Just 7% of participating organizations report difficulty recruiting APPs with fewer than five years of experience, compared with 69% for APPs with five or more years of experience. Compensation is the most frequently cited reason APPs leave an organization, reported by 68% of respondents that track departures, while average annual APP turnover is 8.9%.
The findings come as APPs assume an increasingly important role in healthcare delivery. Recent data from Definitive Healthcare shows that the number of advanced practice providers grew 71% between 2021 and 2025, reflecting the rapid expansion of the non-physician clinical workforce. Acuvance Coker’s research suggests that as the overall supply of APPs grows, the more pressing challenge for healthcare organizations is becoming how to develop, retain and effectively deploy experienced clinicians.
“The healthcare workforce conversation around APPs has changed,” said Matt Jensen, Vice President, Insights & Innovation at Acuvance Coker. “Organizations are no longer deciding whether APPs should play a major role in care delivery. They are determining where APPs can create the greatest access and capacity, how to develop experience when they cannot recruit it, and how compensation, onboarding and oversight models need to evolve as the workforce grows.”
APPs Become a Core Part of Workforce Strategy
Beyond the recruiting divide, the research shows a broader evolution in how healthcare organizations are integrating and managing APPs.
- APP integration is becoming the norm. Ninety-three percent of participating organizations report that the majority of their APPs are organized within the medical group, up from 75% in 2024. Fifty-nine percent now require employment agreements for all or a majority of APPs, compared with 43% in 2024.
- Organizations plan to use more APPs. Approximately three-fourths of respondents are actively seeking to increase APP utilization in primary care, specialty care and surgical care.
- Access and efficiency are driving expansion. Patient access remains the most frequently cited reason for increasing APP utilization, followed closely by physician support and augmentation and increasing efficiency.
- Physician resistance is declining. Fifty-five percent of organizations report some degree of physician hesitancy to work with APPs, down from 71% in 2024. On the separate question of oversight, half report no barriers to physicians’ willingness to supervise APPs.
- Organizations may have unused supervision capacity. Across every specialty studied, physicians currently supervise fewer APPs than respondents consider optimal. In primary care, physicians oversee an average of 1.8 APPs compared with an optimal level of 3.5.
Together, the findings point to a shift from viewing APPs primarily as a solution to physician vacancies toward using physician-APP care models more deliberately to improve access, clinical capacity and workforce efficiency.
“The question is increasingly not whether to use APPs, but how to build a workforce model that allows them to operate effectively and sustainably,” Jensen said. “When experienced APPs are difficult to recruit, onboarding, mentorship and retention become strategic capabilities. Organizations that can develop experience internally will be better positioned to expand access without relying solely on an increasingly competitive experienced-provider market.”
AI and Billing Trends Reveal New Operating-Model Questions
The 2026 survey also examines several emerging issues for the first time, including AI-assisted documentation and APP billing practices. The 2026 survey highlights two emerging areas where APP operating models have not kept pace with changing technology and billing practices.
- AI adoption is ahead of measurement. Nearly three-fourths of participating organizations have deployed AI-assisted documentation tools for APPs, but 44% have not formally measured the impact on APP productivity.
- APP billing is becoming more visible. 54% of organizations predominantly bill APP services under the APP’s own NPI.
- Productivity credit is lagging behind billing. Only 34.8% grant APPs full wRVU credit when the APP is the billing provider for a shared or split visit.
- More than half lack full productivity-credit alignment. 30% provide no wRVU credit and 26% have no formal policy for shared or split visits.
“Healthcare organizations are gaining greater visibility into APP productivity and economic contribution, but their operating models have not always kept pace,” said Alex Kirkland, Senior Vice President, Compensation Strategy. “As APP utilization grows, organizations will need stronger alignment across billing, productivity measurement, compensation and workforce strategy.”
About the 2026 Advanced Practice Provider Strategy & Oversight Survey
The 2026 Advanced Practice Provider Strategy & Oversight Survey is Acuvance Coker’s third biennial study examining how healthcare organizations structure, utilize and manage their advanced practice provider workforce.
Twenty-seven organizations participated in the 2026 study, representing 5,856 APP FTEs and 7,644 physician FTEs. The approximately 70-question survey covers APP organizational structure, utilization and recruitment, turnover and onboarding, productivity expectations, AI-assisted documentation, billing practices, physician oversight, compensation strategy and hospital-based call responsibilities.
The full report is available at: https://info.cokergroup.com/appreport
About Acuvance
Acuvance is a national healthcare advisory company helping hospitals, health systems, physician enterprises and other healthcare organizations address complex strategic, operational, financial, clinical, technology and compliance priorities. With deep healthcare expertise across a broad range of advisory and implementation services, Acuvance works with clients to improve performance, navigate change and advance sustainable growth. Acuvance is backed by Trinity Hunt Partners, a growth-oriented private equity firm focused on building leading services companies. For more information, visit www.acuvance.com.
Source: Acuvance
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