Patient Turnover in the Nurse Practitioner Business

Turnover Business Distribution Sale  - stux / Pixabay

Patient turnover is an expected part of operating a practice. Patients leaving is an unfortunate aspect of owning a practice because it can feel a little more “personal” compared to patients leaving a practice that you just work at, and that is a big part of today’s article. Additionally, if you are just getting started it can feel devastating. It also can be devastating to your finances if you are operating a tight operation but the biggest thing you need to remember with patient turnover is this:


Seriously, patient turnover is part of operating a practice. You can either let it get to you or you can brush it off. Listen, as a business owner you should really try not to let business get personal. If you do, then operating a business might not be for you. It doesn’t matter what type of business you operate: customers will come and go. You need to expect this, and you need to be OKAY with it.

I was talking to a nurse practitioner the other day that operates a wellness practice. She was asking me what I do when patients do not show up for their follow ups or stop answering the phone. I blankly stated, “I don’t know, because I don’t care.” She was stunned.

Seriously, I don’t care if they don’t show up for their follow up or don’t answer the phone. Their decision has been made and I will likely never know why they stopped coming nor will I be able to change their mind. It is like wracking your mind around why an ex-boyfriend/ex-girlfriend broke up with you. Who cares? They did and there is little you can do about it. I don’t take it personally because I expect it!

People’s lives are complex. People have hundreds of things going on in their life in any given week. You are just a small blip on their overall radar. People’s decisions, ambitions, and motivations are none of your business, nor should you care.

Maybe the patient left because they couldn’t afford treatment anymore.

Maybe the patient left because they found a cheaper option.

Maybe the patient left because their spouse didn’t like it.

Maybe the patient left because they weren’t feeling better.

Maybe the patient left because they moved.

Maybe the patient left because they passed away.

Maybe the patient left because they started to feel better and didn’t need help anymore.

Maybe the patient left because treatment was causing explosive diarrhea.

Again, it doesn’t really matter. They left…

Why don’t I care? Because I rarely ever even know about the patient leaving. Why? Because I don’t even give it a second thought and usually don’t even know a patient fell off treatment.

My clinic is designed in a way to where the patient is required to obtain lab work before the next visit is scheduled. Therefore, we don’t schedule patients in advance for follow ups. They receive a text reminder when their lab work is due, and if they don’t get it, then they don’t get a refill. It is that simple. So, if they don’t reach out, then they fall off. We never even know about it.

That is fine… I am booking out 3 weeks in advance anyways at this point with my men’s health clinic.

Now, I think it is important to keep track of your active patients as this will help guide your decisions on growth as a nurse practitioner business owner. How do we do this? We simply just look at our active patients every 3 months and compare it to the 3 months before. It is always higher than the 3 months prior because I continuously market my practice and have delegated work to other nurse practitioners. We are in a position to grow and growing we are.

So, how do I measure turnover? I don’t. Why? Because that is negative measurement that I do not concern myself over because we continue to grow our patient census every quarter. It doesn’t really matter to me because I KNOW and EXPECT patient turnover. It is just part of business folks. As long as we continue to grow, then it is a win in my book.

On the other hand, if business started to slow significantly and patient volume decreased quarter to quarter, then I would be concerned about turnover as it is outpacing growth.



This means that something is very very wrong with your business. This points to multiple possible problems in your business including:

You are not providing enough value to your patients.

You are providing poor customer service.

You are not delivering the level of care patients expect for the price.

You are not improving the patient’s condition or symptoms.

A competitor has out priced you.

And so forth…

If your turnover is outpacing your growth, then you better PAUSE and figure out what the issue is. This can be done by calling ex-patients and simply asking them if there is anything you can do for them. Let them know you miss them. Let them tell you the problem.

Patient turnover can also be prevented by providing surveys from time to time in your practice. Simply ask the patients “What has been a problem you have experienced in the last 3-6 months?” or “What could we do better to provide you the best experience possible?” Sometimes you can find BIG ISSUES that you were not even aware of. If you do, THEN FIX IT. This will prevent turnover and I do this from time to time at my men’s health practice.

The big thing here though is to not take expected patient turnover personally. If you expect it, then you will not let it bother you. There are many aspects of operating a business that you need to expect, and this is one of them.

It doesn’t matter if you are running an ice cream shop or a weight loss practice. Customers will come and go for a multitude of reasons that you will never know. That is fine…

So, continue to provide excellent customer service.

Continue to provide excellent patient care and ensure patients are feeling better.

Continue to provide affordable services that outprice the competition.

Continue to be compassionate and care.

If you do these 4 things, then patient turnover will be minimal, but you will still have it. Patients will fall off treatment. Just expect it and don’t take it personally!

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