The Growing Role of Advanced Medical Practitioners in Workers’ Compensation 

• By: Nancy Germond
• September 25, 2026

Are advanced practitioners (APs) — nurse practitioners and physician assistants — affecting injured employees’ care and return-to-work outcomes? According to recent research from the Workers Compensation Research Institute (WCRI), presented by WCRI Senior Policy Analyst Dr. Bogdan Savych, workers’ compensation medical treatment is undergoing a significant shift in how injured workers receive care. 

Advanced medical practitioners now treat a growing share of injured workers. In 2013, only 18% of first non-emergency workers’ compensation office visits went to an NP or PA. By 2022, that percentage climbed to 37%. Meanwhile, the share of first visits to primary care physicians (PCPs) fell from 64% to 48% over the same period. 

There are reasons for this treatment transformation, and it is occurring in almost every state and is even more prevalent in rural areas. However, the important question for employers, insurers and injured workers is not whether the shift is happening, but does it matter for claim outcomes?  

New research from the WCRI offers some important data on this question. The findings challenge some long-held assumptions, offering insights into what AP-initial care means for injured workers. 

Why the Proliferation of Advanced Practitioners 

To understand the current and emerging state of workers’ compensation, it helps to understand the forces currently reshaping the broader healthcare workforce. 

The number of primary care physicians in proportion to the U.S. population has been shrinking for years. The number of PCPs providing direct patient care has declined relative to population growth, even as their administrative burden has grown. In many states, physicians now must oversee AP-delivered care in addition to their own patient loads, meaning less time for PCPs to provide direct care. 

As PCP numbers, the AP workforce has grown dramatically. The number of physician assistants nearly doubled, rising from approximately 17 per 100,000 people to around 30 per 100,000. The number of nurse practitioners almost tripled, increasing from roughly 30 per 100,000 to approximately 86. 

The Fallout From COVID-19 Accelerated Physician Burnout 

The COVID-19 pandemic accelerated this trajectory. Burnout, exhaustion, and unfilled vacancies, which the American Medical Association described as “harrowing,” pushed many nurses and physicians to reduce hours or leave the profession entirely. Their departures widened the gap that APs increasingly began to fill. 

The Shift in PCP Ownership 

In the last decade, there has been a significant shift in the ownership models where PCPs practice. Physician-owned practices in the last ten years have normally delivered primary care. However, by 2018, nearly 50% of primary care providers practiced in hospital- or health-system-owned settings. Although the interest by private equity (P/E) is greater in specialty practices such as anesthesiology, acquisition by private equity ownership has grown in primary care providers, as well. There is little doubt that acquisition by private equity equates to staffing reductions and pay, increased debt load and the ability to “evade regulatory attention.” 

Rural areas have seen the greatest transition in workers’ care. The share of first office visits with physicians fell from 81% in 2013 to 60% in 2022, while first visits with physician assistants rose from 11% to 22% and first visits with nurse practitioners increased from 5% to 16%, respectively, according to the Waltham, Massachusetts-based institute, as reported on Business Insurance. Well-documented physician shortages and state policies such as “Full Practice Authority,” which grant AP powers to see patients, order tests, and write prescriptions, has made Aps the most dominant provider type in rural America.  

The workforce stats are undeniable: APs are not only supplementing the primary care system. In many markets, they have become the primary care system. 

What Physicians Expected to Find 

Before examining the data, WCRI researchers consulted with workers’ compensation physicians to understand prevailing expectations about AP-first care. Several concerns emerged consistently, including the following. 

• The expectation of more visits because APs may rely more on precautionary or protocol-driven care. 

• Delays in referrals to specialty care: APs may lack the clinical experience to know when specialty intervention is necessary, which would result in slower access to necessary care. 

• Longer disability timelines: Any delay in a correct diagnosis or referral could extend temporary disability periods. 

• Higher medical costs: More visits and any delayed care would increase total medical payments per claim. 

These concerns reflected the doctors’ clinical uncertainty about the influence of AP-first care. Would it perform efficiently in a workers’ compensation context?  

According to the presenter, these concerns were largely unfounded.  

What the Data Actually Showed 

The WCRI study reviewed initial non-emergency office visits across a large dataset of workers’ compensation claims, comparing outcomes for workers initially treated by NPs, PAs and PCPs. This similarity in case mix created outcome comparisons that were valid and meaningful. 

Access to Care 

• Overall, the time from injury to first non-emergency office visit was slightly shorter for NP-first care; however, it was a minimal difference. 

• In rural areas, workers who first saw an NP received care approximately 10% faster than those waiting for a PCP. This is meaningful in markets where care access has long been a legitimate barrier, such as these rural areas.  

