Employee turnover is costly – especially when that employee is your senior medical practice group executive. There are the direct costs of recruiting someone new. There are also the fairly well-documented indirect costs including lost organizational history and experience, lost relationships, lost investment in training, and the lost productivity that accompanies organizational change. Even more significant is the strategic disruption that will occur if a new executive comes into the organization with his or her own strategy, based on past successes in other settings. So often, we have witnessed a change in strategic direction in a medical practice group with a perfectly sound strategy simply because “there’s a new sheriff in town.” There are times when infusing a medical practice with “new blood” and a fresh perspective can be valuable. Nevertheless, change for the sake of change can damage physician trust and engagement, dampen productivity, increase costs, and lead to further turnover.