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Research Brief No. 19: Four Countries, One Pressure Pattern | Concierge Medicine Today
Concierge Medicine Today
Research Brief No. 19. Global Workforce. September 2026.
Research Brief No. 19

Four countries, one pressure pattern

Physician strain and the deployment of nurse practitioners and physician assistants in the United States, Canada, the United Kingdom and Australia, compared as directly as the data allow.

Every system is short on time. Every system is reaching for NPs. Only one has a membership market big enough to learn from.

International workforce slides tend to line up four countries and four burnout numbers as if they were measured with the same ruler. They were not. This brief compares what can be compared, flags what cannot, and draws out the lessons that genuinely travel across borders.

Concierge Medicine Today Editorial Research Desk. Michael Tetreault, Editor-in-Chief. Sources verified September 25, 2026.
Abstract

Summary

Objective. To compare physician workforce strain and NP/PA deployment in four high-income health systems using the most recent national sources.

Methods. Structured review of national agency reports, regulator surveys and professional association data, 2024 to 2026. Each metric was assigned a comparability rating.

Results. All four systems report persistent physician strain. Reported physician burnout ranges from 18% (U.K., "high risk") to 46% (Canada, "high burnout"), on instruments that are not interchangeable. NP roles are expanding in all four. PA roles range from central (U.S.) to constrained (U.K. after the 2025 Leng Review) to minimal (Australia).

Conclusion. Physician strain is structural and persistent, and NP growth is universal. Beyond that, cross-country claims should be made with care. The U.S. is the only system in this group where membership-based primary care operates at scale.

International workforce comparisons require care, because many commonly paired figures were never designed to sit side by side. Burnout in the U.S. is often measured as "at least one symptom." Canada reports "high burnout." The U.K. regulator uses the Copenhagen Burnout Inventory and reports "high risk." Put those in one bar chart without labels and the chart misleads. Figure 19.1 therefore rates each value for comparability.

Results

The side-by-side comparison

Figure 19.1. Apples-to-apples workforce comparison, with comparability ratings
Most recent national figure per metric, 2024 to 2026. Dot color shows how safely each value can be compared across countries.
MetricUnited StatesCanadaUnited KingdomAustralia
Physician burnout 41.9%At least one symptom, AMA 2025 1 46%High burnout, CMA 2025 2 18% high riskAll doctors, GMC; 61% of trainees at moderate or high risk 3,4 No national %45% of trainees report heavy workload, MTS 2025 5
Access gap No direct analogU.S. tracks "usual source of care," which is declining 6 5.9 million adultsNo regular clinician, OurCare 2025 7 Not assessedNo equivalent national count reviewed Not assessedNo equivalent national count reviewed
Physician supply outlook 70,610 FTE shortPrimary care physicians by 2038, HRSA 8 +49% neededFamily physicians to meet current demand, CIHI 9 ParadoxAccess pressure alongside GP underemployment, BMA 2025 10 7,700 GPs short5,560 FTE by 2033, Australian Government 11
Physician supply today 340,319 PCPsPrimary care physicians, 2023, HRSA 8 99,555 physiciansAll specialties, 241 per 100,000, 2024 12 Not assessedNo figure reviewed for this brief Not assessedNo figure reviewed for this brief
NP role 461,000+ licensedFull practice authority in 27 states plus D.C. 13,14 Fastest growing+6.7% per capita in 2024, CIHI 15 ANPs embeddedNo verified national headcount in this review Aged, rural, remote focusRACGP opposes models that duplicate GP services 16
PA role 189,907 certified56 per 100,000 people, NCCPA 17 LimitedRegulated in some provinces only 9 Restricted after reviewRenamed; GMC registration by Dec 13, 2026 18,19 Very limitedNot registered with Ahpra; limited to state-level roles 20
Membership-model relevance High3,036 concierge and DPC sites in 2023 21 LowPublic insurance rules constrain private primary care fees (inference) NichePrivate GP market exists; not assessed NicheNot assessed
Comparable national figureComparable with caveat (different instrument or definition)No comparable figure, or not assessed
Canadian burnout data include practising physicians and residents. U.K. figures come from the GMC's workplace experiences report and National Training Survey. © 2026 Concierge Medicine Today, LLC.
Figure 19.2. Physician burnout is high everywhere, but the rulers are different
Reported share of physicians with burnout, by each survey's own definition. Bars are not directly comparable.
U.S. AMA 2025, 41.9 percent at least one symptom; U.S. Mayo, AMA and Stanford 2023, 45.2 percent; Canada CMA 2025, 46 percent high burnout; U.K. GMC all doctors, 18 percent high risk; U.K. GMC trainees 2025, 61 percent moderate or high risk; Australia, no national comparable figure. 0%25%50%75% U.S., AMA 2025at least one symptom 41.9% U.S., Mayo/AMA/Stanford 2023at least one symptom 45.2% Canada, CMA 2025high burnout 46% U.K., GMC all doctorshigh risk (CBI) 18% U.K., GMC trainees 2025moderate or high risk 61% Australiano national comparable % not reported 50% reference line
Sources: AMA 1,22; CMA 2; GMC 3,4; Medical Board of Australia 5. Burnout remains elevated in every system that measures it, but the figures should not be ranked against one another. © 2026 Concierge Medicine Today, LLC.
Country notes

