Nearly 30% of early-career APPs leave their first job within 3 years, study finds

Nearly 30% of early-career advanced practice providers (APPs) leave their initial job within three years, according to a new study published May 5 in JAMA Network Open. As the APP workforce continues to grow — nonphysician clinicians now make up 40% of the U.S. health care workforce — these findings raise questions about the stability, retention and potential onboarding investments for APPs.

Researchers analyzed Medicare billing data from 217,487 nurse practitioners, physician assistants, certified registered nurse anesthetists, nurse midwives and clinical nurse specialists who entered the workforce between 2010 and 2021.

Turnover was measured by sustained changes in the tax identification number (TIN) under which clinicians billed — serving as a proxy for changing practices.

In total, 26.8% of APPs moved to a different practice during the study period, with a median time to departure of just 13 months. Movement within the same large organization was not captured unless it involved a change in TIN, and consolidation events, like mergers, were excluded to avoid misclassifying structural changes as decisions made by APPs.

Turnover patterns by role and setting

The study found that turnover rates varied significantly based on licensure type, gender, practice size and clinical setting.

• Physician assistants had the highest three-year turnover rate at 33.1%, followed closely by certified registered nurse anesthetists at 32.7%.
• Nurse practitioners had a turnover rate of 28.4% within three years.
• Certified nurse midwives and clinical nurse specialists had lower rates — 15.5% and 18.3%, respectively.

Male APPs were more likely to switch jobs than their female counterparts (29.9% vs. 26.2%), and those who moved were more likely to work in smaller practices. The median number of physicians in practices that experienced APP turnover was 16, compared to 57 among those that retained staff.

Turnover was also more common in certain specialties. Hospital-based clinicians had the highest turnover, with 43% moving within three years. In contrast, clinicians in obstetrics and gynecology and medical subspecialties had the lowest movement rates, at 23.3% and 30%, respectively.

One in seven leave within a year

The data show that turnover happens quickly for many early-career APPs. Within the first year, 14.4% had already changed practices. By year five, the cumulative rate rose to nearly 37%.

This rapid churn comes as the number of new APPs entering the field is expected to increase at five times the rate of physicians between 2023 and 2033, according to the Bureau of Labor Statistics.

The study notes that APPs face fewer regulatory and certification barriers to changing roles compared to physicians, which may contribute to the turnover, but specific drivers of turnover — compensation, job satisfaction, scope of practice, organizational culture — were not assessed in the study.

Regardless, for practices employing early-career APPs, the trend signals lost investments in onboarding and training, disruptions in patient continuity and added administrative costs for recruitment.

“Further work should investigate practice characteristics, specific tasks, remuneration and other potential factors associated with practice turnover,” the authors concluded.

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Shaving, service and success

My previous blogs have looked at other industries, such as airlines, hospitality, and even toy companies, as examples of outstanding customer service. We can learn from these companies and often implement what these successful industries do into our healthcare practices. I have looked at the Dollar Shave Club (DSC) for this blog. One of us, SH, is a member of the "club," which began after watching their irreverent, R-rated YouTube video with more than 28 million views. The concept of the DSC is simple: pay a small monthly subscription fee, and four new razor blades are delivered monthly to your snail mailbox. If you become a member, you will never worry about running out of fresh, world-class razor blades.

Members of the DSC never worry about being without a world-class blade every month. This blog is motivated by the convenience of the DSC.
Making your practice more like the Dollar "Convenience" Club

Truth be told, there's nothing special about razor blades, but what makes DSC special is the customer experience built around convenience.

The DSC promotes convenience as much as, if not even more, than the razor blades and other toiletries.

Inflation and the recent tariffs have led to higher prices, but their customers still buy the razors.

Let's examine five reasons for the DSC's success and how this applies to healthcare practice.

Convenience: This is the reason they exist. It is important to ask, "Is your practice convenient?" Are patients able to obtain an appointment in a reasonable period? Are your phone calls and emails returned promptly? Practices with 2-3 months waiting for an appointment do not have easy access to the practice. Patients who have a study or lab test and must wait weeks to receive the results are not meeting the needs of the patients who want results in a timely fashion. Patients expect phone calls and emails to be answered in 24-48 hours. Any longer is below patients' expectations.

