Looking for a career move that’s both in demand and financially rewarding? Many of the best nurse practitioner (NP) and physician assistant (PA) specialties fly under the radar—yet they offer incredible growth, flexibility, and pay potential. With more than 83 million Americans lacking access to a primary care provider, NPs and PAs are stepping into the spotlight as essential players in the future of healthcare.

The numbers tell the story: Pediatric NPs are projected to see a staggering 38% job growth by 2032, while top-earning PAs in cardiovascular/cardiothoracic care bring in over $152,000 per year. From mental health to anesthesiology, specialized roles are opening doors to higher salaries and long-term stability at a time when physician shortages are reshaping the system.

In this guide, we’ll explore the NP and PA specialties with the highest demand, strongest earning power, and best long-term outlook—plus tips to help you choose the path that aligns with your career goals.

Why some NP and PA specialties fly under the radar

While the field has expanded rapidly, there are still critical areas with soaring demand but too few providers to fill the gap. For career-driven NPs and PAs, these “hidden gem” specialties represent untapped opportunities—offering less competition, higher earning potential, and the chance to make a lasting impact where it’s needed most.

Misconceptions About Scope of Practice

One big reason many NP and PA specialties remain hidden? Widespread myths about what advanced practitioners can actually do. While physicians log tens of thousands of training hours compared to a few hundred for NPs, that gap often gets misinterpreted as a limitation—when in reality, NPs and PAs are already delivering high-quality care across countless specialties.

The rules don’t make things easier. Independent practice is allowed in 28 states for NPs, while PAs face varying supervision requirements in nearly every state. Add in confusing laws about prescribing authority, and suddenly whole specialties look “off-limits” even though they’re wide open in many parts of the country. The truth: these barriers are more perception than reality—and practitioners who see through the noise often uncover opportunities others miss.

Lack of Awareness in U.S. Training Programs

In the United States, NP and PA specialties often remain hidden because of how education and workforce planning are structured. Many new graduates simply aren’t exposed to emerging specialty opportunities during training. NP programs typically emphasize primary care populations, while PA programs follow a generalist medical model. This leaves limited room for early specialty exposure, even though specialty demand is rapidly expanding.

National data collection also adds to the problem. The Health Resources and Services Administration (HRSA) workforce models often group NPs and PAs as “generic providers,” without breaking down their contributions by specialty. Similarly, the National Center for Health Workforce Analysis tracks dozens of physician specialties but does not consistently classify NP and PA specialties. This lack of visibility makes it harder for policymakers, educators, and even students to fully grasp where the biggest opportunities lie.

Clinical training itself varies widely. Some programs give students strong rotations in areas like cardiology, oncology, or behavioral health, while others barely touch on them. As one educator put it, “We have no control over how their 500 hours of training is spent. It could be highly specialized, or it could be wasted.” Without standardized exposure, many students graduate unaware of the full career paths available.

Until training programs and workforce models highlight NP and PA specialties more clearly, these valuable roles will remain under the radar. For practitioners willing to seek out opportunities beyond their formal education, however, this gap can become an advantage—opening doors to high-demand specialties with less competition.

Specialties with rising demand and low saturation

NPs and PAs can find amazing career opportunities in several advanced practice specialties that haven’t reached their full potential yet. These fields give practitioners a chance to do meaningful work where demand is high but competition remains manageable.

1. Psychiatry and Mental Health

The mental health field desperately needs more providers, which makes Psychiatric Mental Health Nurse Practitioners (PMHNPs) incredibly valuable. Mental health issues affect about 15% of people over 60, and this number keeps growing. PMHNPs can make around $130,000 yearly, with some earning up to $157,409. Rural counties face a serious shortage – 69% don’t have a single psychiatric mental health nurse practitioner. This creates great opportunities for providers who want to help these communities.

2. Occupational and Environmental Medicine

Advanced practitioners can thrive in occupational and environmental medicine. The American College of Occupational and Environmental Medicine (ACOEM) now lets NPs and PAs get specialized certification. Their program includes seven detailed modules that cover everything in OEM and provides 30 hours of continuing education credit. Practitioners can work in urgent care, corporate health, and industry-based clinics.

3. Geriatric and Long-Term Care

America’s aging population needs more geriatric specialists. Geriatric NPs and PAs work in private practices, long-term care facilities, hospitals, and academic centers. They focus on person-centered care, detailed geriatric assessment, and mobility management. The job pays well – around $125,000 yearly, with excellent job security as this specialty keeps growing.