Four responses to the same pressure

United States: expand autonomy

The U.S. has the largest NP and PA workforces in the world by a wide margin: more than 461,000 licensed NPs and 189,907 board-certified PAs.13,17 Policy has moved toward NP autonomy, with full practice authority in 27 states plus D.C. on AANP's map and several more states changing law in 2025 and 2026.14,23 HRSA projects a primary care physician shortage of 70,610 FTEs by 2038, and the Commonwealth Fund notes that NP supply in rural areas is projected to keep exceeding demand.8,24

Canada: scale team-based care

About 5.9 million Canadian adults lack a regular family doctor, NP or primary care team, down from 6.5 million in 2022.7 The CMA reports 46% of physicians with high burnout and about 10.4 hours per week on administrative work.2 NPs were among the fastest-growing health professions per capita in 2024.15 PAs remain a small profession regulated in only some provinces.9

United Kingdom: narrow and clarify the PA role

The U.K. offers the clearest cautionary tale. The Leng Review (July 2025) found the safety evidence inconclusive and did not recommend ending the role, but renamed physician associates as "physician assistants" and limited their first-contact work with undifferentiated patients to defined national protocols.18,19 At the same time, the BMA reported GP underemployment, with funding flowing to additional non-GP roles while some newly qualified GPs could not find work.10 GMC data show 18% of doctors at high risk of burnout, down from 25% in 2022.3

Australia: deploy NPs where GPs are scarce

Australia's government projects an unmet demand gap of 7,700 GPs (5,560 FTEs) by 2033.11 NP policy emphasizes aged, rural and remote care, while the RACGP opposes models in which other professions duplicate GP services independently of a patient's usual GP.16 National trainee data show heavy workloads but no burnout percentage comparable to other countries.5 AIHW reports that more than 12% of surveyed practitioners in several professions were contemplating leaving.25

Discussion

Three lessons that travel

Adding NPs and PAs does not automatically relieve physicians. The U.K. shows that funding non-physician roles without a coherent plan for physician employment and supervision can produce professional backlash and even physician underemployment.10

Role clarity matters as much as headcount. The Leng Review did not end the PA role; it defined it. Clear scopes, titles and supervision lines were the remedy, not elimination.18

The U.S. is the relevant laboratory for membership medicine. Concierge and DPC practice sites grew from 1,658 to 3,036 between 2018 and 2023.21 No other country in this group has a comparable private membership market in primary care, so lessons about NPs and PAs inside membership practices must come primarily from U.S. data. Brief No. 20 takes that up.

The defensible macro conclusion is modest: strain is structural, NP growth is universal, and how a system defines roles determines whether new clinicians relieve pressure or add to it.

Methods and limitations

How this comparison was built

Sources

National agencies (HRSA, CIHI, AIHW, Australian Government Office of Impact Analysis), regulators (GMC, NHS Employers, Medical Board of Australia), professional bodies (AMA, CMA, BMA, RACGP, AANP, NCCPA) and peer-reviewed literature. Searches were conducted September 25, 2026.

Comparability ratings

A value was rated comparable when it described the same concept in a national population. It was rated comparable with caveat when the concept matched but the instrument, definition or population differed. Otherwise it was rated not comparable or not assessed.

Limitations

Burnout instruments differ by country. Physician headcounts and FTE projections use different models. Several U.K. and Australian metrics were not assessed and are shown as gaps rather than filled with estimates. Canada's membership-market relevance is an editorial inference based on the structure of public insurance, not a measured value.

Research support

Literature searches for this brief were supported by AI-assisted research tools. Every statistic is tied to the cited source, and derived figures are labeled. Concierge Medicine Today does not accept vendor sponsorship in exchange for coverage.

Cite as: Concierge Medicine Today Editorial Research Desk. Four Countries, One Pressure Pattern: Physician Strain and NP/PA Deployment in the U.S., Canada, U.K. and Australia. CMT Research Brief No. 19. Concierge Medicine Today, LLC; September 2026. Available at https://conciergemedicinetoday.net/global-physician-shortage-np-pa

Disclaimer

This research brief is published by Concierge Medicine Today, LLC for educational and informational purposes only. It does not constitute medical, legal, financial, tax or accounting advice, and it should not be relied upon as such. Scope-of-practice rules, corporate practice of medicine doctrines, title-disclosure requirements, Medicare participation and concierge fee arrangements, and consumer-protection rules for membership agreements vary by state and jurisdiction and change frequently. Consult qualified legal, regulatory and financial professionals before making practice decisions.

