Employee Turnover Rate in Healthcare: Benchmarks and Retention Strategies for Small Practices

Health care does not have the worst turnover in the US economy. It has the most expensive kind. For a hospital system with 3,000 employees, that is a chronic budget line with a dedicated HR team working on it. For a 10-person medical practice where the physician is also the owner, the office manager, and the HR department, one medical assistant leaving creates a staffing crisis that affects every patient scheduled in the next six weeks.

Most of the content available on healthcare turnover rates is written for hospital administrators managing hundreds of nursing positions. This guide is for the clinic owner, the dental practice manager, and the physical therapy group administrator who needs to understand the actual numbers, what they mean for a practice their size, and what retention interventions actually work without an HR department. At FirstHR, we built our onboarding platform for exactly this: small healthcare practices that need enterprise-quality people management without enterprise complexity or cost.

How High Is Healthcare Turnover Right Now

Across health care and social assistance, total separations ran at 35% of employment in 2025 and voluntary quits at 24%, according to the Bureau of Labor Statistics Job Openings and Labor Turnover Survey. Both sit at or below a national average of roughly 40% separations and 24% quits across all US employers.

That contradicts the line most healthcare turnover coverage opens with. The claim that health care turns over at twice the national rate does not appear anywhere in the federal data, and the figures behind it come from private staffing surveys that sample hospitals and long-term care rather than the industry as a whole. What is distinctive about health care is not how often people leave. It is what each departure costs to undo.

For most of the healthcare system, these numbers represent a structural challenge that staffing agencies, travel nursing programs, and float pools have evolved to address. For small practices, there is no float pool. There is no staffing agency contract. There is the owner and whoever is available to cover the schedule until the next hire is credentialed and trained. Understanding the actual numbers for your setting is the starting point for building a realistic retention strategy.

The pressure underneath those rates is measurable too. In the CDC analysis of the General Social Survey Quality of Worklife module, 45.6% of health workers reported feeling burned out often or very often in 2022, up from 31.9% in 2018, and the share saying they were very likely to look for a new job with another employer rose from 11.1% to 16.5% (CDC Vital Signs, October 2023).

Turnover Rates by Healthcare Role and Setting

Healthcare turnover is not a single number, and the trustworthy numbers are thinner than the search results suggest. Two public sources publish turnover for this industry: the BLS Job Openings and Labor Turnover Survey, which stops at the industry level, and the CMS Care Compare file, which carries a rate for nearly every certified nursing home in the country.

The tables below keep those separate from the private survey figures that circulate as though they were official statistics. Where no public rate exists, the table says so rather than filling the cell.

By Role

By Setting

The roles that drive most turnover events at small outpatient clinics, dental practices, and specialty groups are exactly the ones with no published rate: medical assistants, front desk staff, and billing and coding. That is not a reason to adopt someone else's benchmark. It is a reason to measure your own, which the next section walks through.

They are also the roles where structured onboarding and career advancement make the biggest difference to whether a good hire is still with you in year two.

What the Nurse Turnover Rate Actually Measures

The defensible nurse turnover rate comes from the federal government's own survey of nurses. An analysis of the 2022 National Sample Survey of Registered Nurses, published in Health Affairs Scholar in 2026, found that 28.7% of frontline registered nurses had left the primary nursing position they held on December 31, 2021 by the time they answered the survey.

The hospital-specific rates quoted in most coverage come from a private staffing survey of health systems instead. They describe bedside nursing inside large employers, so a clinic with one or two nurses should read them as wage pressure in its market rather than as a benchmark for its own staff.

Who leaves matters more than the headline number. The same federal analysis found turnover highest among nurses in their early twenties, declining sharply as years of experience accumulate, and dissatisfied nurses more than 2.5 times as likely to actually go. Early tenure is the part onboarding moves, and it moves the same way in a nine-person practice as it does on a medical-surgical floor.

Calculating Your Turnover Rate When You Have Nine Employees

Benchmarks are only useful once you know your own number, and the standard formula behaves strangely at small headcounts. The calculation itself is simple: separations during the period, divided by average headcount during the period, multiplied by 100. Average headcount is where practices get it wrong. Use the average of your monthly headcounts rather than your headcount today, because a practice that grew from 9 to 11 people over the year did not have 11 employees at risk of leaving for all twelve months.

