In 2025, the median physician search took 119 days to fill, and the typical new physician started work 229 days after the job was posted. By the end of the year, half of all physician searches were still open. Those figures come from the Association for Advancing Physician and Provider Recruitment’s 2026 Physician and Provider Recruitment Benchmarking Report, which tracked more than 10,000 searches.
For a hospital, that is more than seven months of shifts to cover between a resignation and a replacement. So the real question is not whether you will need outside help. It is which staffing model fits the gap in front of you. This guide compares the four main options, shows when each one makes sense, and lists the questions worth asking any staffing partner.
Why physician gaps are getting harder to close
The national shortage is not easing, and it is not spread evenly. The Health Resources and Services Administration’s latest physician projections, released in December 2025, project a shortage of 141,160 full-time physicians by 2038. Metro areas are projected to have 95% of the physicians they need. Nonmetro areas are projected to have just 42%.
Rural hospitals are absorbing that gap while their margins stay thin. The Chartis Center for Rural Health’s 2026 State of the State report found that 40% of rural hospitals have negative operating margins and 417 are vulnerable to closure. Chartis also tracks the services rural hospitals have stopped offering: 331 ended obstetrics between 2011 and 2024, and 448 ended chemotherapy between 2014 and 2024.
Every uncovered shift adds to that pressure. Our earlier article, What an Unfilled Shift Actually Costs, breaks down where that cost shows up and why it is so easy to underestimate.
Four staffing models, compared
Each model solves a different problem. Most hospitals end up using more than one.
| Model | How it works | Best for | Watch for |
| Locum coverage | A credentialed physician covers shifts or blocks for a defined period | Sudden vacancies, leaves, seasonal volume and bridging a permanent search | Credentialing and privileging lead time; continuity if physicians rotate often |
| Contract-to-hire | A physician works a defined trial period (Inspire uses 90 days) before a permanent offer | Roles where fit with the team and community matters as much as credentials | Clear conversion terms for both sides |
| Permanent recruitment | A direct hire into a long-term role | Stable, long-term needs where you can plan months ahead | Time to fill: a median of 119 days, and 229 days to start |
| Managed department staffing | A partner staffs and schedules an entire department, such as the ER | Hospitals that want full coverage without running physician scheduling themselves | Who manages day-to-day issues and how the team is vetted for fit |
Locum coverage is the fastest way to keep a schedule whole, and it is often the bridge that makes a careful permanent search possible. Credentialing still takes time, so the earlier you start, the fewer gaps you carry.
Contract-to-hire lets your team and the physician work together before anyone commits long term. For a rural hospital, where one physician can shape the culture of a whole department, that trial period is often worth more than speed.
Permanent recruitment remains the goal for most core roles. The AAPPR numbers are a reason to start sooner and to plan coverage for the months in between, not a reason to stop recruiting.
Managed department staffing takes physician scheduling off your plate entirely. It suits hospitals whose emergency departments need reliable 24/7 coverage and a consistent team, not a rotating list of names.
Matching the model to the gap
The right choice depends on the specialty and on why the gap exists.
- A sudden vacancy or leave. Start locum coverage right away and open the permanent search in parallel. Waiting to decide usually costs more than either option.
- Cardiology and urology. These are some of the hardest searches to close. By the end of 2025, only 28.3% of urology searches and about one-third of cardiology and neurology searches had been filled, according to the AAPPR data. HRSA projects the U.S. will have 84% of the urologists and 85% of the cardiologists it needs by 2038. Defined clinic days or call blocks covered by locums can protect the service line while a long search runs.
- Orthopedics. HRSA projects 88% adequacy by 2038. Because orthopedic work is often scheduled, block coverage can keep procedures on the calendar rather than sending patients elsewhere.
- Primary care. HRSA projects family medicine at 76% adequacy by 2038, one of the steepest gaps it tracks. Chartis reports that 80% of rural census tracts are in primary care shortage areas. Contract-to-hire fits here, because a primary care physician is building a long relationship with your community.
- Emergency medicine. Nationally, HRSA projects enough emergency physicians by 2038. Rural hospitals know the national number does not staff their ER. With nonmetro areas projected at 42% adequacy overall, many rural emergency departments are better served by a managed team than by filling one shift at a time.
Six questions to ask any staffing partner
Whatever model you choose, these questions show quickly whether a partner can deliver.
- How fast can you present physicians, and when can they realistically start? Ask for the timeline after credentialing and privileging, not just the date of the first resume.
- Who handles credentialing and onboarding? Your team’s time is part of the cost.
- How far ahead are schedules built? Two months of visibility is a reasonable standard. Last-minute schedules create gaps of their own.
- How do you vet for fit, not just credentials? Ask how the partner learns your team, your patient mix and your community before presenting anyone.
- What happens if a physician isn’t the right fit? A good partner has an answer before you need one.
- Can you support more than one model? Locums now and a permanent hire later should not mean starting over with a new partner.
What working with Inspire looks like
Inspire builds coverage around fit before fee. We start with a customized staffing plan and get back to you within a few days. We handle credentialing and onboarding, and we build schedules two months ahead so every shift is clear and covered.
We offer locum coverage, contract-to-hire and permanent placement nationwide. Across the Southeast, we also staff and manage full emergency departments, and we’ve had zero unstaffed shifts in nearly 30 years. You can see the hospitals we work with on our Current Partners page, or estimate your own coverage needs with our Staffing Calculator.
Physicians weigh these same models from the other side of the table. Our companion article, Locums, Contract-to-Hire or Permanent, explains how they choose.
Frequently asked questions
In 2025, the median physician search took 119 days to fill, and new physicians started a median of 229 days after the job was posted, according to AAPPR’s 2026 benchmarking report.
Locum coverage fits sudden vacancies, leaves of absence, seasonal volume and the months between a resignation and a permanent hire.
A physician works a defined trial period, often 90 days, before the hospital and physician decide on a permanent role.
Yes. HRSA projects nonmetro areas will have 42% of the physicians they need by 2038, compared with 95% in metro areas.
Yes. In a managed model, the partner staffs, schedules and supports the ER physician team. Inspire offers this across the Southeast; learn more on our Hospital Staffing page.
Build your coverage plan before you need it
The best time to choose a staffing model is before the next resignation letter lands. If you want to see what coverage could look like for your hospital, schedule a meeting or contact us to set up a conversation.
