When I open an NP or PA search, I pull the competing postings in the market first. Strip the logos and most of them are the same document. Specialty, schedule, a comp range, a benefits list, a line about a collaborative team.
Those details get a clinician to read the posting. The decision gets made on four questions almost nobody puts in writing.
And these clinicians have room to be picky. BLS projects nurse practitioner employment to grow 40% from 2024 to 2034, the third-fastest of any occupation in the country. Physician assistants are projected at 20%, with about 12,000 openings a year. Someone with that many options doesn't have to guess what your job is really like. They just move on to the next one.
In New England, autonomy is a culture question
AANP's State Practice Environment map, last updated May 2026, lists 27 states plus DC as full practice for NPs. All six New England states are on it. So when an NP here asks about autonomy, she already knows what the law allows.
She's asking whether you'll trust her. Whether her charts get second-guessed. Whether she runs her own panel or carries out someone else's plan. I've watched NPs in full practice states feel boxed in because every decision ran up an approval chain, and NPs with a restrictive agreement feel completely free because the physician respected their judgment.
"We support APP autonomy" answers none of that. Write down what actually happens. APPs carry their own panel. They consult a physician when they want a second set of eyes. Prescriptive authority is full within scope. A candidate can test that sentence in the interview, and that's why it works.
Scope surprises drive the six-month phone call
A lot of the APPs who call me looking to leave are less than a year into the job. The most common reason is scope. It wasn't what they were told.
Sometimes the role was narrower. They were hired as a provider and found a protocol-driven job with little room for judgment. Sometimes it was wider. They were hired for one population and got pulled into areas they weren't trained for, with nobody to back them up. Home health, post-acute and community health settings see both, because the work changes with census and staffing.
Here's what candidates want to know before they accept:
The actual encounter. Acuity, complexity, time per visit, visits per day.
Procedures. What's in scope and what isn't allowed.
New role or backfill. A backfill has a track record. A new role means building it as you go, which some APPs love and some hate.
Hard limits. Anything APPs can't manage independently in your setting.
Honest scope costs you some applicants. They're the ones who would have been calling me in month six.
Collaboration style is the mismatch nobody writes down
This drives more early exits than anything else I see.
Some APPs want the physician down the hall, weekly case review, regular clinical contact. Others want a phone number and to be left alone with their patients. Put the first kind in a hands-off practice and she feels abandoned within a month. The second kind in a tightly run practice starts updating his CV around week six.
Neither preference is wrong. The mismatch is the problem, and a posting can prevent most of it. Say whether the physician is on site or reachable by phone. Say how often APPs and physicians talk about patients. Say whether case review is scheduled or happens when someone needs it. Say whether APPs are expected to escalate often or only when something is truly outside their lane.
That's fifteen minutes of writing. Most practices skip it and assume the interview will sort it out. Usually it surfaces around day ninety.
Silence on trajectory filters out your strongest candidates
APPs five to fifteen years into practice keep asking me the same thing. If I do good work there, what happens next.
That's a reasonable question from someone with options. If the honest answer is that the job stays clinical, say so. Plenty of experienced NPs and PAs want exactly that, and they'll read it as a plus.
If there's more, spell it out. A lead APP role. Precepting students. A directorship. A service line you're planning to open. When a posting says nothing, the clinicians who care most about growth assume there's nothing. They tend to be the best people in the pool. They don't apply, and you never learn they looked.
The practices that write these four answers down are the ones I don't hear from again for years.
Sources: American Association of Nurse Practitioners, State Practice Environment map, updated May 2026. U.S. Bureau of Labor Statistics, Employment Projections 2024–2034 and Occupational Outlook Handbook entries for nurse practitioners and physician assistants, accessed September 2026.