4. Hospitalist and Inpatient Medicine

Hospital medicine programs have embraced NPs and PAs – 84% of adult programs and 45% of pediatric programs include them. These practitioners help reduce hospital stays compared to physician-only teams. They manage their own patients while working closely with physicians in paired rounding models. NP and PA hospitalists earned a median salary of $106,246 in 2015.

5. Surgical Subspecialties (e.g., Urology, ENT)

Surgical subspecialties offer lucrative paths for advanced practitioners. Urologist demand will likely grow by 45% from 2021 to 2035. The number of PAs and NPs doing urology procedures has more than doubled between 2014 and 2021. Cardiovascular/cardiothoracic surgery pays the most, with PAs earning about $152,000 yearly.

6. Dermatology

Dermatology shows great promise with over 75 million people living in areas that lack health professionals. Advanced practitioners help fill this gap, especially since dermatologists only handle 40% of skin disease cases nationwide. More post-graduate dermatology fellowship programs for NPs and PAs keep opening up at places like Regis University, Penn State, and University of Rochester.

7. Critical Care

Critical care needs keep growing faster than the number of physician specialists. Advanced practitioners in ICUs get similar or better patient outcomes, including shorter hospital stays. PAs in critical care earn more than other specialties – about $137,793 on average. The field has grown steadily from 1,060 PAs in 2015 to 2,561 currently.

8. Urgent Care

Urgent care gives NPs and PAs great independence and variety in their practice. About 48.2% work in physicians’ offices, 17.9% in hospitals, and 9% in outpatient care centers. Practitioners can diagnose and treat acute conditions on their own, often without having a physician on-site.

How to assess if a specialty is right for you

Picking the right specialty needs more than just looking at potential salary. Your decision should match your strengths, lifestyle preferences, and career goals. Let’s get into the key factors that help you see if a specialty lines up with what you want professionally.

Matching your interests with patient population

Your clinical experience gives you a natural place to start when looking at specialties. To cite an instance, if you worked in pediatrics, family practice might feel natural, while ICU nurses often do well in critical care NP roles. Your passion for specific patient populations ended up being what keeps you going through tough days in your practice.

Take time to think about which age groups and medical conditions really interest you. Your excitement about your chosen patient population becomes the driving force that helps you push through challenging times. The kind of care you want to provide helps you decide if the nursing or medical model works better for your goals.

Work-life balance and shift structure

Your ideal work schedule substantially affects how happy you are in your career. Some specialties give you regular weekday hours in private clinics, while hospital roles usually mean nights, weekends, and holiday shifts. This difference matters even more when you have family responsibilities.

More than that, picture your “ideal schedule” before you take any position. Think about personal factors like children, your partner’s schedule, and commitments that affect when you want time off. The way your shifts are set up—standard eight-hour days, four 10-hour shifts weekly, or 12-hour rotations—deeply affects your quality of life.

Opportunities for advancement

Long-term growth potential is vital when choosing a specialty. Some fields have clearer paths up or better earning potential than others. Certain specialties just need specific certifications or extra training that might affect your choice.

Think over whether your chosen specialty creates opportunities beyond clinical work. Many PAs move into pharmaceutical research, academic teaching, healthcare administration, or public sector roles. Others find satisfaction in locum tenens positions that offer schedule flexibility and help prevent burnout.

The employer’s support system is another vital factor to consider. Look for solid onboarding processes, continuing education support, and shared workplace cultures that encourage professional growth. Research into high-demand areas like rural or underserved regions might show opportunities with competitive salaries and loan repayment incentives.

Training pathways and certifications

Healthcare environments are competitive. NPs and PAs can advance their careers by choosing specialized training paths. Getting certified in high-demand specialties is a vital step to secure better positions.

NP specialty tracks and board exams

Several nationally recognized bodies certify nurse practitioners. The American Association of Nurse Practitioners Certification Board (AANPCB) certifies Family, Adult-Gerontology, Emergency, and Psychiatric Mental Health NPs. The American Nurses Credentialing Center (ANCC) also provides board certification for Family, Adult-Gerontology Acute Care, and Primary Care specialties.

You’ll need a graduate degree (MSN or DNP) and must pass a national exam to get certified. Your license stays valid through continuing education. NP programs include at least 500 clinical hours, and certification remains valid for five years. To recertify, you must complete 75 hours of continuing education and log 1,000 practice hours.