Quality products: The blades are high quality, and few members complain about their ability to remove the hair on their faces. Quality is important to DSC customers. Patients expect quality care from a physician who is perceived as an expert. Practices should start measuring outcomes and posting favorable results on their practice's websites. We know that quality is a difficult metric for the healthcare profession. However, there are examples of quality that are important to patients and that can be measured. The take-home message is that what gets measured gets done.

Price: Even though customers are willing to pay a premium for convenience, which is almost as compelling as the convenient experience. The time has arrived for price transparency in healthcare. We can no longer be like deer paralyzed when looking into the headlights and when patients ask about the cost of care. We know what an office visit should be for a new patient, an existing follow-up patient, and a newly diagnosed cancer patient who will require a longer appointment to discuss treatment options. By providing the cost of care to patients, we can avoid sticker shock when a bill arrives when no price discussion has been conducted.

For example, many practices use only 15-20 drugs most of the time. In that case, prices can be obtained from local and discount online pharmacies. One of us, NB, asks the pharmaceutical representative to find the cost of these prescriptions and update the list twice a year. This is very appreciated by the patients and allows the physician to discover if the cost is more than a patient can afford, then a less expensive drug can be prescribed.

Consistency and reliability: Customers know what to expect and when to expect it. The predictable schedule and consistent quality create trust and confidence in the product. If a patient calls with a question and the doctor plans to return the call at the end of the day, then it is helpful to give the patient an approximate time to expect a call from the doctor. This avoids that game of phone tag and encourages the patient not to be on the phone during that time.

Fun: This is a bonus, but who doesn't like a little fun? The experience is fun and may not be appropriate for everyone, but it may be for some medical practices. DSC's commercials are funny, which makes them stand out in a crowded razor blade market.

The DSC doesn't promise better blades; they sell a better experience. Suppose your practice does what it's supposed to, like diagnosing and treating disease, and you add the exceptional experience that patients want. In that case, you will have a successful combination.

Bottom Line: Emphasize what makes your patients appreciate you. That answer will get your patients to talk about your practice to family and friends, and, most importantly, loyal patients will return for their medical care.

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Pros and cons of AI patient portal messages

Between increased administrative burdens and an influx of patient messages, many primary care physicians (PCPs) are turning to generative artificial intelligence (AI) tools to help draft patient portal messages. A new study suggests those tools can help — but they may also introduce dangerous errors that physicians fail to catch.

The study, published in Digital Medicine, found that most physicians missed critical mistakes in AI-generated message drafts in a simulated exercise. Some of the errors had serious safety implications.

“All but one physician ‘sent’ at least one fictitious response to a patient that contained an error,” the authors wrote.

A closer look

Researchers from MedStar Health, Georgetown University and the Naval Research Laboratory recruited 20 practicing PCPs in the Baltimore-Washington area. Participants were asked to review and edit 18 AI-generated responses to common patient portal inquiries. Four of the drafts contained significant errors.

These errors included:

• A typo in a medication name.
• Outdated COVID-19 vaccination guidance.
• A failure to recognize urgent signs of a possible blood clot.
• A missed case of diabetic ketoacidosis (DKA) in a child — mistakenly dismissed as a stomach bug.

At least 65% of participants missed each of the four errors, and between 35% and 45% submitted the problematic messages without any edits. Only one participating physician caught and corrected all four errors.

“Helpful” — But at what cost?

Despite these oversights, most PCPs responded positively to the AI assistance. According to post-task surveys:

• 95% said the AI-generated drafts were helpful.
• 90% said they trusted the AI’s performance.
• 80% agreed the tool reduced their cognitive workload.
• 75% believed the drafts were safe to use.

“I found the AI drafts to be helpful in responding to these [patient portal messages],” one survey statement read. Nineteen of the 20 participants marked it as true.

But the researchers argue that this trust — however well-intentioned — may lead to over-reliance.

“As the occurrence of automation complacency increases with reliability, the fact that most AI-generated drafts did not contain an error or patient safety risk may have resulted in vigilance decrement,” the authors noted.