Concierge Medicine Today is an independent leadership publication and industry convener. It does not endorse any practice model, company or vendor, and it does not disparage other models of care or other professions. References to organizations are informational and do not imply endorsement by or of those organizations.

Statistics are reported as published by the cited sources. Where CMT has derived, rounded or inferred a figure, the brief says so. Readers should consult original sources before citing any figure. Corrections are made openly: if you identify an error, contact the editors and it will be acknowledged and corrected.

© 2026 Concierge Medicine Today, LLC. All rights reserved.

References

  1. American Medical Association. Physician burnout rate continues to decline, falling to nearly 42%. April 16, 2026. ama-assn.org. Coverage: Fierce Healthcare, April 21, 2026. fiercehealthcare.com
  2. Canadian Medical Association. Five years since onset of COVID-19, Canada's physicians still suffer high rate of burnout (2025 National Physician Health Survey). October 14, 2025. cma.ca
  3. Medscape. GMC: burnout drops, but doctors still eyeing exit (General Medical Council workplace experiences report, 2025). August 2025. medscape.com; GMC full report PDF
  4. British Medical Association, The Doctor. Demand to tackle burnout (GMC National Training Survey). July 2026. thedoctor.bma.org.uk
  5. Medical Board of Australia and Ahpra. 2025 Medical Training Survey: high-level snapshot. medicaltrainingsurvey.gov.au
  6. HRSA. State of the Primary Care Workforce, 2024 (hosted copy). iafp.org
  7. Canadian Medical Association. New survey reveals access to primary care growing, but 5.9 million adults in Canada still lack regular doctor (OurCare Survey 2025). December 8, 2025. cma.ca
  8. Health Resources and Services Administration, National Center for Health Workforce Analysis. State of the Primary Care Workforce, 2025. bhw.hrsa.gov
  9. Canadian Institute for Health Information. The state of the health workforce in Canada, 2024. December 2025. cihi.ca
  10. British Medical Association. Letter to the Secretary of State on GP unemployment. May 20, 2025. bma.org.uk; BMA campaign page bma.org.uk
  11. Australian Government, Office of Impact Analysis. Building the General Practice Workforce: impact analysis. February 2025. oia.pmc.gov.au
  12. CIHI. Physicians (2024 supply). cihi.ca
  13. American Association of Nurse Practitioners. Nurse practitioners recognized nationwide during National NP Week. November 10, 2025. aanp.org. Also: A behind-the-scenes look at the 2025 nurse practitioner count. November 11, 2025. aanp.org
  14. BellMedEx. Full practice authority states for nurse practitioners (citing the AANP state practice environment map, updated May 2026). July 2026. bellmedex.com
  15. CIHI. Health workforce in Canada: overview. cihi.ca
  16. Royal Australian College of General Practitioners. Submission: Nurse Practitioner Workforce Strategic Plan consultation. February 2023. racgp.org.au
  17. National Commission on Certification of Physician Assistants. PA profession adapts to evolving health needs: 2024 Statistical Profile of Board Certified PAs. May 12, 2025. nccpa.net
  18. Patient Safety Learning. The Leng Review: an independent review into physician associate and anaesthesia associate professions. July 16, 2025. pslhub.org; Hill Dickinson analysis hilldickinson.com
  19. NHS Employers. Physician associates. April 2026. nhsemployers.org; Management in Practice. Practices urged to check PA registration ahead of GMC deadline. 2026. managementinpractice.com
  20. InSight+, Medical Journal of Australia. Physician assistants in Australia: regulatory and training concerns. 2024. insightplus.mja.com.au; The Medical Republic, 2024. medicalrepublic.com.au
  21. Johns Hopkins University Hub. Concierge medicine rising. December 18, 2025. hub.jhu.edu
  22. AMA. National physician burnout survey (AMA, Mayo Clinic and Stanford Medicine series, 2011 to 2023). 2025. ama-assn.org
  23. Nurse.org. Nurse practitioner practice authority by state, 2026. August 2026. nurse.org
  24. Commonwealth Fund. The state of rural primary care in the United States. November 2025. commonwealthfund.org
  25. Australian Institute of Health and Welfare. Health workforce. July 2026. aihw.gov.au
© 2026 Concierge Medicine Today, LLC. Educational and informational content only. Not medical, legal, financial or accounting advice. Return to all research briefs.