Including Nurse Practitioners in the Calculation of Primary Care Health Professional Shortage Areas

Geographic Primary Care Health Professional Shortage Area (HPSA) designations drive the allocation of government resources to improve access to care, but designations are based only on physicians and therefore obscure the available primary care workforce. In this cross-sectional study, we linked 2025 data from the National Plan and Provider Enumeration System and state licensure data to estimate active nurse practitioners (NPs) providing primary care. We then used data from the Health Resources and Services Administration to estimate the number of counties that would continue to meet the HPSA threshold after including NPs in population-to-provider ratios. Including NPs as primary care providers reduced the number of counties with an HPSA by nearly 80% under conservative inclusion criteria and employment and patient capacity assumptions. This finding highlights the need to reconsider HPSA scoring to reflect primary care provider availability and effectively allocate resources to address persistent shortages.