A worked example. Your practice starts January with 9 employees, ends December with 11, and averages 10 across the twelve monthly counts. Three people left during the year. Three divided by ten is 0.30, so your annual turnover rate is 30%. That single number is worth almost nothing on its own, which is the point of everything below.

At eight employees, a single resignation moves your annual rate by 12.5 percentage points. That means a practice can swing from "better than the industry" to "crisis" on one person's decision to move closer to family, and it means comparing your 30% against the 24% industry quits rate tells you very little in any single year. Three fixes make the number usable at small scale.

Track it on a rolling twelve months, not a calendar year. Recalculate at the end of every month using the previous twelve. A calendar-year rate hands you one data point in January and nothing to act on until the following January. A rolling number shows a trend forming in month four.

Split voluntary from involuntary. Total turnover includes people you asked to leave, and firing someone who was not working out is a hiring problem, not a retention problem. Then split voluntary departures again into regrettable and non-regrettable. A practice with 30% total turnover made up of one termination, one retirement and one person following a spouse out of state has a very different problem from a practice where three medical assistants left for a competing clinic.

Track first-year turnover separately. Divide the number of people who left with less than twelve months of tenure by the number of people you hired in the same period. This is the single number onboarding actually moves, and in most small practices it is dramatically worse than the headline rate. If you hired four people last year and two of them are already gone, your onboarding is the problem regardless of what your overall rate looks like.

That list is the first tab below. Add a row the week somebody gives notice, while the reason is still specific, and the second tab turns the same rows into a rolling rate and a separate first-year number without you having to rebuild anything in January.

Why Small Healthcare Practices Lose Staff Faster

Small practices do not just experience the same turnover as large health systems at a smaller scale. They face structural disadvantages that make retention harder, and the consequences of each departure are disproportionately severe.

The Asymmetric Impact: Small Practice vs. Large Health System

The same turnover percentage creates fundamentally different situations depending on the size of the organization experiencing it.

This asymmetry is why turnover strategies developed for large health systems do not translate to small practices without significant adaptation. A hospital system can absorb the industry quits rate as a management challenge. A 10-person practice experiencing the same rate is in a constant state of partial disruption, and the owner is personally absorbing a significant portion of the operational burden.

What Turnover Actually Costs a Small Medical Practice

The full cost of one departure includes direct costs (recruiting, temporary coverage, onboarding) and indirect costs (lost productivity during the transition, reduced patient capacity, the effect on everyone who stays). Gallup prices replacement at one-half to two times the departing employee's annual salary and calls that a conservative estimate.

Applied to median pay from the Bureau of Labor Statistics Occupational Employment and Wage Statistics survey (May 2025), that band is what each role actually costs you. The table sorts by median pay, lowest first.

The physician line deserves attention because the number looks absurd until you account for enrollment. A family medicine physician at the $244,180 national median carries a replacement band of $122,000 to $488,000 on the same arithmetic, and most of the upper half is the months when nobody can bill for the work.

Medicare lets a newly enrolled physician bill retrospectively for services furnished up to 30 days before the effective date of enrollment, and commercial plans generally pay nothing before their own effective date. During that window the practice loses the revenue from that physician's panel, pays for a locum tenens physician, or redistributes the panel across the providers who remain. All three are expensive, which is why physician retention is a financial strategy and not only an HR one.

Why a Clinical Vacancy Costs More Than the Wage

The reason clinical turnover is more expensive than the salary line suggests is that a licensed hire cannot generate revenue on their start date. Between the signed offer and the first billable encounter sits a sequence of verifications that nobody at your practice controls, and each one has its own queue.

Two mechanics decide how much of that period you actually eat. The first is the effective date. Commercial payers generally will not pay for services delivered before the provider's effective date with that plan, and each plan sets its own.

Encounters performed during credentialing therefore go unbilled, get billed under a supervising provider where the payer's rules and your contract genuinely allow it, or sit in a work-in-progress queue. The Medicare retrospective window described above is the one real exception, and 30 days is narrow against a process that runs for months.

The second mechanic is when you start. Nothing requires the person to already be on your payroll, so credentialing can begin the day the offer is signed. That timing is the largest single saving available to a small practice here.

Keeping provider profiles current in the shared credentialing database most payers pull from, including the periodic re-attestation those profiles require, removes weeks of back-and-forth before the applications even go out.

