How to Recruit and Retain Advanced Practitioners

A health system executive shares tips for securing a satisfactory cultural fit, communication, pay, and work-life balance for NPs and PAs.

With demand dwarfing the supply of advanced practitioners, it's a good time to be a nurse practitioner or physician assistant. But even though such nonphysician practitioners (NPPs) essentially have their pick of where to work, they're not all satisfied with their current employment.

Nearly 16% of PAs and 19% of NPs expect to change jobs within one year, according to a survey of 1,070 advanced practice clinicians conducted by PracticeMatch, a provider of staffing resources. Overall, one-third of respondents said they'd consider a change.

For insights into how healthcare leaders can set NPP relationships up for success, I spoke with David Taylor, FACHE, FACMPE, corporate vice president of Cox Health in Springfield, MO. The following is an edited transcript.

HealthLeaders Media: Would you agree that recruiting and retaining NPPs is a challenge?

Taylor: Absolutely. Every medical specialty today is using advanced practitioners in some way. In our organization, we're probably using six times as many NPPs as we did 10 years ago. And within primary care, we're moving toward a ratio of three NPs or PAs for every one physician. So that will up the ante as far as supply and demand.

Even with a dozen or more programs in our state that train NPs and PAs, and our own college producing about 30 [NPPs] a year, we can't hire enough.

HLM: With such high demand, is it even possible to be selective for cultural fit? What are the keys to forging long-term relationships with clinicians?

Taylor: It starts with your physicians. They have to buy into it and understand who these people are, what their roles are, and how they can be utilized in the delivery of care. Senior leadership has to also be behind it and understand the value of team-based care.

There's also the aspect of how we communicate with NPs and PAs. We hold three to four forums a year where our NPs and PAs can come together and discuss what's happening nationally in healthcare or within our own system.

HLM: According to the survey, salary and work-life balance were by far the most influential incentives to NPPs. How have you addressed these desires?

Taylor: When it comes to compensation, we treat our advanced practitioners a bit like physicians in that there are bonus plans based on production. And depending on the supply and demand, there may be a sign-on bonus and retention bonuses.

We also find that these clinicians really value flexibility. So we have a lot of part-time roles and options for where people can work, whether it's in a traditional clinic, retail clinic, or even doing telemedicine from home. People might spend two days in one setting and three in another, so there's variety. It's important to have a broad array of things we can fit from a cultural standpoint and an interest standpoint of these individuals.

HLM: You mentioned the importance of physician and leader buy-in into team-based care, but how does an organization go about getting that?

Taylor: We've been blessed to for the most part, have it from the beginning, partly because of the way we use NPs in our residency program.

But we don't mandate or set a strict schedule to roll out adding NPs and PAs across our clinics. Rather, we let it evolve, beginning with early adopters. Then once other physicians see how other practices are doing it or talk to their colleagues, they may come forward wanting to bring it into their practice.

Or we may approach a practice that is starting to reach the point where access is becoming a problem, and we offer adding NPs and PAs as a way to enhance that aspect of the clinic in a particular community.