Nurse practitioners (NPs), physician assistants (PAs) and certified nurse midwives(CNMs) play growing roles in the health care workforce. Experts recommended in the mid-1990s that their numbers be increased to address concerns about an inadequate supply andmaldistribution of primary care practitioners. In response, educators have dramatically increasedthe numbers of students educated in these professions. Efforts are underway in many states to expand the scope of practice and enhance the reimbursement of these practitioners.