What role will nurse practitioners likely have in the next 20 years?

This is an excellent question and I think if you were to ask a few different sources you will get several different answers. Bottom line, it's uncertain but I think the short answer to your question is not one or the other but both. Even know the primary shortage is getting a fair amount of media attention, we are also seeing shortages in intensivists (ICU critical care physician). I think that NPs fulfill both of these roles quite well in both of these settings.

NPs are part of the primary care shortage solution, along with primary care physicians and other advanced practice providers, such as physician assistants and primary care physicians. The purpose is not to supplant or replace primary care physicians, rather to augment the workforce since the primary care demand is so very high. I think we will continue to see growth in primary care with NPs providing this valuable service especially to underserved communities.

Specialty services can often be provided in-clinic or in a hospital, and I'm sure you see nurse practitioners in both of these settings - but you also might see other advance practice providers, such as physician assistants as well. A big question: Are PA's utilized more predominantly in these settings? The answer depends and is largely influenced by a number of factors such as geographical area, state licensure laws, health care leadership preferences and even physician preference. There are areas such as the east coast of the United States that seem to integrate NPs very well in these acute care and specialty settings whereas the west coast of the United States is just starting to realize their potential after traditionally underutilized NPs favoring PA's in these settings. As someone who initially worked on the east coast and now lives on the west coast, I've noticed a clear difference in the roles even though NPs are educated to the same standard nationwide.

In the end, I think both show great opportunities - but you should decide on what area interests you the most.

Best of luck, and I feel you should get a few different perspectives, especially from our physician colleagues - the issue of full practice authority is a hotly contested issue right now - so that could certain influence your decision.