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A study published in Annals of Internal Medicine found that nearly one-third of new nurse practitioners licensed across four states in 2024 had attended for-profit programs, compared with 2.4% in 2010. The researchers say the growth raises questions about training quality, but they found that available evidence is not sufficient to establish how graduates’ education affects patient care.
Nearly one-third of newly licensed nurse practitioners in four U.S. states in 2024 were educated at for-profit programs, up from 2.4% in 2010, according to a study published in Annals of Internal Medicine. The findings document a major shift in the training backgrounds of new clinicians, while researchers say the available evidence does not yet show whether graduates’ education affects the quality of care they provide.
The researchers examined 117,156 nurse practitioners licensed from 2010 through 2024 in California, Florida, Iowa and Texas. They selected the states for their size and representation of different parts of the country, according to the study. The share of new licensees educated at for-profit schools increased in all four states.
In 2024, the share was highest in California at 40.9%, followed by Florida at 35.1%, Texas at 21.1% and Iowa at 14.8%. The overall finding refers to the four-state study population; it should not be read as a nationwide count of all newly licensed nurse practitioners.
The paper, by researchers including lead author H. T. Neprash, was published in Annals of Internal Medicine as “Growth in the Share of Advanced Practice Registered Nurses Educated at For-Profit Programs in Four U.S. States.” The study was funded by Arnold Ventures and the U.S. National Institute on Aging.
The shift comes as the nurse practitioner workforce is projected to expand rapidly. The U.S. Bureau of Labor Statistics projects employment of nurse practitioners and related advanced practice roles will grow by 35% over the next decade, compared with 3% growth for physicians over the same period, according to the source report. The growing number of graduates from for-profit programs could therefore shape a substantial part of the future workforce.
That makes the question of how training programs prepare students relevant to patients, employers and regulators. The study measures where new nurse practitioners were educated; it does not measure their clinical performance or patient outcomes. Its findings point to a need for more information, rather than demonstrating that graduates of one type of school provide better or worse care.
The study authors also cite prior evidence associating for-profit nursing education with lower pass rates on National Council Licensure Examinations. That evidence concerns a related measure of nursing education and does not, on its own, establish the quality of care delivered by nurse practitioners after licensure.
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How For-Profit Training Expanded
The study’s period runs from 2010 to 2024, during which the share of new licensees in the four states who had attended for-profit programs rose from 2.4% to nearly one-third. The source report also says the number of for-profit nurse practitioner training programs increased by 400% between 2007 and 2016. That figure describes program growth during that specific period, not the change in graduates or schools after 2016.
Senior author Dr. Michael Barnett, a professor at Brown University’s School of Public Health, told News-Medical that the rise is striking given the size of the nurse practitioner workforce. He said the expansion of the profession has drawn more schools into training, including for-profit providers, and noted the sector’s history of regulatory scrutiny, settlements with the Federal Trade Commission and lawsuits. Those points provide context for the authors’ concerns but are not findings that every for-profit program has the same record or outcomes.
“That is enormous growth, especially since nurse practitioners are such a big workforce to begin with.”
— Dr. Michael Barnett, senior study author and professor at Brown University’s School of Public Health
Care Outcomes Remain Unmeasured
The study shows the changing share of new licensees who attended for-profit programs in four states. It does not establish the same share nationwide, explain why students chose particular programs, or determine whether the type of school caused differences in exam performance or clinical ability.
Researchers say there is not enough hard data to assess the impact of for-profit nurse practitioner education. The study did not compare patient outcomes by training background, and the source report does not provide state-by-state trends for every year. It is also unclear from the reported findings how the results relate to differences among individual schools, programs or students.
Calls for Program-Level Data
Barnett said a next step would be public disclosure of licensure-exam pass rates and other student statistics for all nurse training programs, so students and the public can better compare them. The authors also called for research comparing outcomes among patients treated by nurse practitioners with different educational backgrounds.
The study does not announce a specific regulatory change or a timetable for further research. Until comparable program data and patient-outcome evidence are available, the findings describe a workforce trend and raise questions about transparency; they do not resolve how program ownership relates to the care patients receive.
Key Questions
What did the study find?
Researchers found that nearly one-third of newly licensed nurse practitioners in California, Florida, Iowa and Texas in 2024 had attended for-profit programs. The corresponding share in 2010 was 2.4%.
Does the figure represent the entire United States?
No. The study covered 117,156 nurse practitioners in four states. The source describes the states as large and geographically varied, but the reported figure is not a national estimate.
Does the study show that for-profit-trained nurse practitioners provide lower-quality care?
No. The researchers tracked education backgrounds and did not compare patient outcomes by training type. They said more evidence is needed to determine whether, and where, differences in care exist.
What information do the researchers say should be made public?
Senior author Michael Barnett called for disclosure of licensure-exam pass rates and other student statistics across nurse training programs. The authors also said researchers should examine patient outcomes by practitioners’ educational backgrounds.
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