Advanced practice providers have become indispensable to American medical groups,  and how organizations compensate them is becoming a defining strategic question. With APP total compensation climbing nearly 20% over five years and practices increasingly relying on nurse practitioners (NPs) and physician assistants (PAs) to maintain patient access, the pressure to design smarter, more intentional pay models has never been greater. 

Yet the industry remains divided on how to do it. A growing number of medical group leaders are experimenting with value-based incentives, quality metrics and productivity bonuses for their APP workforces, while others are holding firm to straightforward salary models that offer budgetary predictability in an era of persistent cost pressures. 

Our May 5, 2026, MGMA Stat poll found that more than four in 10 (43%) of medical groups updated APP compensation methodologies to add value or incentives in the past two years, while half (50%) did not and 7% were unsure. The poll had 261 applicable responses. 

What you told us  

Across respondents, the biggest change was adding or increasing productivity-based incentives (often tied to wRVUs, volume, or collections), frequently paired with quality metrics. Many groups also expanded incentives for access, call coverage, extra shifts, and team goals, and adjusted RVU rates or bonus structures. A smaller number focused on retention, simplification of comp models, or alignment with clinical goals and documentation performance. 

For respondents who said “no,” most reported no formal APP incentives in place, or only a base salary with no structured value-based components, though several noted plans to develop incentives soon. Among those that do offer incentives, they are heavily weighted toward productivity (wRVUs, production bonuses, per-visit or profit-based incentives), with fewer including quality, patient satisfaction, or team goals. Overall, incentive use is inconsistent and often limited or informal rather than part of a comprehensive comp model. 

For organizations that do not use a productivity-based model, some practice leaders said the variable portion of APP pay was primarily limited to shift and call stipends, which can create challenges in tying compensation to documentation compliance needed to support reimbursement and utilization. 

APP compensation: Dramatic growth, evolving models 

The financial picture for APPs has shifted substantially in recent years. According to the 2025 MGMA Provider Compensation and Productivity data report — reflecting 2024 data from more than 220,000 providers — median total compensation for APPs rose 3.17% in a single year and 19.39% over five years. Primary care PAs led the way with an 8.27% one-year gain and nearly 30% growth over the 2020–2024 period, while primary care NPs posted 3.62% annual growth and 20% over five years. 

These increases have outpaced many physician specialties and, in some regions, outstripped the Consumer Price Index, reflecting the strategic premium organizations are placing on APP talent. MGMA's data show that APP five-year compensation growth was remarkably uniform across regions — ranging from roughly 18% in the Midwest to 20% in the South and East — suggesting that the demand for APPs is not limited to any one geography. 

At the same time, compensation models remain in flux. In a March 2025 MGMA poll, 44% of medical group leaders reported using salary plus incentives for APP compensation, matching the 44% who still rely solely on salary or hourly wages. Only 6% used an RVU-based model and 3% used volume-based pay. That poll marked a slight retreat from a 2023 MGMA poll in which salary-with-incentives stood at 51%, suggesting that momentum behind incentive-laden APP pay has cooled somewhat — even as the broader industry moves toward quality-driven physician compensation. 

The quality-metric question 

The tension between incentive-based and fixed-salary APP compensation exists as straight base salary still dominates the compensation allocation — accounting for about 84% of mean reported APP pay in 2023 data, with productivity at roughly 10.5% and quality and patient experience at just over 1%. While these quality-tied shares are small, they represent a foothold that many practice leaders expect to grow as value-based care arrangements with payers expand. 

A workforce in transition 

The push to rethink APP pay is inseparable from the larger restructuring of care teams as a response to physician shortages. Meanwhile, the APP pipeline keeps expanding: the number of licensed NPs grew nearly 12% in 2024 to more than 431,000, and board-certified PAs reached nearly 190,000 by year's end — a 28% increase since 2020. The Bureau of Labor Statistics projects NP employment to grow 35% or more between 2024 and 2034, far outpacing most other health professions. 

Medical groups have responded accordingly. In a November 2025 MGMA Stat poll, 48% of practices reported adding more APPs relative to physicians over the course of the year, while 40% held steady and only 11% shifted toward a more physician-heavy ratio.  

Leaders laid out a straightforward trade-off: as it takes longer to hire physicians and patient panels keep getting bigger, APPs are filling the gaps to preserve access through same-day visit blocks, chronic-stable care panels and expanded triage roles. In physician-owned practices specifically, MGMA data back this up — APP productivity rose sharply in 2024, with encounters up 39.3% and work RVUs up 21.9% — showing that organizations being more intentional about using APPs to their full scope of practice. 

By Q1 2025, roughly two of every five U.S. providers were APPs, according to Kaufman Hall reporting.⁵ Scope-of-practice legislation has accelerated this trend: five states granted NPs full practice authority in 2025, bringing the total to 34 states plus Washington, D.C., that allow NPs to practice independently. The growing NP and PA supply, combined with broadening autonomy, gives us the chance to shift from asking, "how much should we pay APPs?" to "how should we pay them to get the most value for patients and the organization?" 

Looking ahead 

The prevailing care team model taking shape across the industry is physician-led and APP-enabled — structured pods that expand panel capacity through protocoled visit types, standing orders and rapid consult pathways. Compensation models will need to keep pace. As organizations begin to budget for 2027, many are weighing how to fold quality, access and patient-experience metrics into APP pay without creating administrative burdens or perverse incentives that compromise the collaborative care model. 

Whether your practice has recently overhauled its APP compensation methodology, is planning to do so, or has decided the current model works just fine, benchmarking against the market remains essential. The pace of change in APP utilization, scope of practice and compensation means that what worked two years ago may already be outdated. 

Join the conversation  

• MGMA Stat polls are conducted weekly to give medical practice leaders a pulse on the latest trends in healthcare management. To participate, sign up for MGMA Stat at mgma.com/mgma-stat.  
• Have a success story in updating APP comp models or care team design? Let us know in the MGMA Member Community or email us at connection@mgma.com.