It’s March, and in the urgent care business, flu season is winding down. Like clockwork, the first resignation notices of the year come with it. Urgent care is a cyclical business– volumes slow in the summer, are higher in the winter, and provider turnover follows a similar pattern.
Keeping providers happy and reducing turnover is always on our issue list, but this is easier said than done. As an urgent care provider and manager, I am constantly looking for ways to improve provider satisfaction and retention so we don’t lose team members. Hiring a new provider is expensive, time-consuming, and takes resources away from an experienced provider.
Yet, I don’t think we talk enough about how costly it is to hire and train providers– or what we can do to keep the ones we already have. So let’s break it down.
Why a Lower Salary Doesn’t Always Mean Lower Costs
I’ve handled hiring for several local urgent cares. Just when I think I have a solid team in place, another resignation comes in, and the cycle starts all over again. After going through this process multiple times, I’ve noticed clear patterns when hiring providers at different career stages.
Hiring a new provider seems like a cost-saving move on the surface. You can bring in a new provider at $60-$65 per hour, compared to an experienced provider making $70-$75 per hour. But in practice, salary is just one piece of the puzzle. A provider’s efficiency, experience, and ability to manage high patient volumes– especially when working solo– impact the clinic’s flow and bottom line more than their hourly wage.
That said, not every clinic needs a provider who sees the highest volume of patients. If your clinic has a finite number of patients or multiple providers per shift, patient volume per provider may not be the most pressing issue. However, if efficiency is a priority and staffing is limited, an experienced provider is often the better investment.
The Experience Advantage
Experienced providers don’t just see more patients; they often generate more revenue per visit because they chart better and have higher average EM codes. They can handle a full patient load when single-covered, which keeps the patient flow steady and wait times low. This could lead to higher patient satisfaction and repeat business, although this can depend on their personality as much as their experience level and is hard to quantify.
On the other hand, a new provider typically needs at least 3-6 months to ramp up fully. During this time, they see fewer patients per hour, have more documentation errors (requiring extra time from billing and coding), need training from an experienced provider (taking them away from patient care), and could have lower-level charts (leading to lower reimbursement rates) due to inexperience with charting.
Let’s look at some real numbers from our clinics over the past year. The experienced provider in this example has over 3 years of experience, works full-time,and was double covered when the new provider started. The new provider was fresh out of school and had never worked as an APP before. These numbers were from the new providers’ first month on their own.
Productivity & Revenue Comparison
| Category | Current, Experienced Provider (>3 years in practice) | New Provider | |
| Annual Salary | $151,200 | $131,040 | |
| Double-Staffed Patient Encounters Per Hour | 2.8 | 1.87 | |
| Total Patient Encounters Per Month | 411 | 299 | |
| Revenue Per Visit (Avg. CPT Code Reimbursement) | $160 | $140 | |
| Monthly Revenue | $65,760 | $41,860 | |
| Single-Covered Patient Volume Potential | 4-5 patients/hr | 2-3 patients/hr | |
| Single-Covered Revenue per 12-hour Shift | $7,680 – $9,600 | $3,360 – $5,040 | |
| Potential for Repeat Business | Higher patient retention, more satisfied patients | Harder to quantify but could be lower |
Patient Volume Trade-Off
Managing provider schedules is a balancing act between maximizing productivity and preventing burnout. As you can see in the table, even an experienced provider won’t always hit their full potential in a double-covered clinic setting simply because there are only so many patients to be seen.
For a new provider, running a clinic solo is typically unrealistic for at least 3 months. If placed in a single-covered, busy clinic setting too soon, they can struggle to maintain patient flow, leading to longer wait times and lower patient satisfaction. In contrast, an experienced provider typically has a better workflow and can keep wait times lower and operations running smoothly.
If your urgent care model relies on single-covered shifts, investing in provider retention or paying more for experienced providers may be smarter. The salary difference between an experienced and new provider closes fast when factoring in revenue per shift, efficiency, and ramp-up time– and that’s before even considering the cost of onboarding and training.
Hiring, Onboarding, and Training Costs
Hiring a new provider isn’t just about signing a contract and adding them to the schedule. The process of getting them up to speed requires an investment of time, money, and resources.
First, there are upfront hiring costs–job postings, recruiting fees, and administrative fees with processing. Then come the onboarding expenses, including licensing, credentialing fees, and malpractice insurance. Finally, there’s training, which requires you to pay a full salary to a provider who isn’t yet working at full capacity. If the clinic is already double-covered or would typically only require single coverage, the trainee’s salary is an additional expense that wouldn’t otherwise exist.
One minor cost-saving factor when hiring a new provider is that they don’t qualify for 401(k) matching until after one year of employment. Additionally, payroll taxes are lower for a lower-salaried provider. However, these savings are temporary.
Onboarding & Training Costs for New Providers
| Category | Cost |
| Job Posting & Recruiter Fees (2-4 weeks) | $980 – $1,960 |
| Credentialing & Licensing Fees | $1,500 |
| Malpractice Insurance (First-Year Cost) | $1,500 |
| Trainee Salary (168 hours at $65/hour) | $10,920 |
| Revenue During Training Period (14 shifts per month, two patients/hour) | $19,600 |
| Potential Revenue Lost Per Month During Ramp-Up (Consideration) | $37,940 |
Calculating potential lost revenue:
A typical training period for a new provider is 14 shifts over a month. Assuming that during the first month of training, they are only seeing 1-2 patients per hour, the revenue they will bring in does not come close to a fully-training provider seeing 2-3 patients per hour on a double-covered day and 4-5 patients per hour on a single covered day.
