UChicago Medicine cut advanced practice provider turnover by 10%, saved $25 million in direct costs and increased clinic patient access by 200% with a systemwide APP transformation, Brooke Schweitzer, DMSc, PA-C, the system’s chief advanced practice officer, told Becker’s.
It started in 2023 when the system hired a consultant to evaluate the state of UChicago’s APP workforce. That workforce had grown from 200 APPs before the COVID-19 pandemic to 650, but the system was not seeing gains in access and throughput to match that growth. That report showed leaders that improvement was needed. In late 2023, UChicago hired Dr. Schweitzer as its inaugural chief advanced practice officer and in 2024, it began a transformation.
One of the first steps was creating the Center for Advanced Practice, which Dr. Schweitzer oversees as executive director. UChicago then launched individual scorecards for APPs to have insight into their numbers, similar to physicians. Next, the system clarified APPs’ roles and expectations.
“For APPs, role ambiguity is one of the biggest drivers of dissatisfaction — we know it’s the number one reason for turnover,” Dr. Schweitzer said. “People need to know where they fit and what’s expected of them before they can understand where to go and where to thrive. That’s the background we started this whole process with.”
This combination of an individualized approach, leadership alignment, data pulling and continuous effort has paid off for the system.
“I’m thankful UChicago allowed us to spend this time investigating and doing this work, because there’s no proven methodology for it,” she said. “Every system does it on their own, so there was no guarantee we’d get these results. But they said this is something they believed was important for our patients, and it worked.”
The results
The system’s efforts cut APP turnover from 19% to 9% over the course of four years, which equated to more than $25 million in direct cost savings from improved retention. Engagement scores also improved, and the system generated $10 million in the last year alone in professional revenue tied to the clarity in roles and expectations, Dr. Schweitzer said.
On the ambulatory side, the system has seen a 200% increase in the number of clinics hosted by APPs and a more than 200% increase in access.
“More appointments are available to patients and have been completed by APPs than we’ve ever had in the system,” Dr. Schweitzer said. “Our data show that growth was a contributing factor, but the data also demonstrate that our efforts have been the primary driver.”
At the same time, physician productivity also improved, “suggesting the strategy strengthened the overall care model rather than shifting work from one provider group to another,” she said. “It’s been a true triple win: better for patients, better for APPs and better for the organization’s bottom line,” she said.
Duplicating results
Dr. Schweitzer said this transformation is not something a single person can achieve and there’s no “secret email” a leader can send to get these results. The results come from years of work, as well as buy-in and support from the system’s senior leaders.
The first step was creating a multidisciplinary task force of physician, ambulatory, nursing and operational leaders across the system. That team has had more than 100 meetings and developed individualized approaches for “every nook and cranny of our organization, anywhere there was an APP,” Dr. Schweitzer said. This step helped incorporate change into the culture of the system.
Next, she recommends developing the foundation of what role clarity means, and doing an inventory of the hospital’s current state. From there, she advocates creating the “ideal state” to reach and begin work finding the data and leader buy-in needed to close the gap between the current and ideal states.
What’s next for UChicago
UChicago leaders are continuing to optimize APP work with projects in the inpatient setting. They are also continuing to revamp the compensation model to recognize not only productivity, but the professional contributions of APPs.
“Our goal is to become the gold standard for APP practice,” Dr. Schweitzer said, adding that there is currently no one system or hospital that is the go-to destination for APPs. “We want APPs to think UChicago Medicine is a place where they can thrive, use the skills they worked so hard in school to develop, and see their career take off — a place that will support their professional development, their learning, and support them practicing at the top of their capabilities.”
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