training, the majority of nurse practitioners feel that specialty switching either has no impact on the cost of care or decreases the cost of care,” says the AMA issue brief.
Data from the American Association of Nurse Practitioners (AANP) shows “that 89% of nurse practitioners are trained and certified in primary care,” the brief adds. Yet only about one-third or less actually practice in a primary care setting, and more turning to other specialties such as dermatology, emergency medicine and cardiology. There are optional certifications for nurse practitioners in various specialties, but 92.8% of NPs lack them, says an AANP report.
Nurse-practitioner programs generally last two to four years. However, some nurse practitioners can get their degree in as little as 18 months after becoming an RN. Online-only programs are allowed. Physicians, by contrast, must complete four years of medical school to earn a degree as an MD (a doctor of medicine) or a DO (doctor of osteopathic medicine). There are no online medical schools.
Meanwhile, nurse practitioners have no residency training requirement, whereas physicians must complete three to seven years of residency and fellowship training depending on which specialty they pursue. Nurse practitioners will tally just 500–750 patient-care hours in training. By comparison, physicians get between 12,000 and 16,000 hours of patient-care experience.
Similar results among physician assistants
More than 40% of physician assistants switched specialties, according to a separate AMA issue brief focused on PA trends (PDF). Nearly 20% switched twice or more, with about three to four years in one specialty before making the move. The vast majority of physician assistants surveyed said switching specialties was common and easy.
While 32% of respondents said physician assistants should be required to earn additional certifications when switching specialties, 89% said training “could be completed on the job as opposed to before practicing in the specialty,” the AMA brief says.
Only 17% of PAs said they would personally pursue more formal training when switching specialties, compared with 75% satisfied with on-the-job training, while another 8% deemed additional training unnecessary. About two-thirds of the physician-assistant respondents said they got training they needed from a physician when switching specialties.
Physician assistant programs usually run about two years long, or perhaps two and a half. In addition, physician assistants have no residency-training requirement.
An AMA State Advocacy Summit panel discussion Friday touched on the results, and experts unpacked what the trends mean for the practice of medicine, including the risks posed when health professionals without specialty training rapidly shift into new fields.
Two other AMA issue briefs were published last week, based on the surveys of nurse practitioners and physician assistants. One examines nurse practitioners’ views on physician-led care (PDF), and the other details those of physician assistants (PDF)—with both generally placing a high value on physician collaboration and mentorship.
Taken together, says the AMA, “these findings underscore the vital importance of maintaining physician-led care.”