Remember: this is only a true cost if patient demand exceeds the new provider’s capacity. If the new provider is double-covered with another provider, the more experienced provider will pick up the slack.
However, if the clinic normally operates with single coverage, hiring a new provider results in a direct revenue loss equivalent to the difference between what they can see versus what a fully productive provider would see. Even in the double-covered scenario, the financial impact may be lower, but it still shifts more workload onto experienced providers who take on the burden of single-covered shifts, increasing the risk of burnout and dissatisfaction.
The biggest loss occurs when a new provider can’t yet work alone– which we refer to as “their ramp-up time, ” usually lasting 2-3 months after their training period. During this time, you might have to extend double coverage or limit the patients that go through the clinic to a single provider that isn’t ready to take on a full load.
Turnover Costs
Now that we all know onboarding and training a new provider is expensive, it is obvious that turnover is just as expensive. Every time a provider leaves, the clinic starts over with finding a replacement.
Even in the best-case scenario, where a replacement is found quickly, credentialing alone can take 2-3 months. During this time, shifts may need to be covered by other providers– potentially with an incentive to get them to take more shifts (leading to increased costs) or left unfilled (resulting in potentially lost patient visits).
The impact of turnover goes beyond just hiring and training. It includes the time it takes to find a replacement, the potential for loss of revenue while waiting for the new provider to be fully productive and the repetition of onboarding costs.
Turnover Costs for New Providers
| Category | Cost |
| Time to Find Replacement | 1 month |
| Additional Time for Credentialing | 2-3 months |
| Total Vacancy Period | 3-4 months |
| Repeat Recruitment Costs | $1,000 – $2,000 |
| Repeat Credentialing & Licensing Fees | $1,500 |
| Training Time by Senior Provider (168 hours at $75/hour) | $12,600 |
| Fixed Onboarding & Training Costs | $17,070 |
| Potential Revenue Lost Per Month During Ramp-Up (Consideration) | $37,940 |
Because of the potential for lost revenue, most urgent cares enforce a 90-120-day notice requirement– which gives them time to find a replacement and minimize the burden of an unexpected vacancy.
Another downside to turnover that isn’t always discussed is the increased frustration from remaining providers. When a provider leaves, the rest of the team could be forced to pick up extra shifts, leading to burnout and even more turnover.
Retention over Hiring
I am solution-driven, so after looking at the numbers, it’s clear that hiring and onboarding a new provider is a significant cost. So, how can we cut hiring costs? Reduce turnover. But when hiring is necessary, here are some tips that might improve your process.
Improve your Hiring Strategy
1. Look beyond salary
I’ve started being more upfront with new providers about expectations– how many patients they need to see per hour, when they’ll be expected to work alone, and what their expected ramp-up period is and what it will look like. We’ve had better success hiring ER-training nurses as NPs or providers with 1-2 years of experience rather than new grads with limited clinical exposure.
It also helps to dig deeper during hiring. Ask previous employers about their efficiency, charting habits, and workflow. A provider says all the right things in an interview but can struggle in real life– which can be a costly error to make.
2. Hire for fit, not just availability
More times than I would like to admit, I rushed to fill a vacancy instead of waiting for a more qualified candidate. Now, I prioritize experience, efficiency (Can they handle the patient volume?), and personality (Will they be team players and fit in with the team?).
Taking extra time to find the right provider will pay off.
But if you’ve ever been responsible for hiring, you’re probably rolling your eyes right now– because while this sounds great in theory, it’s not always feasible. There are times in hiring when you are short-staffed and don’t have time to wait for the perfect fit for the clinic. The immediate need is to keep the clinic running, prevent provider burnout, and avoid excessive wait times, which can push you to hire fast. If I have to hire fast and am concerned about their experience level, I just make sure they have more double-covered shifts (ideally in the winter when you need the extra person anyway) and put them with stronger providers to bump up their skills. Use their first few months as a trial period, if they are not up to speed by the time the volumes slow, you can make adjustments at that time.
3. Competitive compensation and incentives
Money isn’t everything. I have given providers raises and have them leave a few months later—however, competitive pay matters when attracting good candidates.
Beyond base salary, consider performance-based incentives, such as bonuses for productivity, accurate charting, or patient satisfaction. These can motivate providers to stay longer and perform at a higher level.
4. Offer career growth opportunities
Providers sometimes leave if they don’t see any long-term opportunities for advancement. Consider offering leadership roles– such as lead provider roles, training opportunities, or involvement in admin work. When providers feel invested in the clinic’s success, they’re more likely to stay.
Conclusion
Hiring a new provider is more than just filling a spot in your schedule– it’s an investment that comes with significant cost. Onboarding, training, and turnover are large expenses for a clinic.
The best strategy? Retention. Keeping experienced providers lowers hiring costs and helps increase clinic efficiency– if they are a good culture fit. However, when hiring is necessary, use some of my tips to hire smarter and try to prevent turnover.
Knowledge is power; knowing how much it costs to hire a new provider will help you make a more conscious decision on making sure they are the right fit for the clinic instead of just focusing on filling the void in the schedule. At the end of the day, an experienced and supported provider team can lead to better patient care, smoother clinic operations, and higher reimbursement rates.