Across the United States, care delivery is shifting from a physician-only model to diversified teams where nurse practitioners (NPs) and physician associates/assistants (PAs) carry a growing shareof front-line care. There are now more than 431,000 licensed NPs nationwide, up sharply in just the last few years, and their ranks continue to climb. At the same time, board-certified PAs have reached approximately 190,000, with the profession growing nearly 28% over the past five years.

This growth is occurring against a backdrop of persistent healthcare workforce gaps, particularly in areas outside major metropolitan areas. While physician supply grows at only 3% annually, constrained by limited medical school and residency capacity, demand continues to accelerate. Federal analyses continue to project shortages in nonmetropolitan areas and in key specialties, underscoring the need to utilize the clinicians we already have effectively.

The supply is growing, the need is urgent, and a fundamental constraint to unlocking access to more clinicians is operational: how quickly and safely organizations can license, credential, supervise, and deploy these clinicians across 50 different regulatory environments.

“The question isn’t just how many clinicians you can hire,” Griffin Mulcahey, President, Zivian, explains. “It’s whether you can credential, license, and deploy them quickly and safely enough to meet demand.”

The hidden tax on scale

Compliance friction shows up in boardrooms as missed revenue targets and delayed market entries. But on the ground in health settings, it manifests as something more tangible. Clinicians hired but unable to see patients, go-to-market plans waiting on legal sign-off, and operations teams manually tracking collaboration ratios in spreadsheets across dozens of states.

Legal counsel can map the rules, but that work doesn’t scale. Each new state requires fresh research, new templates, ongoing monitoring for regulatory changes, and manual coordination between HR, legal, clinical leadership, and individual physicians serving as collaborators. The administrative burden compounds with every clinician added and every state entered.

Multistate launches stall while teams parse ambiguous scope-of-practice statutes. Credentialing drags from weeks into months because each jurisdiction demands different documentation and timelines. Collaboration agreements become negotiations, matching physician availability to state-mandated ratios, sometimes requiring physical proximity that the organization can’t easily provide. And the audit trail lives everywhere and nowhere; spreadsheets track one piece, email threads capture another, and outside counsel memos gather dust in shared drives.

The operational consequence is waste. Clinicians sit idle waiting for paperwork to clear. Care models miss launch windows. Legal spend climbs. And critically, leadership loses confidence that expansion can happen without regulatory exposure, creating a drag on growth that has nothing to do with clinical capability or market demand.

“The ‘math’ of healthcare no longer works if we rely on physicians alone,” Dr. Rafid Fadul, co-founder and CEO, shared. “The population is growing and aging, while the number of doctors isn’t keeping pace; the only way to meet the need is to activate the clinicians who are ready to treat, NPs, PAs, pharmacists, and RNs, with infrastructure built for them.”

Turning red tape into runway

Drawing on his experience as a physician and healthcare operator, Fadul recognized that compliance couldn’t remain an afterthought. It had to become infrastructure.

“Our goal was to take something painful and turn it into a durable system for care delivery,” says Fadul. “When compliance is continuous, automated, and auditable, you don’t just avoid delays, you build confidence to scale.”

Zivian productizes compliance, making it repeatable operations rather than a bespoke legal project in every state. The company’s initial wedge was a physician-collaborator marketplace that fills hard-to-staff oversight roles and medical directorships, especially in “challenge states,” in days, not months. As demand grew, Zivian layered software on top, including rule-mapping for each jurisdiction, automated licensing and renewals, checklist-driven chart-review ratios, and an auditable record that stands up to board scrutiny.

The impact is evident in the time saved and markets unlocked. Calibrate Health, a virtual metabolic care company, utilized Zivian to scale its advanced practice provider (APP) workforce across 11 new states, activating thousands of clinical hours that would have otherwise remained idle, saving an estimated six months of administrative burden.

Pomelo Care, a maternal health platform, needed physician medical directors to oversee high-risk pregnancy care across a growing footprint. Through Zivian’s marketplace, Pomelo secured a medical director in seven days and launched in 25 new states, compressing what typically takes months into weeks. The company estimates it saved roughly eight months of time-to-scale and avoided approximately $500,000 in sourcing and administrative costs.

The Zivian effect is real. Organizations that would otherwise spend months navigating state-by-state requirements instead deploy clinicians in weeks, often with higher confidence in their compliance posture than they had managing everything internally.

Building for the workforce of the future

Zivian’s current platform addresses the immediate pain of APP compliance and physician collaboration. However, the company’s ambitions extend further. The vision is a comprehensive workforce infrastructure that consolidates credentialing, licensing, continuing education tracking, performance management, and engagement into a single system.

The reasoning is structural. The information employers need to manage clinical teams overlaps almost entirely with what individual clinicians need to maintain their careers. License renewals, continuing medical education (CME) credits, procedure logs, certifications, these requirements exist whether the clinician works for one organization or five. A unified platform could serve both, creating a network effect where more users mean better data, better matching, and more value for both individuals and organizations.

Zivian’s 100-plus enterprise customers span digital health and traditional brick-and-mortar providers, creating a broad base from which to expand functionality. And the compliance wedge remains essential; no amount of workforce tooling matters if clinicians can’t legally practice where they’re needed.

Rethinking healthcare infrastructure

The physician shortage isn’t resolving. Medical school seats remain constrained, residency slots haven’t expanded proportionally, and burnout continues to pull clinicians out of active practice. Meanwhile, the U.S. population is aging into higher-acuity care needs, and 78% of the country sits in a healthcare desert by some measures.

APPs represent the most scalable path to closing that gap, but only if the operational and regulatory barriers come down. Zivian’s thesis is that compliance infrastructure, done right, becomes a competitive advantage rather than a tax. Organizations that can deploy clinicians faster, manage oversight confidently, and adapt to regulatory changes without rebuilding workflows every time will capture more market share, deliver better access, and operate with lower risk.

For APPs, streamlined compliance means faster onboarding, clearer career paths, and less time stuck in administrative limbo. It’s infrastructure that respects their capability rather than treating them as a workaround. For patients, the outcome is straightforward – more clinicians are able to see them sooner, in more places.

The regulatory complexity isn’t going away, but it doesn’t have to remain a bottleneck. That’s the opportunity Zivian is building toward, turning the labyrinth into a system of support to deliver care.