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

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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.