This analysis synthesizes 5 sources published the week ending Oct 14, 2026. Editorial analysis by the PhysEmp Editorial Team.
Two numbers from the federal provider registry do not fit together easily. Nurse practitioners registered 5,097 new practices between January 1 and September 26, 2026, nearly six times the 859 registered in the same window of 2019. Over those same years, newly registered individual NPs fell 19% from their 2023 level, to 20,312 from 25,115. For the Healthcare Workforce & Labor Market, the gap points to a change in how advanced practice labor is organized, not a change in how much of it exists.
The figures come from a Medical Boulevard analysis of CMS registry data, reported by Medical Economics. In 2019 there were 3.7 new NP practices for every 100 new NPs. In 2026 there are 25.1. The analysts are careful about what this proves: an organization registration is not evidence that a clinic opened, and some entries will be billing entities or second locations.
What the registry shows, and what it cannot
More than half of the 2026 practices, 2,734 of them, are psychiatric and mental health NPs, up from 271 in the 2019 window. Family NP practices roughly doubled since 2022. The same dataset also finds growth in registrations with wellness, weight, hormone or IV terms in the name, from 227 in 2022 to 1,019, though the authors call that keyword count only indicative.
Coverage of NP independence usually runs through the scope-of-practice fight, and Medical Economics notes that many physicians told it independence has gone too far. The registry data does not fit that frame well. Growth since 2022 was 2.58 times in full-practice states, 3.25 times in reduced-practice states and 2.86 times in restricted-practice states, and Florida and Texas, both restricted, lead the country in raw counts. Permission to practice alone does not explain the pattern. The registry also does not record why a practice was formed, so the cause is an open question rather than a finding.
When practice formation rises while new clinician entry falls, the relevant labor-market variable is retention of supply inside employed roles, not the size of the pool. Every NP who becomes an owner may leave an employer vacancy behind.
Employers are asking for fewer NPs and CRNAs, and paying more for the ones they get
Recruiting data points the same way, with a caveat. An AMN Healthcare review of 1,293 permanent search engagements, summarized by Becker’s Physician Leadership, put nurse practitioners first among requested searches for the sixth straight year, but at 209 searches, down from 222 a year earlier and 426 two years before. AMN’s sample reflects its own client work, not the whole market, so the decline may say as much about where employers use that firm as about demand.
The CRNA numbers are starker. AMN logged 23 CRNA searches, against 86 in the 2021-22 review, and attributed part of the fall to nurse anesthetists moving into locum and 1099 contract roles for higher pay and flexibility, which raises employer costs. A Becker’s ASC account shows what that looks like from the other side. A Niagara Falls surgery center found no local anesthesia group willing to take it on and switched to a CRNA-based group that bills payers directly. The administrator said reimbursement does not cover CRNA pay, which the article puts at $288,000 in 2026, up 59% from $181,000 in 2019, against 29% growth for anesthesiologists per a Veralon report it cites.
The implications differ by seat. For surgeons, the same account shows a new duty arriving with the model: surgeons at the center now supervise CRNAs, a role they were not trained for, and the center dropped pediatric cases when one surgeon declined to supervise them. For recruiters and executives, a shrinking permanent-search count combined with rising contract pay suggests the competition for advanced practice talent now includes the clinicians’ own practices and agencies, not only other employers.
A pipeline that cannot easily refill the pool
Supply is the harder constraint. A BNO News explainer argues that NP programs can add classroom seats faster than clinical placements, because placements depend on individual clinicians agreeing to precept, and most preceptors have historically been unpaid. Students described spending 40 or more hours a week cold-emailing clinics in placement season. The article relays the Bureau of Labor Statistics projection of 40% NP employment growth from 2023 to 2033 and a figure of roughly 300,000 licensed NPs; it is bylined to a contributor and cites those numbers secondhand, so treat them as context rather than fresh data.
The placement problem and the practice boom may feed each other. A practice owner who precepts gives up productive hours, and small practices, the article says, are the ones least able to absorb students. If a growing share of NPs work in small clinics they own, the clinicians most likely to be asked to train the next cohort are those with the least slack to do it. That link is an inference from separate sources, not something any of them measured.
Nobody in these sources says the pipeline is closed. Stipends, matching networks and state incentives for preceptors are under discussion, and the BNO piece says none of the fixes works alone.
The number to watch
As of September 26, the 2026 count was 56 short of the 5,153 practices registered in all of 2025, so the year will almost certainly set a record. The more useful figure is the ratio of new practices to new NPs. If it keeps climbing past 25 while individual registrations keep falling, employers recruiting NPs and CRNAs will be bidding against a growing number of clinician-owned practices and contract arrangements for a pool that is not growing, and pay for those roles will keep moving toward the contract market’s price.
Sources
NPs are registering new practices at nearly 6 times the 2019 rate – Medical Economics
Nurse Practitioner Practice Registrations, 2026 – Medical Boulevard Research
Physician recruiting shifts to smaller communities: 8 things to know – Becker’s Physician Leadership
Why this ASC closed Fridays to make CRNA math work – Becker’s ASC
Nurse Practitioner Shortage: Why Clinical Placements Are Becoming Harder to Find – BNO News