Most of the airtime surrounding "clinician entrepreneurship" goes towards nurses and nurse practitioners, but what about the 178,000 physician assistants (PAs) in the US? There has been significant movement in recent decades of increasing practice autonomy for PAs. With a large base of clinicians gaining increased autonomy, we’d expect an upswell of entrepreneurial activity. This report aims to understand the scale and patterns of PAs starting and growing their own businesses.
To provide a comprehensive analysis, we analyzed the LinkedIn profiles of 160,218 physician assistants, with a focus on those who self-reported as founders or owners of businesses. We merged this analysis with data sets from Google search activity and corporate formation data. These different angles provide a full picture of the growth of entrepreneurialism within PAs, the kinds of businesses they are forming, and opportunities for further growth.
While the number of active PAs has more than doubled in recent decades in the US, the trend of PA entrepreneurship has grown much faster. There were 75,000 active PAs in 2010 and 178,000 active in 2025. California, which provides public business formation data, shows 114 PA businesses formed in 2024 versus 1 formed in 2010 (a 11,300% increase).
Growth of PA owned business was minimal until 2022, when it saw a steep upward trend. This is likely driven by two trends. First, increased autonomy in PA practice: California expanded PA autonomy in 2020 allowing the PA’s collaborating physician to be remote. Second, across the board increases in entrepreneurial activity triggered in COVID years among clinicians including NPs, CRNAs, RNs, and PAs.
These two trends have bolstered PA entrepreneurialism, but as we will show, we believe PA business formation is disproportionately held back (in comparison to NP) due first to continued greater regulatory burden on PAs in starting businesses. Varied state regulations create some encouraging and some discouraging environments for PAs. Second, we will show that much of the growth in NP entrepreneurialism has been driven by Psych NPs (PMPNP) responding to the demand for mental health services with little equivalent growth from PAs. Third, we will show that PAs have less social scaffolding for them to lean on (online courses, Facebook Groups, role models). They are more "on their own".
To better understand how regulations can impact PA entrepreneurship, let's look at rates of business formation by state.
Compared to Nurse Practitioner entrepreneurship, PA business formation is more nascent. Given this, we see more randomness in state by state entrepreneurship rates but also some trends. Our LinkedIn data shows that generally states with greater levels of PA autonomy have greater levels of entrepreneurship. This autonomy includes scope of practice limitations, physician supervision requirements, and physician business ownership requirements (CPOM).
Top states for PA entrepreneurship either have notably higher amounts of practice autonomy for PAs, such as Montana and Idaho, or have more accommodating Corporate Practice of Medicine Laws (CPOM) such as Florida. The AAPA rates many of the top entrepreneurial states as Advanced or Optimal for PA practice autonomy.
The states with the least PA entrepreneurship tend to have stricter regulations on PAs practice autonomy. The AAPA rates Ohio and New York as “moderate” autonomy.
According to the NCCPA yearly reports on PA employment, some states are growing quickly in their numbers of PA owned practices. The trend appears to be triggered by states passing new regulations to open up PA practice autonomy. Wyoming, Indiana, and New Hampshire have all recently increased autonomy for PAs, which is correlated with accelerating PA-owned practice formation.
Each way we slice the data, it appears that lower levels of practice autonomy drive lower levels of entrepreneurship, and overall PAs have less autonomy than NPs. Conversely, increasing autonomy appears to trigger PA business formation as we see in specific states that have changed regulations like California or Wyoming.
Based on our LinkedIn data, PAs predominantly establish aesthetics, primary care, and wellness practices—exhibiting higher rates in aesthetics and primary care than NPs. Conversely, NPs create three times as many mental health practices.
In California in 2024 around 30% of new NP businesses are in mental health (have “mental health” or “psych” in the business name), compared to 0% of PA businesses. This matters because there has been a boom in demand for mental health services (and specifically telemedicine) since the pandemic and psych NPs are forming businesses to fill the demand. Psych NPs have a much higher rate of entrepreneurship than non-psych NPs. According to the LinkedIn data, Psych NPs (5.5%) are more than twice as likely to open practices in comparison to non-psych NPs (2.4%). If you remove psych NPs from the calculations, NPs are no more entrepreneurial than PAs.
