{
  "source": "Cooked Index — occupational AI risk register",
  "page": "https://cookedindex.com/jobs/nurse-practitioners/",
  "methodology": "https://cookedindex.com/methodology",
  "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.",
  "scored_at": "2026-08-11",
  "model": "claude-opus-5",
  "occupation": {
    "title": "Nurse Practitioners",
    "soc_code": "29-1171",
    "category": "Healthcare",
    "us_employment": 323040,
    "median_annual_wage": 132300
  },
  "verdict": "SAFE",
  "risk_resistance": 80,
  "contested": false,
  "near_boundary": false,
  "dimensions": {
    "task_resistance": 13,
    "embodiment": 16,
    "liability_shield": 18,
    "trust_premium": 16,
    "judgment_accountability": 17
  },
  "reasoning": {
    "task_resistance": "A 13 reflects the split day: palpating an abdomen, draining an abscess, inserting an IUD, and reading a patient's affect across the exam table stay off-limits to software, but chart review, ICD-10/CPT selection, refill triage, standing-order protocol visits for strep or UTI, and the entire note-writing load are already being handed to scribes and algorithms — enough of the shift is screen work to keep this out of the 14+ band.",
    "embodiment": "A 16 is earned in acute and primary care rooms where you do the pelvic exam, the joint injection, the wound closure, the neuro exam, and the code — uncontrolled bodies, uncooperative kids, home visits and SNF rounds — though it stops short of 18-20 because a meaningful and growing share of NP visits are telehealth and e-consult where nobody is touched.",
    "liability_shield": "An 18 tracks the fact that your NPI and DEA number go on the prescription, your state licence is what a board can suspend, and in 27-plus full-practice-authority states you are the named defendant rather than a collaborating physician's extension — the two points held back acknowledge that scope-of-practice is statute, and legislatures rewrite statute.",
    "trust_premium": "A 16 reflects panel medicine: patients request you by name, disclose the drinking and the domestic violence because of continuity across years, and adherence to the plan depends on whether they believe you — but urgent care, retail clinics, and locum coverage make a real fraction of NP encounters one-off, which caps it below the 18-20 of a solo therapist or midwife.",
    "judgment_accountability": "A 17 covers the calls that guidelines don't close: whether this chest pain goes to the ED or home with a stress test next week, whether to start or refuse a controlled substance in a patient with a flagged PDMP, when to override a sepsis alert, and how to work up a vague complaint in someone with six comorbidities — you sign the differential and own the miss, with the shortfall from 20 reflecting how much of primary care runs on USPSTF and specialty algorithms."
  },
  "rationale": "Nurse practitioners physically examine patients, perform procedures like suturing, joint injections, and pelvic exams, and hold prescriptive authority that requires a licensed human signature — none of which an AI can execute or legally own. The documentation-heavy layer of the job (note writing, coding, prior-auth letters, patient education handouts, differential-diagnosis brainstorming) is exactly what current models do well, so ambient AI scribes and decision support will compress the clerical share of the day rather than the clinical one. The likely outcome is more patients per NP and faster panels, not fewer NPs; note that the licensure/prescribing shield is regulatory and scope-of-practice rules can shift.",
  "outlook": "Demand keeps climbing as NPs absorb primary care shortfalls, with AI eliminating most of the charting burden and pushing NPs toward higher patient volumes and harder cases.",
  "what_would_raise_it": {
    "levers": [
      {
        "dimension": "liability_shield",
        "change": "State boards or DEA rules explicitly requiring that any AI-generated prescription, dosage change, or triage disposition be reviewed and signed by a licensed independent practitioner with personal liability — analogous to the pharmacist-countersign model. Also: full practice authority expansion (now in ~27 states plus VA) makes NPs the accountable signer rather than a physician-supervised extender, moving the shield onto the NP's own license.",
        "plausibility": "already happening",
        "would_add": 2
      },
      {
        "dimension": "judgment_accountability",
        "change": "If ambient scribes and decision support absorb documentation, coding, and differential generation, the residual day is disposition calls, undifferentiated complaints, and goals-of-care conversations. Watch for malpractice insurers (e.g. NSO/CNA NP policy language) pricing 'AI-assisted' visits with an explicit override-documentation requirement, which formalizes the NP as the accountable decider on every AI recommendation.",
        "plausibility": "plausible",
        "would_add": 2
      },
      {
        "dimension": "task_resistance",
        "change": "Genuine two-tier structure: the clerical tier (notes, prior-auth letters, handouts, coding) is the tier being automated; the residual tier is procedures, exam findings under uncertainty, and dispositions. Panel-size growth per NP raises the judgment density of each remaining hour rather than lowering total task resistance.",
        "plausibility": "already happening",
        "would_add": 2
      },
      {
        "dimension": "trust_premium",
        "change": "Payer or employer contracts guaranteeing a named human clinician per patient panel — e.g. direct primary care and concierge models that market continuity with a specific NP, and CMS primary-care management codes (99490, G2211) that pay for a continuous clinician relationship rather than an encounter.",
        "plausibility": "plausible",
        "would_add": 1
      }
    ],
    "ceiling_note": "Already 80/100; headroom is small and the main downside risk is the mirror of the upside — scope-of-practice liberalization that lets pharmacists, RNs, or AI-supervised protocols handle the routine prescribing tier would erode the licensure shield rather than reinforce it. Employment risk here is panel-size dilution (fewer NPs hired per population), not task substitution."
  },
  "adjudication": null,
  "employment_history": {
    "points": [
      {
        "y": 2017,
        "emp": 166280,
        "wage": 103880
      },
      {
        "y": 2018,
        "emp": 179650,
        "wage": 107030
      },
      {
        "y": 2019,
        "emp": 200600,
        "wage": 109820
      },
      {
        "y": 2020,
        "emp": 211280,
        "wage": 111680
      },
      {
        "y": 2021,
        "emp": 234690,
        "wage": 120680
      },
      {
        "y": 2022,
        "emp": 258230,
        "wage": 121610
      },
      {
        "y": 2023,
        "emp": 280140,
        "wage": 126260
      },
      {
        "y": 2024,
        "emp": 307390,
        "wage": 129210
      },
      {
        "y": 2025,
        "emp": 323040,
        "wage": 132300
      }
    ],
    "from": 2017,
    "to": 2025,
    "change_pct": 94.3,
    "comparable_from": 2019,
    "spans_soc_revision": true
  },
  "pivots": [],
  "license": "https://cookedindex.com/terms"
}