As GI practices increasingly rely on advanced practice providers (APPs) to meet growing patient demand, experts say that effective onboarding has become critical to retaining clinicians, reducing burnout, and supporting long-term success.During a session on APP onboarding strategies at Digestive Disease Week® 2026, speakers shared practical strategies GI practices can use to better integrate nurse practitioners and physician associates into clinical care while building confidence and clinical competency over time.“Right now, APPs represent 40% of the provider workforce in the US, but 30% of them leave their jobs within the first three years,” one of the speakers, Sarah Enslin, PA-C, MS, an APP manager at the University of Rochester Medical Center, told attendees.Direct turnover costs range from $85,000 to $115,000 per clinician, she added, excluding indirect costs such as lost productivity and revenue.According to Enslin, poor training, burnout, limited opportunities for growth, and unclear job expectations are major reasons people leave. She also explained that many new hires do not feel fully comfortable in their roles for up to two years, and without ongoing support and career development conversations, they may begin to feel disengaged or stuck between years two and three.“If you don't feel like you're making an impact, [that] definitely is a reason for burnout and resignation,” Enslin said.In her experience, successful onboarding starts with evaluating a new hire’s prior experience, followed by structured clinical training and a gradual transition into clinical responsibilities. Programs should include shared patient visits, supervised independent practice, and a gradual transition to full autonomy. Mentorship, regular feedback, and ongoing performance tracking are also important for supporting growth and measuring progress over time.“One of the most impactful things that we can do is to sit down and actually provide feedback,” she said. “When we're onboarding, that has to be done more regularly than just once a year.”Enslin outlined a staged timeline for clinical progression in academic practice settings. During the first three months, clinicians typically participate in shadowing and shared visits. Between three and six months, they transition to supervised independent care, and by six to 12 months, they begin building their own patient panels.Measures of success include how quickly clinicians can practice independently, clinical quality outcomes, patient access, and retention rates. Although productivity measures such as relative value units are often tracked, she suggested waiting to focus on them until clinicians are fully settled into the practice and confident in their roles.Enslin explained that academic centers often offer APPs exposure to subspecialties, multidisciplinary teams, and strong teaching support. Community practices may help APPs gain independence more quickly and manage higher patient volumes, but they often provide less formal mentorship and training. Without adequate support, APPs in these settings may be more likely to feel overwhelmed early in their careers.To address these differences, Enslin and fellow presenter Amy L. Stewart, MSN, FNP-C, lead APP at Capital Digestive Care in Washington, DC, recommend adaptable onboarding frameworks that include standardized checklists, curated clinical exposure, and template-based scheduling to match patient complexity with clinician experience. For example, early exposure to routine visits, such as pre-procedure evaluations, may help build confidence before managing complex cases.“One of the big challenges in community practice is a risk of early overload or unrealistic expectations that [APPs] can come out of school and have a full clinic schedule within a month,” Stewart said. “We don't have GI fellowships.” This requires physician colleagues to take an active role in teaching, she added, APPs to support and learn from one another, and organizations to dedicate the time needed for meaningful training and development.Stewart said that while onboarding checklists can help guide new hires, formal mentorship is even more valuable, especially when physicians regularly check in with and support APPs. “Maybe you set aside half an hour or an hour on Friday afternoons and you look at your most difficult patient of that week and talk through it together,” she said. “But having this time carved out, not trying to squeeze it in at lunch or at 6 p.m. when the physician is finishing their charts, is key.”Enslin and Stewart disclosed serving as speakers, consultants, or both for multiple pharmaceutical companies.DDW is AGA’s annual meeting, jointly sponsored by AGA, AASLD, ASGE, and SSAT. Learn more at ddw.org.