As we showed from the California incorporation data, NPs start businesses at greater rates than PAs. We also showed the regulatory burdens such as supervision requirements and corporate ownership limits, drive down rates of PA business formation, but we believe there is another factor: the lack of a support network for PAs to start their own practices.
There is a long history in the US of physicians opening practices, it used to be the norm, less so now, but still 12% of physicians are self-employed. There is a more recent history of NPs opening practices. Our LinkedIn Data shows NPs are 30% more likely to start businesses, and the California business formation data is even more extreme, showing NPs starting businesses at 3x the rate as PAs.
We can answer this question by looking at Google search volume. Are PAs searching for resources surrounding starting businesses at the same rates as NPs?
Yes, they are. Both NP and PA searches surrounding starting their own clinics have been growing, and recently they are at very similar levels. Since there are less PAs in the US than NPs, this means PAs are actually seeking out help to start their own clinic at higher rates than NPs.
Every way we can slice it, there are a lot less resources available to PAs looking to start their own clinics. There are a handful of Facebook Groups supporting NP entrepreneurs, but we’re not able to find any supporting PA entrepreneurs. If you Google search “nurse practitioner business ideas” you get 135 results, if you search “physician assistant business ideas” you get 1. It appears that the support structure has yet to be created for physicians assistants.
Does this lack of support cause less PA entrepreneurship or is it caused by less PA entrepreneurship? Marc McManus PA-C, Psy.D, who is also a PA entrepreneur says, “PAs are a dependent profession, there isn’t a culture of mentorship. Especially for starting your own business, we don't have a lot of PA coaches or PA guidance.” With 1,120 PAs every month Googling for help in opening their own clinic, it seems like the time has come for enterprising PAs to step in and create that guidance.
It seems like the right mental model to think about physician assistant entrepreneurialism is “just a little behind” that of NPs. Practice autonomy regulations have been slower to change for PAs, compared to NPs. As regulations change, a “cottage industry” emerges of supportive resources like masterclasses, Facebook Groups, mentors, and role models. In sum, that support network is yet to emerge for physician assistants. We say, "physician assistants: it's time to build”.
To investigate Physician Assistants' entrepreneurial trends, we gathered data from LinkedIn, targeting profiles that listed current or past job titles with “physician assistant” in them. This approach resulted in a pool of 160,218 PA profiles. From there, we honed in on profiles where 'founder' or 'owner' was specified in the current job title, identifying a group of PAs who had ventured into business ownership. This selection formed the basis for the trend analysis presented in our report.
Sources: LinkedIn, California Secretary of State Business Search, Google Ads Keyword Planner, NCCPA Statistical Profile of Board Certified PAs by State
Fair Use: Feel free to use this data and research with proper attribution linking to this study.
Media Inquiries: For media inquiries, contact team@singleaimhealth.com
Thanks to Kevin Riddleberger, Marc McManus PA-C, Psy.D, Eric Bergersen, PA-C, MHA, Kusum Chanrai, Terra Curtis, and others for reviewing this article.
NPs are 87% female, PAs are 66% female. Some have proposed that the higher rates of female NPs could describe higher rates of entrepreneurship, for example, women seeking more flexible work arrangements at higher rates. We looked at the LinkedIn data, and saw no pattern indicating gender influenced entrepreneurship rates among NPs and PAs.
PAs make slightly more ($130,000/yr) than NPs ($126,000/yr) on average. A hypothesis is since PAs make more money while employed, then they have higher opportunity cost in starting their own business. Our data set provides no way of exploring this, but given the small difference in pay we think this is unlikely a large factor.
From the most comparable data, burnout rates appear similar between PAs and NPs, so it seems unlikely this is a significant factor driving differences in entrepreneurialism rates.
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