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During the past 35 years, the roles for nurse practitioners (NPs) and physician assistants (PAs) have evolved in parallel with the roles that physicians have come to play. Shifting needs in primary care and expanding opportunities in specialty medicine have been the dominant trends. Future directions will be influenced additionally by the deepening physician shortage. NPs are preparing for this future by developing doctoral-level training programs in comprehensive care, whereas PAs are adding training opportunities in specific specialties. Yet, neither discipline has expanded its training capacity to the degree that will be required, and, like physicians, neither will have a supply of practitioners that will match future demand. Coordinated planning to increase the educational infrastructure for physicians, NPs, and PAs is essential.