Long-Term APP Retention: Building Success for Practices and Providers Save

Advanced Practice Providers (APPs) play an increasingly vital role in rheumatology practices across the country. With rising patient volumes and a growing demand for timely, high-quality care, incorporating an APP into a rheumatology team can be transformative. When the partnership is structured thoughtfully, everyone from the practice benefits. Patients receive better access to care, and clinicians share the workload more sustainably, and the practice functions more efficiently. However, successful integration does not happen automatically. The goal is to have a long-term partnership and retain an APP who is deeply trained, highly knowledgeable, and confident in the complexities of rheumatologic medicine. 

Retention of an APP requires intentional planning, communication, and support from day one.

One of the most essential elements of retaining an APP is setting clear expectations from the outset. Roles for APPs can differ dramatically across practices. For instance, some APPs function with a high degree of independence and see both new and follow-up patients across a wide range of conditions, while others focus primarily on follow-ups or specific disease states. Before hiring an APP, practices should openly discuss the intended scope of practice, the potential growth trajectory, and the long-term vision for the role. Equally important is understanding what the APP is hoping for in their career. If those two visions do not align, such as when an APP desires broader autonomy than the practice is comfortable with, or when a physician expects rapid independence that the APP does not yet feel ready for, it sets the stage for dissatisfaction on both ends. Early, honest conversations help ensure the relationship is built on shared goals, which is essential for long-term success.

Thoughtful, comprehensive onboarding is another crucial component of retention. 

Rheumatology is a challenging specialty with a steep learning curve, and no APP can be expected to master it without structured support. Initial periods of shadowing can be incredibly valuable for an APP who is new to rheumatology, allowing the APP to learn disease patterns, treatment approaches, and clinic workflow. Training in the clinic itself also requires an investment of time and energy from physicians, especially during the first months, and sometimes even after hours for those newer APPs who need extra guidance. Discussion of disease states, reviewing cases, and providing frequent feedback are all beneficial to the onboarding and training process. While this may require additional effort upfront, it pays off in the long run by helping APPs become stronger, more confident providers and better long-term fits for the practice.

A strong onboarding plan also requires intentional investment in education and ongoing learning. The American College of Rheumatology (ACR) offers foundational training modules. Other platforms like RheumNow provide high-quality case discussions, clinical pearls, and expert perspectives that strengthen practical diagnostic and management skills, while RhAPP offers free, continually updated educational tools specifically designed for APPs, helping both new providers and experienced ones refresh or expand their knowledge. Supporting APPs to attend local and national rheumatology conferences, including assisting with CME hours and related expenses, is additional important way to invest in their growth. These experiences improve clinical competency and reinforce a culture of continuous learning.

Compensation also plays an important role in retaining APPs. Although salary discussions can feel sensitive, it is important to recognize that competitive pay and a comprehensive benefits package are essential to job satisfaction. Equally important measures to the make the APP feel valued include appropriate support, a manageable workload, and adequate time off. Compensation and benefits signal value, but so does creating an environment where APPs are not overworked or taken advantage of. When APPs feel respected, supported and valued, they are more likely to stay long term. While exact numbers vary based on geography, experience, and practice structure, offering a fair and competitive total package helps ensure stability and continuity. Retaining a well-trained APP is always more efficient, financially and operationally, than repeatedly onboarding new hires.

When expectations are aligned, onboarding is thorough, and compensation and benefits reflect the value APPs bring to a practice, the entire care team thrives. Successful APP retention benefits everyone: the physician gains a reliable partner, the APP feels supported and empowered in their role, and most importantly, patients gain better access and have better continuity of care. A strong APP-physician partnership strengthens the practice at every level and ultimately enhances the quality of care delivered to the patients we serve.