Scope of practice rules add a state-level variable to all of this. Nurse practitioner authority ranges from full practice authority in some states to a required collaborative or supervisory agreement with a named physician in others, and physician assistant supervision requirements vary similarly.

If the departing clinician was the collaborating physician on someone else's agreement, their resignation can suspend a second provider's ability to practice until a replacement agreement is executed. That is a second vacancy you did not plan for.

Nursing hires are usually faster. In states that participate in the Nurse Licensure Compact, an RN or LPN whose primary state of residence is a compact state holds a multistate license and can practice in the other compact states without applying for a new single-state license first. It is a recruiting advantage worth knowing whether you have.

7 Proven Ways to Reduce Turnover in Your Practice

These seven strategies are ordered by implementation ease and ROI for small practices specifically. Enterprise healthcare retention programs (formal mentorship cohorts, comprehensive total rewards overhauls, leadership development academies) are not on this list because they require resources and infrastructure that small practices do not have. These do not.

The First 30 Days After Someone Resigns

Retention strategies reduce how often this happens. They do not get you to zero, and healthcare offboarding carries obligations that a generic checklist misses. The order below is roughly the order the clocks run out.

Access, on the day you are notified

The HIPAA Security Rule tells you to implement procedures for terminating access to electronic protected health information when a workforce member's employment ends. It is an addressable specification, which means you either implement it or document why something equivalent fits your practice better. That is not one switch.

It is the EHR, the e-prescribing platform, the clearinghouse, the patient portal admin console, the practice management system, shared email accounts, the fax service, the after-hours answering service, any payer portal logins, and physical items like badges and keys.

Write that list once for your practice and keep it with your offboarding checklist, because reconstructing it during a resignation is how orphaned accounts survive for two years. For staff working out a notice period you usually keep clinical access active until the last day, which makes the deactivation date something you schedule deliberately rather than something that happens when someone remembers.

Final pay and benefits, on the state's clock

Final paycheck timing is a state rule and it varies more than most owners expect. Some states require payment immediately or within a day or two of an involuntary termination and allow the next regular payday for a resignation, others treat both the same.

The rules on paying out accrued but unused PTO also differ by state and can be modified by your own written policy. Look up your state requirement once and record it in your offboarding checklist rather than deciding under time pressure.

Benefits run on a federal clock instead. If you sponsor a group health plan subject to COBRA, ERISA gives the employer 30 days to notify the plan administrator of the qualifying event, and the administrator 14 days to send the election notice.

State continuation rules then apply to many smaller employers whose plans sit below the COBRA threshold. A practice under 20 employees is often not exempt from continuation obligations, only from the federal version of them.

Patients and licensure continuity

When a treating clinician leaves, patient notification is a professional obligation as well as a courtesy, and state medical, dental and nursing boards set their own expectations for how departing practitioners and their employers handle notification, records access and continuity of care. Employment agreements frequently address who may contact which patients and how, which is exactly why that clause is worth reading before the resignation rather than after. Practically, the practice needs a named provider covering the departing clinician's panel from the last day forward, a plan for open refill requests and pending results, and a documented handoff of anything mid-treatment.

What to do with the role

The reflex is to post the same job description the same afternoon. Resist it for a week. A departure is the only moment you get to redesign a role without disrupting anyone, and small practices routinely discover that the job that just opened was actually two jobs, or that half of it should have been automated, or that a current employee wants a piece of it and would treat that as the advancement they have been asking for. Then run the exit conversation, ideally with someone other than the person's direct manager, and ask when they first started considering leaving. The answer is usually months earlier than the resignation, and it tells you which of your remaining employees is in the same place right now.

The Onboarding Connection: Where Most Healthcare Turnover Starts

The most commonly overlooked driver of healthcare turnover in small practices is the first 90 days. According to SHRM, up to 20% of all employee turnover happens inside the first 45 days on the job. The trigger is almost always the same: the job was meaningfully different from what was described in the hiring process, or the employee felt unsupported and unclear about expectations during onboarding.

Healthcare-specific onboarding has compliance layers that generic onboarding tools do not handle well: HIPAA training completion tracking, credential expiration date management, and the DEA and state license verification workflow. These are not optional steps. They are legal requirements, and tracking them by hand is how renewal deadlines slip and gaps open in the documentation.

The payoff for getting the first months right is measurable. SHRM reports that newly hired employees who complete a structured onboarding process are 58% more likely to still be with the company three years later.

Frequently Asked Questions