Introduction “Disruptive innovation” (DI) has recently been heralded as a tool to mitigate out of control health care spending in the UnitedStates,1,2,3 however few doctors are familiar with the concept. Overall, there is a tendency in medical culture to regard changes to established treatment and management models with some reticence, increasing the difficulty for reform. In this article we will introduce readers to the concept of DI as a means to reduce costs in the American health sector. We will illustrate current uses of DI in health care, using the particular example of the expanding role of nurse practitioners (NPs). It is not ourintention to debate the virtue of NPs per se, but we will examine arguments for and against the development of the NP role that illustrate traditional barriers in health care to DI adoption, and some of its potential synergies.