Nurse Practitioner Entrepreneurs—An Untapped Primary Care Lifeline

Nurse practitioners (NPs) who own practices are filling critical primary care gaps in underserved and rural areas, but financial and policy barriers to practice ownership must be addressed, researchers express in a JAMA Health Forum viewpoint published on January 16, 2026.  

As the NP workforce expands, more NPs will seek to open their own practices after working in health systems that face structural pressures and rising health care costs, which hinder the delivery of effective primary care. NPs who have opened or acquired practices are improving access to care by offering office visits, telehealth, home-based care, and remote monitoring. However, there are regulatory and reimbursement barriers that are unique to NPs who own practices, including required formal agreements with collaborating physicians, lengthy credentialing processes driven by outdated payer policies, and the 15% reimbursement gap between physicians and NPs. These barriers have led to NPs assuming personal financial risks to open their own practices, such as refinancing their homes. Private sector solutions have emerged to address policy gaps, but more work is needed to truly transform the care NPs provide, the authors say.  

“Sustaining and scaling NP-owned primary care practices enhances clinician competition and expands patient choice, both of which are key priorities of the federal government’s broader free-market vision for health care,” the researchers conclude. “Promoting a regulatory environment that eliminates barriers to NP practice ownership is a promising approach to strengthening the nation’s primary care infrastructure, particularly in underserved communities.”