Executive leaders help shape most formal physician and advanced practice provider retention strategies, but they rarely run them, according to a 2026 report from the Association for Advancing Physician and Provider Recruitment.
The report is based on a survey of 158 physician recruitment professionals and healthcare leaders. Among the 38 organizations with a formal retention strategy, 76% said executive leadership has direct input on it. Only 21% said executives own the strategy, and 5% said executives drive day-to-day execution, according to the report.
Recruitment teams are closer to the work. They drive day-to-day execution at 34% of organizations with a strategy and own it at 26%. AAPPR calls this the “recruitment team paradox”: Recruiters see turnover patterns firsthand but have limited influence over strategy. Recruiters have the least say at the largest systems. Among organizations with more than 1,000 physicians, 67% said their recruitment team has minimal input on the retention strategy.
Clinical leaders own the strategy at one-third of the largest systems, more than any other function. Recruitment teams own it at 44% of organizations with 200 or fewer physicians. Human resources plays a smaller role overall: It owns the strategy at 11% of organizations and drives execution at 8%.
Organizations without a formal strategy most often cite unclear ownership as the barrier (51%), ahead of lack of executive buy-in (48%). Among the largest of these systems, the share citing unclear ownership rises to 62%. Even among organizations with a strategy, 36% cited unclear ownership as a challenge.
Leaders have told Becker’s that keeping physicians requires more than a sign-off from the C-suite.
“Physicians need to be part of strategy conversations, not just recipients of decisions,” Patsy McNeil, MD, executive vice president and system chief medical officer of Gaithersburg, Md.-based Adventist HealthCare, told Becker’s in 2025.
Dr. McNeil said effective retention requires “plans that are supported at the highest levels of leadership and reviewed regularly for impact.”
Clinical leadership may also be stretched thin.
“Just like there’s a shortage of physicians, there’s a significant shortage of physician leaders,” Nari Heshmati, MD, chief physician and operations executive of Fort Myers, Fla.-based Lee Physician Group, told Becker’s in 2024.
Dr. Heshmati said building that leadership bench, which he called “quite shallow right now,” will take years.
Overall, 39% of organizations surveyed have a formal, documented retention strategy, and another 39% do retention work informally, according to the report. AAPPR recommends making one function or leader accountable, whether recruitment, clinical leadership or a cross-functional team.
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