Turnover Among Early Career Advanced Practice Providers in Urology

Objective

To understand the patterns and predictors of practice movement among advanced practice providers (APPs). The role of APPs in urology has grown significantly, yet early career turnover is common and remains poorly understood.

Materials and Methods

We conducted a retrospective cohort study using Medicare Data on Provider Practice and Specialty files between 2010 and 2021. We identified nurse practitioners and physician assistants who first billed Medicare Part B in urology practices. Time-to-event analysis was performed to examine the risk of practice movement, and Cox proportional hazards regression models identified factors associated with movement.

Results

Of the 1003 APPs identified, 307 (30.6%) moved to a different practice, with a median time to movement of 14 months. Physician assistants were more likely to move compared to nurse practitioners, and APPs who moved were more often female and in practices with fewer physicians and other APPs. Most APPs who left urology transitioned to non-surgical specialties, with only 8.8% joining another urology practice.

Conclusion

Practice movement among APPs in urology is common in the early career and most APPs who leave urology practices go on to work in other specialties. Factors such as clinician type, gender, and practice size may influence practice movement. Our findings suggest that smaller practices may require improved strategies to retain APPs. Further work is needed to better understand reasons for this turnover and identify strategies for retention.