• For PA-first care, time to first visit was comparable to PCP-first care, with no significant rural advantage or disadvantage. 

Office Visit Volume 

A key concern for physicians was that AP-first care would cause more follow-up visits. The data did not support this. Total office visit counts were almost identical across NP-first, PA-first and PCP-first claims. There is no evidence that APs keep patients in care longer or generate unnecessary medical treatments or delays. 

Specialty Care Utilization 

The most closely watched metric was specialty care access. This was specifically whether AP-first care led to delays or underutilization of specialist services. The findings here were clear. 

• Rates of neuromuscular testing services were comparable across provider types. 

• Time to first specialty service was similarly comparable. 

• Rates of pain management injections and time to those injections showed no meaningful differences. 

Workers first treated by NPs or PAs were neither more nor less likely to access specialty care, accessing it at similar intervals. 

Medical Payments 

Total medical payments at 12 months of claim age were comparable across provider types, with only marginal differences that fell within statistical uncertainty ranges. 

Temporary Disability Duration 

To employers, metrics related to temporary total disability benefits are critical. The data showed little to no difference between AP-first and PCP-first claims. The data showed no evidence of longer temporary disability benefits.  

What This Means for Workers’ Compensation Stakeholders 

For all workers’ compensation stakeholders, these results are significant.  

• For employers and payers, this data should help to reduce any concerns about AP-first care, triggering higher costs or longer claims. With higher AP access in rural markets, this may improve access without damaging outcomes. 

• For adjusters and case managers, although care if comparable between APs and PCPs, your focus should remain on injury type, treatment appropriateness, and return-to-work planning. It only makes sense in a fracture, for example, if you can immediately refer care to an orthopedist, that would normally be the best choice for any appointment time constraints.  

• For managed care networks and occupational health administrators, AP workforce capacity is a genuine resource in markets with declining PCP availability. This study’s outcome supports treating NPs and PAs as full participants in the care delivery model, not as second-tier alternatives. 

• For clinicians and medical directors, physicians should reassess any prior assumptions. Physicians queried expected AP-first care to underperform. In most measurable respects, it did not. That outcome reflects not just individual AP competency, but the collaborative, team-based environment in which most APs practice, where they work alongside and are supervised by physicians embedded in the same clinical workflows. 

What We Still Don’t Know 

Good research can raise as many questions as it answers. 

This analysis focused on first non-emergency office visits in primary care settings. Several important gaps remain in the following areas. 

• Occupational medicine clinics, where APs are increasingly prevalent, will play a central role in workers’ compensation. The WCRI has identified this as a priority for future research. 

• Patterns of care beyond the first visit for injured workers at visits two and three is a natural next step in research. Injured workers often see a combination of provider types across their claim.  

• PCP-versus-specialist comparisons are an important next step in research, according to WCRI. Comparing primary care and specialist-first care is methodologically complex because the injury variety diverges substantially. A worker who goes directly to a surgeon likely has a different severity profile than one who starts with a PCP. But this comparison is important and calls for careful review.  

• Provider experience: One underexplored variable is the extent of clinical experience providers have with specific injuries. An NP who has handled hundreds of low back pain claims in an occupational setting may deliver results comparable to, or even better than, those of a PCP who occasionally treats such cases. Experience with a particular injury type, not credentials alone, is likely a meaningful driver of outcomes. 

The Bottom Line 

In the workers’ compensation arena, the data is clear — advanced practitioners are not a temporary workaround for a physician shortage. They are a permanent and growing feature of how the current medical structure delivers medical care in the United States. 

The WCRI research makes a clear case that this shift, at least as it relates to first non-emergency care, has not compromised claim outcomes. Workers are getting to care at least as quickly, accessing specialty services at similar rates, off on temporary disability over similar periods, and generating comparable medical costs regardless of whether their first provider held a PCP, NP, or PA credential. 

Still, provider type is not irrelevant to claim outcomes. Adjusting an injured worker’s claim is both an art and a science. Timely, clear communication and prompt access to appropriate medical care still improve outcomes. What this study does challenge is the assumption that AP-first care is inherently inferior to PCP-first care. Stakeholders who continue to rely on that assumption risk misallocating resources, creating unnecessary delays in care access, and missing opportunities to work effectively with the medical workforce that exists today. 

The workers’ compensation system has always adjusted to shifts in the broader healthcare market. Advanced practitioners are now part of that change. The data from this study, and I am sure others to follow, suggests the system can make that adjustment without sacrificing the outcomes that matter most. 

This article is based on research and findings presented by Dr. Bogdan Savych, Senior Policy Analyst at the Workers Compensation Research Institute (WCRI). The full study is available through the WCRI website. WCRI does not make policy recommendations or take positions on the findings it publishes. 

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