The psychology behind the misses

The study points to several possible reasons why seasoned physicians may have missed obvious red flags:

1. Automation bias: Relying too heavily on AI tools.
2. Confirmation bias: Assuming the AI’s response aligns with their own.
3. Functional fixedness: Failing to see alternative diagnoses when the AI’s answer seems plausible.
4. Burnout and workload: Reducing diligence due to mental fatigue.

“These results highlight how physicians, as well as other stakeholders, understandably have a growing appetite for AI-driven technologies that can address workload burden,” the researchers wrote. “[They] may in fact be so overextended that any technology promising a reprieve is eagerly adopted despite the risks.”

Growing use, growing concerns

More than 100 health systems are already using generative AI to support clinician inboxes, including tools integrated into popular EHR platforms like Epic. The researchers behind this study argue that rollout may be outpacing safety testing.

While the AI drafts didn’t always include outright AI hallucinations, some gave incomplete or misleading advice. In the case of a child showing textbook signs of DKA, the Ai offered a generic response about stomach viruses — an omission flagged by only five of the 20 participating physicians.

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Unlocking the hidden potential in your medical office investment

For many physicians, the strategic importance of their medical office is often overlooked. More than just bricks and mortar, your medical office is the engine of your practice, driving both patient care and profit. A well-designed office space does more than function efficiently—it transforms how care is delivered, reduces staff turnover, and significantly boosts your bottom line. Recognizing and optimizing every aspect of your office, from its strategic location to the flow of patient traffic and the subtleties of its layout, is essential for turning this overlooked asset into a cornerstone of your financial success.

Incorporating Evidence-Based Design (EBD)

Evidence-Based Design (EBD) focuses on creating healthcare environments that are scientifically proven to improve patient outcomes, staff efficiency, and safety. By integrating EBD into the medical office design, physicians can directly impact their practice's effectiveness and patient satisfaction.

1. Patient-centered layouts: Designing patient areas to minimize stress and promote healing can significantly enhance patient satisfaction—a key metric in value-based care models. Features like natural light, calming colors, and noise-reducing materials can contribute to faster recovery rates and reduced readmission rates.
2. Efficient workspaces: Efficiently designed staff areas reduce fatigue and enhance productivity. Ergonomic workstations, logically placed equipment, and streamlined workflows reduce time wastage and improve the overall efficiency of care delivery.
3. Safety, efficiency, and infection control through design consistency: Using Evidence-Based Design (EBD), we standardize exam room sizes and layouts to enhance operational efficiency and minimize medical errors. This uniformity not only simplifies workflows for caregivers but also improves patient safety by reducing the likelihood of falls or injuries. Additionally, consistent room designs support effective infection control practices, essential for maintaining a clean and safe environment. These strategic design elements substantially improve patient outcomes by optimizing both safety and efficiency.

Enhancing Value-Based Care through EBD

Value-based care models prioritize patient outcomes and satisfaction, which directly affect reimbursement rates under these models. By designing an office that enhances patient experiences and outcomes, physicians can improve their performance on value-based care metrics, such as patient satisfaction scores and outcome measures. This improvement translates into higher reimbursements and bonuses for quality care delivery.

External factors affecting medical office ROI

In addition to internal office design, several external factors critically influence the functionality and accessibility of a medical office, directly impacting patient satisfaction and practice profitability:

• Accessibility and traffic flow: Easy access to the office from major roads and minimal traffic congestion can reduce patient stress and lateness, improving satisfaction and increasing the number of timely appointments.
• Adequate signage: Visible and clear signage not only assists in easy navigation but also enhances the professional appearance of the practice, contributing to first impressions and patient confidence.
• Sufficient parking: Ample and convenient parking is essential for patient accessibility, reducing late arrivals and no-shows due to parking difficulties.
• Building condition and aesthetics: The external and internal condition of the building conveys a message about the quality of care. A well-maintained facility can enhance patient trust and comfort.
• Local area and services: Proximity to pharmacies, hospitals, and other health services can increase convenience for patients and may lead to partnerships and referrals.