PA generalist training and specialization options

PA education follows a different path than NPs. PAs complete standardized master’s programs that last about 27 months and include over 2,000 hours of clinical rotations. This broad foundation gives them career flexibility—49% of PAs work in multiple specialties throughout their careers.

PAs can switch between specialties without extra formal education thanks to their detailed medical training. Most PAs who change specialties (73%) stay within either primary or non-primary care. Their training covers family medicine, internal medicine, pediatrics, surgery, and emergency medicine.

Postgraduate programs and CAQs

Certificates of Added Qualifications (CAQs) let PAs showcase their specialized expertise beyond board certification. CAQs are available in twelve specialties—including cardiothoracic surgery, dermatology, emergency medicine, and psychiatry. These certificates require specialty experience (2,000-4,000 hours), specialty-specific CME credits, peer attestation, and passing a specialty exam.

NPs and PAs can also choose optional postgraduate fellowships. These 12-month programs at institutions like Mayo Clinic provide focused training in hospital medicine, critical care, and palliative care. Postgraduate training makes you more competitive in high-demand specialties. The Accreditation Review Commission currently accredits 16 clinical postgraduate PA programs nationwide.

Future outlook and workforce trends

Healthcare careers for advanced practitioners show faster growth than ever before. The U.S. Bureau of Labor Statistics projects a 45% growth rate for nurse practitioners from 2023 to 2033, making it one of the fastest-growing healthcare careers. Physician assistant positions will likely grow by 37% between 2024 and 2034.

Most needed nurse practitioner specialties by 2030

Several specialties will see significant growth as we move toward 2030. Psychiatric Mental Health guides the way as one of the top 3 most in-demand nurse practitioner specialties. Family Nurse Practitioners will play a crucial role since family medicine faces physician shortages between 17,800 to 48,000 by 2034. Adult-Gerontology Primary Care NPs will become essential as one out of every 5 Americans reaches retirement age by 2030.

How locum tenens can open specialty doors

Locum tenens work helps practitioners learn about different specialties. Healthcare facilities now depend on temporary providers, with 85% using these services. Opportunities are plentiful in autonomous practice states and rural communities. Primary care and behavioral health positions remain common, while acute care roles have grown significantly in the last decade.

Policy changes expanding NP/PA roles

NP practice authority reached a milestone in 2025 when Michigan, Alabama, Louisiana, South Carolina, and Wisconsin joined states allowing independent practice. Now 34 states and DC offer full practice authority. PA roles continue to expand too. Arizona’s practitioners with 8,000 hours of clinical experience can now establish collaborative practices without direct physician supervision starting in 2024.

Conclusion

NPs and PAs can now work way beyond their traditional roles. Our research shows several specialties with huge growth potential that don’t have much competition yet. Psychiatry, occupational medicine, geriatrics, and surgical subspecialties are great options that forward-thinking practitioners should think over.

Many people overlook these specialties because they misunderstand what they can do in these roles. But the rules keep changing, and more states give full practice authority each year. These changes open up amazing career paths for professionals ready to try something different.

You need to take a good look at yourself when picking your specialty. Your chosen field should line up with your interests, the patients you want to work with, your ideal schedule, and your long-term goals. On top of that, knowing about certification options helps you plan your career path better.

Specialized NPs and PAs have a bright future ahead. Job forecasts show nurse practitioners will grow by 45% and physician assistants by 37% over the next decade. These numbers mean qualified professionals will have excellent job security and strong negotiating power.

Take a close look at these emerging specialties as you map out your career. These fields let you do meaningful work helping patients with critical needs, whether you choose traditional jobs or locum tenens positions. Professionals who spot these hidden opportunities now will lead the way before everyone else catches on.

Key Takeaways

These insights reveal high-growth specialty opportunities for NPs and PAs that remain underexplored despite exceptional career potential and rising healthcare demands.

• Psychiatry and mental health lead demand – 69% of rural counties lack psychiatric NPs, with salaries reaching $157,409 annually

• Regulatory barriers create artificial limitations – Misconceptions about scope of practice keep practitioners from exploring lucrative specialties like surgical subspecialties

• Generalist PA training enables specialty flexibility – 49% of PAs work in multiple specialties throughout their careers without additional formal education

• Job growth projections are exceptional – NP positions will grow 45% by 2033, PA roles 37% by 2034, creating unprecedented opportunities

• Full practice authority is expanding rapidly – 34 states now grant NPs independent practice, with more states joining annually

The healthcare workforce shortage creates a perfect storm of opportunity for advanced practitioners willing to explore these hidden specialty paths before they become oversaturated.