When health systems evaluate their APP workforce, the conversation often starts and ends with a single question: Do we have enough APPs?
But workforce health is about much more than headcount.
This month, I would like to share a framework for assessing the health of your APP workforce using data. Drawing from aggregated, anonymized data across multiple health systems, we found that leaders can learn a great deal by tracking four metrics:
- Workforce size and composition
- How are APP retention patterns shaping the future composition of the clinical workforce relative to physicians?
- Turnover trends and volatility
- Is retention stable, or are we seeing signs of emerging workforce instability?
- Variation across specialties and departments
- Where are retention challenges concentrated, and which groups may need additional support?
- Financial impact
- What is APP turnover costing the organization in recruitment, onboarding, productivity, and lost capacity?
Together, these metrics tell a much richer story than turnover alone.
1. Start with the trend line
The first question is whether APP turnover is changing over time relative to the rest of the clinical workforce.
In the data below, APP turnover remained consistently higher than physician turnover throughout 2025, reaching approximately 10% compared to roughly 9% for physicians by year-end.
This doesn’t necessarily indicate a crisis. But it does suggest that APP retention deserves its own attention and strategy, rather than being lumped into broader clinician workforce metrics.
2. Look beyond the average
Many organizations benchmark overall turnover rates. The problem is that averages can hide where risk is concentrated.
In this sample, the average APP turnover rate was 10.2%, but specialties varied dramatically. Cardiology, palliative care, pulmonary critical care, optometry, and gastroenterology all exceeded the average, while many others fell well below it.
The takeaway: there is no such thing as a single APP retention strategy. Different specialties often require different approaches.
3. Identify your danger zone
One of the most interesting patterns emerged when we looked at turnover by tenure.
APP turnover peaks between years three and four, reaching approximately 18%, nearly double the rate observed during the first year.
Why does this matter?
Because many retention programs focus heavily on onboarding and first-year support. Yet, the data suggests the highest-risk period often comes much later, after APPs have become experienced, productive, and deeply integrated into care teams.
The organizations that understand these patterns can intervene earlier, before valuable clinicians walk out the door.
The goal isn’t simply to measure turnover.
It’s to understand where risk is building, when it’s most likely to emerge, and what it could mean for access, continuity, and organizational performance.