Considering a sew office space

If your current office does not support optimal practice operations or patient care, it may be time to consider a new space. Key indicators that a new office might be necessary include:

• Lack of space for new services: If your current setup cannot accommodate emerging services such as telehealth or specialized treatment areas, it may limit practice growth.
• Inadequate technology integration: An office that cannot support new medical technology may hinder your ability to provide state-of-the-art care.
• Poor layout for efficient workflow: An inefficiently arranged office can lead to wasted time and increased staff frustration, impacting patient experience.
• Inability to expand: If there is no room to grow or reconfigure your space to meet evolving healthcare demands, this can restrict your practice’s potential.

Conclusion

Your medical office is more than just a physical space; it is a strategic asset that can significantly enhance your financial portfolio through improved patient care and increased efficiency. Evidence-Based Design not only facilitates better patient outcomes but also optimizes operational efficiency, directly impacting the profitability of practices operating under value-based care models. By focusing on these principles, healthcare providers can ensure their office space is a powerful tool in achieving business success and exceptional patient care.

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Lead through crisis with confidence: A health care leader’s playbook for resilience and reputation

A crisis is no longer a rare disruption — it’s a defining feature of modern leadership. Today’s health care executives don’t face just one crisis at a time. You manage many layered and compounding crises: labor disruptions, patient safety incidents, cybersecurity breaches, public misinformation, AI-driven disinformation and shifting regulatory demands.

We are now operating in an era many call 'permacrisis' — a time defined by ongoing societal disruption, where the next challenge is never far behind. According to PwC, 96% of organizations have experienced disruption in the past two years, and 76% of leaders said it had a medium to high impact on business operations. Considering these high levels of disruption and impact, organizations without a well-integrated crisis response plan risk serious operational and reputational fallout.

For health care leaders, this means crisis is not a matter of if, but when, making readiness a strategic imperative. Whether they are leading a small practice or a large health system, health care leaders must be prepared to lead through volatility without sacrificing trust, care quality or organizational integrity. Crisis readiness is not a reactive task. It’s a well-planned strategic imperative. Crisis readiness can protect brand reputation, support continuity and strengthen stakeholder relationships when they matter most.

When health care organizations lead with values and communicate with transparency and urgency, they don’t just survive disruption, they grow trust, culture and credibility in the process.

Protect what you’ve built before crisis hits

The first step in your crisis readiness journey is protecting what you've already built: your organization's hard-earned reputation. This reputation is one of an organization’s most valuable and vulnerable assets.

Health care brands are built on credibility. A single crisis — whether a data breach, malpractice claim or public protest — can unravel a brand reputation if not handled with speed and purpose. In a digital-first world, where every mistake can quickly become a headline, how you respond matters as much as what happened. Silence often creates more harm than the incident itself. Leaders must act fast, speak clearly and connect every message to the organization's core values.

• Start here:Identify your top five reputational risks
• Align your leadership team on who leads response efforts
• Pre-approve messaging templates that reflect your values, not just legal language

This isn’t about crafting the perfect message — it’s about communicating in a way that reflects who you are and what you stand for.

Earn trust before you need it

Trust requires continuous, proactive investment. It’s both your most powerful asset and your most fragile. Internally, employees look to leadership for clarity in a crisis. Externally, patients and community members watch what you do, not just what you say.

Data tells us trust in health care has declined measurably. During the COVID-19 pandemic, public trust in health agencies dropped sharply — and it still hasn’t fully recovered. That shift raises the stakes for health care leaders. Clear communication and visible leadership are no longer optional. They’re foundational.

But trust isn’t built through communication alone. It’s sustained through actions that align with your purpose. In a crisis, people pay close attention to whether you follow through on what you say. Do your decisions reflect your values even under pressure?

Your internal and external messages and actions must also align. What your staff hears should reflect what the public sees. Trust is earned through consistency and built with empathy. Speak early and be honest about what you know and what you don’t. Explain the actions you’re taking and how they reflect your values. When your words and actions align, trust follows and credibility grows.

Many organizations, however, overestimate the trust they’ve earned. PwC found that while 86% of executives believe employees highly trust their leadership, only 67% of employees agree. And 22% say they’ve left a company due to trust issues. In crisis, that disconnect becomes even more damaging. Trust isn’t just a message — it’s a measurable business risk.

