This study compared health services use and costs depending on whether the primary care provider was a physician, NP, or PA.

• NPs and PAs are taking a larger role in the primary care of medically complex patients with chronic conditions, but there concerns about the effects on costs.
• This study used Veterans Affairs data on medically complex patients with diabetes to compare health services use and costs depending on whether the primary care provider was a physician, NP, or PA.
• Use of NPs and PAs as primary care providers for complex patients with diabetes was associated with less use of acute care services and lower total costs.