Free Resource for APP Leaders

The APP Retention
Risk Audit

A practical scorecard to catch the system failures that make good hires leave — before they show up as frustration, drift, or turnover.

Read the Audit Book a Discovery Call
5 System domains covered
20 Questions to score your team
4 Years Zero turnover proof point behind it
Fast Built for real leaders, not theory

Why this exists

Most APP teams do not have a retention problem first. They have an early-warning problem.

By the time a strong APP is visibly disengaging, the system usually failed them much earlier — in onboarding, role clarity, feedback, workload design, or team integration.

This audit helps APP leaders assess whether their current environment is quietly creating avoidable turnover risk.

It is built from the same operating principles behind four consecutive years of zero APP turnover in a cardiac surgery program.

Who this is for

  • APP leads
  • PA and NP managers
  • Service line leaders
  • Medical directors responsible for APP development
  • Programs trying to improve first-year retention without guessing

How to use it

  • Rate each statement from 1 to 5
  • Total your score across all 20 questions
  • Use the interpretation guide to spot your weak points
  • Start fixing the friction instead of relying on luck

The audit

Score your retention system across 5 domains

If your score is weaker than expected, the issue is usually not your people. It is too much variation in the system around them.

Domain 1

Role Clarity

Can new APPs clearly explain what success looks like, what decisions they own, and where escalation belongs?

Domain 2

Onboarding Structure

Do you have a real onboarding process, or are you relying on whoever happens to be available to train that day?

Domain 3

Feedback & Development

Is feedback specific, timely, and useful — or mostly vague reactions after something has already gone wrong?

Domain 4

Sustainability & Work Design

Are you asking APPs to build confidence inside a system that is challenging but sustainable — or chaotic by default?

Domain 5

Team Integration & Retention Signals

Would leaders hear about frustration early, or only after someone has already mentally checked out?

Quick interpretation

How to read your score

85–100

Strong foundation

You likely have real structure, not just good intentions. Protect the practices that are already working as your team grows.

70–84

Functional but exposed

You probably have strong people and a few solid habits, but the system still depends too much on personalities and workarounds.

55–69

Risk zone

The work still gets done, but good hires may be carrying more ambiguity and friction than leaders realize.

Below 55

Structural retention risk

Turnover risk is probably being created by the system itself. Redesign the operating model before blaming resilience or culture.

Next step

Want help pressure-testing your onboarding and retention system?

If you want a second set of eyes on your APP onboarding process, retention risks, or development structure, I help teams build practical systems that improve consistency and reduce preventable turnover.

Book a Discovery Call