America does not have enough neurosurgeons, spine surgeons, or procedural specialists to meet the demand already in the waiting room. The Association of American Medical Colleges projects a shortfall of 13,500 to 86,000 physicians by 2036, including a gap of 10,100 to 19,900 in surgical specialties. Residency slots alone will not close that gap. What helps patients in real clinics and operating rooms is a team model that multiplies the surgeon’s reach without diluting responsibility.

That is the purpose of National APP Week, observed September 21–25, 2026 under the theme “The Pulse of Progress: APPs Powering Tomorrow.” Advanced practice providers—physician assistants (associates), nurse practitioners, CRNAs, clinical nurse specialists, midwives, and anesthesiologist assistants—are not a substitute for the physician shortage. They are the teammates who keep high-acuity systems solvent and help surgeons safely take care of patients.

The Physician Shortage Problem Is A Capacity Issue

A complex spine operation does not end when the incision closes. Patients still need clinic triage, imaging review, preoperative counseling, overnight checks, wound checks, medication titration, and the hundreds of micro-decisions that keep a case from becoming a complication. One surgeon cannot do all of that at scale and still spend the hours the operating room demands.

The analogy is a cockpit. The surgeon is responsible for the whole flight but cannot fly the plane, load the bags, brief the cabin, and check every seatbelt at once. The extra work is not the incision. It is the clinic inbox, the imaging that has to be justified to an insurer before the next case is booked, the wound that needs another set of eyes at 4 a.m., the medication that has to be titrated, and the family that needs a real answer while another case is already underway. The license and the outcome still sit with the surgeon the way command still sits with the pilot. A flight attendant is not a consolation prize for too few pilots. It is how the aircraft stays safe when each person does their job by working together.

What An APP Force Multiplier Actually Means

The military taught American medicine this decades ago: delegate with force multipliers. The modern PA profession began in 1965, when Eugene Stead, M.D., launched the first training program at Duke and recruited former Navy hospital corpsmen—already forged in high-stakes care—to extend physician capacity. That origin story was never about replacing the surgeon. It was about multiplying the team so the scarce specialist could stay on the hardest work.

In neurosurgery and spine, that looks concrete. APPs staff clinic so new patients do not wait months for a first conversation. They first-assist in the OR, close, manage drains, and own postoperative pathways. They are the trusted face patients see between surgeon visits. Medicare analyses of single-specialty surgical groups that added APPs have linked the model to fewer complications and readmissions, shorter length of stay, lower episode payments, and more office visits per surgeon. In outpatient neurosurgery specifically, patients accept APP visits when the team is transparent and the surgeon remains accountable for the plan—especially when the alternative is a longer wait.

And, that role is growing.

The Bureau of Labor Statistics counts 168,900 employed physician assistants in 2025, with employment projected to grow 21 percent from 2025 to 2035. Board-certified PA ranks passed 200,000 in 2025. Nurse practitioners are growing even faster—BLS projects 41 percent growth for NPs from 2025 to 2035 .

The bottleneck is not whether APPs exist. It is whether health systems can financially integrate them as partners instead of treating them as “mid-levels” within a complex budget.

How We Integrate APPs On The Gulf Coast

At the University of South Alabama and USA Health Spine Institute, our APPs are not peripheral. Our physician assistant and nurse practitioner team often begins the care journey as the first spine specialist a patient meets. They prepare cases, assist in the operating room, see patients in clinic, and keep the surgeon informed without making the patient wait for every update. Bluntly, that is how an academic neurosurgery practice is able to treat more patients.

Our APPs make 24/7 in-house neurosurgery access real at a Level I trauma center. When a car accident, a fall, or a bleed hits the Gulf Coast at 2 a.m., they are already in the hospital—triaging, stabilizing, and getting the attending into the fight—so the community is safer. A neurosurgeon is still the one making the operative decisions and performing the surgery. We cannot do that work without APPs on the front line.

If you strip the titles and watch a busy spine day, the pattern is obvious. The surgeon’s scarce hours go to the decisions only a neurosurgeon can make. The APP’s hours go to everything else that makes those decisions safe and timely. That division of labor is not a hierarchy of worth. It is the only honest response to the math of demand.

What National APP Week Should Change

Recognition weeks matter most when they change how we talk to patients and the public. National APP Week is a chance to say out loud what good teams already practice: it is a strength, not a consolation, when an APP is on your case with your surgeon.

APPs do not solve every physician-scarcity problem. They cannot mint more surgeons overnight, and they are not a substitute for the hardest decisions only a surgeon can make. What they do is let surgeons safely help more people—more clinic visits, more prepared cases, more postoperative check-ins—without asking the patient to wait for every answer from the one person who cannot be in two places at once. That is worth naming, thanking, and defending.

The relevant question is not hierarchy. It is capacity, continuity, and accountability. It will scale only if hospital systems, payors, and governments invest in APP recruitment, training pipelines, competitive retention, and team models that treat them as essential capacity—not optional overhead. When surgeons and APPs practice as one service line, more patients get the right care at the right time—and that is the standard worth building.