Advanced Practice Providers (APPs) like Nurse Practitioners (NPs), Physician Assistants (PAs), and Certified Nurse Midwives (CNMs) play a pivotal role in the U.S. health system. Independent practice autonomy and career development vary greatly across states. FPA states allow APPs to independently diagnose, treat, and prescribe, whereas other states restrict their practice and require physician supervision.

Other than regulatory distinctions, employment and remuneration vary in the nation as well. Higher remunerations, higher employment markets, and superior career advancement opportunities are offered by a few states as compared to other states. This article considers top APP states on the basis of scope of practice regulations, areas of employment, remunerations, and all-around career gains.

Scope of Practice Regulations for APPs

Scope of practice means the law that governs what APPs can do within a state. The states are categorized by the American Association of Nurse Practitioners (AANP) into three categories: Full practice, Reduced Practice, and Restricted Practice.

In full-practice states, the NPs can diagnose illness, order testing, prescribe and order medication, and order treatment without physician supervision. These are the most autonomous and are best for APPs who want to practice at the highest level they are licensed.

NPs in the Reduced-practice states need to have an agreement of collaboration with a physician regarding patient care issues, i.e., prescribing. This can generate bureaucratic drags and diminish clinical impact.

NPs in the restricted practice states need to practice under direct physician supervision and are thus effectively excluded from diagnosing, treating, and prescribing except with physician approval. The statutes do keep APPs from practicing the full extent of their training and capability.

For Physician Assistants (PAs), state law also regulates the degree of supervision. Some allow independent practice, while others mandate written agreements between physicians and PAs outlining job duties and prescribing privileges.

Highest States for Advanced Practice Providers

1. Oregon – Highest Salaries and Full Autonomy

Oregon is the APP-friendliest state due to its full-practice privilege, strong employment-based economy, and high-salary range. Oregon NPs and PAs have full authority to diagnose, treat, and prescribe. APPs are the foundation of the state’s healthcare delivery system, particularly in rural areas. Oregon NP average salary is about $144,950 per year, one of the highest-paying states.

2. Washington – Improving Healthcare Career Opportunities

Washington is an independent practice state where NPs and PAs practice independently without a supervising physician. Washington’s growing health care sector offers lucrative career prospects, mostly in urgent care, primary care, and specialty medicine. Washington is also one of the most rewarding state for APPs since NPs earn a median annual salary

 of $145,400.

3. Arizona – Horrendous APP Demand

Apart from complete practice permission and a developing employment market, Arizona is a state that welcomes APPs rather strongly.  Arizona’s old population and physician scarcity in the areas of geriatrics, chronic illness management, and primary care mean that Advanced Practice Provider (APPs) are much sought for.  Given the average compensation for a nurse practitioner in Arizona, $121,530, the state is quite economically appealing for APPs.

4. New Mexico – Rural Healthcare Access Leader

New Mexico is an excellent place for APPs to gain experience serving rural and underserved populations. New Mexico has full practice authority for CNMs and NPs with strong legislative backing to grow the APP workforce. New Mexico also has loan forgiveness programs for healthcare professionals working in rural areas, further boosting job appeal. The mean annual NP salary is $118,480, with rural healthcare providers being incentivized.

5. Colorado – Increasing Employment Opportunity for APPs

Colorado gives nurse practitioners complete practicing authority following a short transition-to–practice period.  For advanced practice practitioners who want to work alone, the state is thus a perfect venue.  According to the Colorado Rural Health Center, especially in rural parts of the state of Colorado, APPs are absolutely vital in filling primary care gaps.  Given the average annual NP pay of $117,440, APRs get a nice compensation package.

Highest-Paying States for APPs

Salary potential is also a deciding factor for APPs regarding where they practice, as pay rates vary based on demand, cost of living, and healthcare policy. According to BLS 2023 statistics, the highest-paying states for NPs are:

California – $161,540 per year

New Jersey – $145,030 per year

Washington – $145,400 per year

New York – $150,500 per year

Oregon – $144,950 per year

Such states pay competitive wages based on inordinate patient load, physician shortage, and greater utilization of APPs to cover up shortages in healthcare. While California and New York have some of the highest paying jobs, their restrictive-practice laws could negatively impact professional autonomy. APPs practicing in such states have to practice under supervision or alongside physicians, which obstructs independent practice. Conversely, Washington and Oregon not only offer fair compensation but also full-practice independence, granting APPs more liberty to direct patient care.

Best States with Job Opportunities

Advanced Practice Providers will be in increased demand over 38% between 2022 and 2032, estimates the U.S. Department of Health and Human Services. The most favorable states for favorable employment opportunities for APPs are:

Texas – APPs are needed in more rural clinics and hospital settings.

Florida – Growing geriatric and chronic care population calls for more APPs.

North Carolina – Increasing care systems with PA opportunities and NP-owned practices.

Georgia – Increased health infrastructure offers APP job opportunities.

Tennessee – Providing full-practice authority with rural shortage areas make it an attractive place for APPs.

States with Most APP Restrictions

The states with the most restrictions, with major scope of practice limitation, as designated by the AANP, are:

They are not the most attractive places in which to work as an APP because:

California – Signed physician contracts must be furnished for NP practice.

Texas – Requires tight physician oversight of NPs and PAs.

Florida – Requires collaborative practices in medicine prescribing.

Georgia – Limits NP independence by direct physician calls to supervise.

Missouri – Requires distance limitations on supervising NPs, which means less access to healthcare in rural areas.

These states still offer competitive pay and career advancement but limiting legislation impacts professional growth and care access.

Tips for Selecting the Ideal State for Your APP Career

Track scope of practice – The more autonomous and flexible the full-practice states are.

Scan salary potential – Some states compensate a great deal more than others.

Review job market demand – Choose states with rising healthcare demand and APP-friendly policies.

Scan cost of living – Higher pay in some states might be counterbalanced by high cost of living.

Learn licensing regulations – Licensing regulations are more intuitive in certain states than others.

Pursue professional incentives – Loan forgiveness incentives and rural health surcharges may be part of career incentives.

Conclusion

The ideal state for a career as an Advanced Practice Provider is established based on several factors such as scope of practice, employment, income potential, and professional independence. Full-practice authority states Oregon, Washington, Arizona, and Colorado give APPs the greatest autonomy. While California and New York are lucrative, their reduced practice law can limit professional autonomy. Tennessee and New Mexico, however, provide good job security and professional incentives, particularly for rural medical professionals. With other states considering implementing APP practice legislation, APPs will need to stay abreast of new laws as well as employment trends to allow them to make use of the most advantageous job opportunities.