By Jim Creason, President and CEO at ThriveAP
It’s no secret: hospitals and health systems are being asked to do more with less. The financial landscape is shifting as reimbursement cuts, Medicaid changes, and reductions in supplemental aid reshape the economics of care delivery. At the same time, workforce costs continue to climb. Recruitment, retention, and the day-to-day realities of staffing are consuming an ever-larger share of budgets.
When leaders face this combination of shrinking revenue and rising expenses, the instinct is often to scrutinize external partnerships first. Vendor contracts and programs perceived as “non-essential” are quick to land on the chopping block. That reaction makes sense in the moment, but it risks cutting areas that can actually protect long-term stability.
Where the Pressure Is Greatest
One of the most pressing challenges I hear consistently is the difficulty of retaining advanced practice providers (APPs). National studies show that APP retention hovers around 70 percent at three years. That means nearly one in three APPs leaves their existing roles within just a few years of practice.
Each departure is expensive. Recruitment alone can reach six figures per APP. Add in the impact on patient continuity, lost productivity during onboarding, and the ripple effects across teams, and the true cost is even higher.
Why Early Support Matters
With all of this said, we cannot solve workforce challenges by focusing only on recruitment. Retention is just as critical. One of the most effective ways to strengthen retention is through dedicated transition-to-practice (TTP) programs.
These programs help new or early-career APPs move from onboarding into confident, sustainable practice. They combine continuing medical education with mentorship and practical skills for navigating today’s complex care environment. The result is stronger retention, faster ramp-up to productivity, and more consistent patient care.
In practice, the effects of TTP programs are even clearer. Organizations that invest in structured development and support with ThriveAP have been seen to achieve retention rates near 95 percent. For example, two independent health systems with whom ThriveAP partners, one in the Midwest and one in the Southwest, improved retention significantly, avoided repeated recruiting costs, and reported measurable financial savings tied directly to APP stability – all attributed to TTP programming. This type of improvement has a direct and lasting impact on workforce sustainability and financial performance.
Looking Beyond Short-Term Cuts
The financial realities we face are significant, and cuts may feel unavoidable. But the question leaders should be asking is: what will position our organization to thrive in three years, not just three months?
Investments that stabilize the workforce, improve retention, and expand access to care should be evaluated differently than line items with no measurable return. Innovative tools are also making it easier to assess that value in terms everyone can understand, from the CFO to the CNO. ThriveAP recently rolled out our new ThriveAP ROI calculator for this very reason, and I encourage you to give it a try and let us know what you think.
The calculator leverages data from 6,300 APP program months, showing consistent gains in productivity and financial returns. For example, a 10-APP primary care team could realize an estimated $229,500 annual return and a 3.83 ROI after program costs. While results vary, there is clear evidence that supporting APPs through structured development pays off in a myriad of ways.
Moving Forward
The pressures facing healthcare today will not ease quickly — but we do have options. By reframing how healthcare leaders view budget decisions, not as a list of cuts to make but as a set of choices about where to build resilience, we can navigate this moment with more confidence.
Retention is not simply a staffing issue. It is a financial strategy, a patient care strategy, and ultimately, a leadership strategy.