• Trust-building actions:Align decisions with stated values even under pressure
• Create a unified messaging approach for employees and external audiences
• Follow through visibly on commitments made during disruption

Don’t let an old plan create new problems

With trust as your foundation, your next priority is ensuring your response systems are current and ready to activate. Most health care organizations created or updated their crisis plans during the COVID-19 pandemic. But in the years since, the risk environment has changed dramatically.

AI can now generate fake videos, alter clinical messages or spread disinformation in minutes. Hackers target electronic health records. Labor actions escalate quickly in public view. Turnover at the executive level means fewer people know how to activate your plan — if a current plan exists at all.

A crisis plan must be more than a document. It should be dynamic, accessible and well-rehearsed. Every leader should know their role. Every employee should understand the basics. Your plan should flex to distinct potential incidents, with scalable tiers and clear operational actions communication pathways.

• Refresh your plan with these steps:Incorporate AI risks, misinformation and digital threats into your scenarios
• Review and update your crisis plan annually, and after leadership changes or major events
• Run tabletop drills twice a year with executive leaders and designated crisis team members

The best time to revise your crisis plan was yesterday. The next best time is before a headline breaks.

Prioritize continuity because care can't wait

Your responsibility to provide care doesn’t pause in the midst of a crisis. Even when systems fail, patients still need access. Your organization’s ability to maintain continuity and a high level of patient care — without compromising safety, service or trust — is one of the clearest tests of crisis readiness, and a challenge unique to health care.

Continuity isn’t just about keeping the doors open to care for patients. It’s about sustaining clinical quality, protecting employee well-being and ensuring patients receive accurate, timely information. Whether leading an independent practice or a complex health system, you must prepare to operate through disruption — not around it.

That level of preparation starts with a strong infrastructure and practiced coordination. Cross-functional response teams. Localized decision-making authority. Communication plans that reach patients and staff across multiple channels.

Essential continuity actions:Map your critical systems and identify points of failure
Establish backup communication methods such as text, phone, signage, and digital tools
Train clinical and administrative leads to coordinate clearly and calmly in real time

Continuity is more than best practice in health care. It’s a commitment to those who depend on you most. While disruption is inevitable, disorganized response doesn’t have to be.

Create a culture that responds with resilience

Your ultimate defense against crisis is your organizational culture — the values and behaviors that guide your team when systems are stressed.

Every crisis is a cultural stress test. It reveals whether your values are just words on the wall or whether they are deeply embedded in how you operate. Health care teams that trust leadership and feel informed respond with stronger unity. Teams left in the dark often fracture under pressure.

Leaders have the opportunity to set the tone in every moment. Show up early and speak honestly. Acknowledge what you know (and what you don’t) without fueling fear. Offer clear actions and anchor every decision in your organization’s purpose.

Crisis-ready cultures do not emerge overnight. They are intentionally built through communication, leadership modeling, psychological safety and continuous learning. Invest in those traits now, and your organization can emerge from disruption stronger than it started.

To support culture during a crisis:

• Define crisis response expectations in onboarding and role descriptions
• Recognize calm, mission-aligned action after high-pressure events
• Align internal messaging with your values and mission or purpose

Lead forward through uncertainty

Health care leaders cannot prevent crisis, but they can accept and prepare for the inevitability of a crisis and lead through one with confidence, clarity and care.

The health care practices that invest in crisis preparedness today will be the ones key stakeholders trust tomorrow. The clinics that communicate with transparency and humanity will retain staff during turbulence. The health care leaders who respond with values-driven purpose will find opportunity on the other side of disruption.

Your next crisis is coming. You decide today whether your organization will be ready to lead or forced to react. Resist the urge to feel overwhelmed. Start where you are by updating what’s outdated. Lead with purpose, and protect what matters most: your people, your reputation and the care your community counts on.

____________________________________________

Ayme Zemke, APR, is Chief Client Officer and certified crisis expert at Beehive Strategic Communication. She brings more than 25 years of experience guiding executives across health care, education, financial services and manufacturing through crisis and change. Ayme specializes in helping mission-driven organizations lead with purpose and communicate with confidence during high-stakes moments.

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