The Affordable Care Act is expected to bring an influx of newly insured patients to primary care as the number of internists and family medicine doctors is flat at best. The federal government has designated some areas as shortage areas. Nationally, the Bureau of Labor Statistics predicted faster than average job growth for physician assistants and registered nurses, which include nurse practitioners. New York may already be seeing that growth; the number of licenses issued for each profession has increased over the past three years. PAs and NPs have worked in local specialty and primary care practices for decades.