Recruitment and Retention of PAs and NPs in Primary Care is Critical

Written by on July 1, 2013 in Practice tips - No comments

Fewer than 25 percent of new doctors in the United States go into primary care, and only about 5 percent open offices in rural areas.  While estimates on exact numbers vary, changes in health care reform guarantee to put more patients into an already complicated system.  Bridging the gap with Physician Assistants (PAs) and Nurse Practitioners (NPs) will be inevitable.

PAs and NPs are skilled medical professionals who play an integral part in health care delivery.  Especially in primary care, PAs and NPs attract and manage a significant following of patients, especially in rural communities.   Recruitment is challenging in more underserved areas, however, retention is often more important as practices and patients invest in an individual with the hope that they will stay and practice for a considerable amount of time.

In the United States, about 66 million people live in rural areas or urban neighborhoods with too few primary care doctors or a shortage of primary care in clinics. Estimates indicate that 1 in 5 Americans lacks access to essential primary care and could develop more serious health problems as a result.

So how do you attract a great PA or NP to your practice?

Suburban, rural and smaller practices all have the same complaint that they cannot recruit to their area because they cannot pay as much in salary as their competition.  However, often these groups are missing the mark as they often qualify for loan repayment within the state, or they might offer flexibility within a clinical work schedule that is appreciated by the provider.  For example, if a PA/NP lives in town where they work, it might be agreeable that they can leave at 3 to pick up a child from school and then come back to wrap up the clinical day.  Such flexibility is not easily achievable in a larger hospital or health system. Highlighting those “extras” will be important as you list all the reasons why your office is a great place to work.

Highlighting the type of duties you need performed as well as the type of patient population is critical to the messaging.  For example, don’t just say family practice PA/NP wanted in Xyz town, NC.  Instead, say: Dynamic PA/NP wanted for charming rural underserved area in Xyz, NC.  Interested providers will be responsible for health care delivery to an appreciative population that has limited resources.  Medicare and Medicaid credentialing are a must.

You’ve hired a great PA or NP.  Now how do you keep them?

Once the practice team is expanded with a great PA or NP, retention becomes the new norm.  Often practice administrators are frustrated because they say PAs and NPs change jobs too often.  My response to them is that if you create a great work environment, any employee, from front office to physician will want to stay and contribute.  Often, PAs and NPs will leave a position if they feel their contributions are not valued.  This is referencing not only patient care decisions, but also decisions related to work environment or technology.  For example, if the physician does not support the PA/NP care rendered to a patient publicly or if they do not advocate for the PA/NP within the medical community, these are flags of incomplete acceptance and lack of full incorporation into the team.

Recognition is individual and personal to every PA/NP.  Some may prefer a public acknowledgement at a staff meeting while others may greater appreciate a personal note or face meeting.  Supervisors and practice managers should have processes in place to assess communication styles and play to team strengths.

It’s not always about the money….

Often, individuals leave a position for reasons that are not financial.  Fostering improved communication will result in improved retention of your medical staff.  Genuine acknowledgement of value and contribution goes a long way to foster loyalty to the practice and the group, and ultimately to the patients we serve.


About the Author:

Lisa P. Shock, MHS, PA-C, is a seasoned PA who has worked with clients to expand care teams in both large and small settings. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at

By Lisa P. Shock, MHS, PA-C
President/CEO Utilization Solutions in Healthcare, Inc.

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