You fill the vacancy. Six months later, you’re recruiting for the same position.
For hospitals struggling with physician and Advanced Practice Provider (APP) shortages, this cycle can feel relentless – recruit, onboard, fill the schedule, and then start over when turnover creates another gap.
Hospitals across the country are competing for a limited pool of physicians and APPs. This challenge is especially difficult in rural and underserved communities, where recruiting often takes longer and fewer clinicians may have existing connections to the area.
That reality has pushed many organizations to focus heavily on filling open positions as quickly as possible. Yet this strategy is oftentimes shortsighted.
Recruiting matters, but a signed agreement or completed schedule doesn’t necessarily create stability. If leadership is inconsistent, workloads are unsustainable, or clinicians feel disconnected from the hospital, vacancies are likely to return.
For hospital executives, the more important question is not simply, “How quickly can we recruit clinicians?” It’s, “What are we recruiting clinicians into?”
Retention begins before the first interview
Clinicians evaluate more than compensation when considering an opportunity. They want to understand the workload, schedule expectations, available resources, leadership structure, and level of influence they will have within the program. If those realities differ from what was communicated during recruitment, even strong candidates may choose not to stay.
Effective recruiting begins with an honest assessment of the program. Is coverage aligned with patient demand? Are administrative expectations clear? Is there a credible clinical leader in place? Do clinicians have a meaningful way to raise concerns and contribute to improvement?
Hospitals that cannot answer those questions may continue filling positions without addressing the conditions driving turnover.
Local leadership creates stability
Strong local clinical leadership is one of the most important elements of a stable program. Medical Directors provide more than schedule oversight. They connect frontline clinicians with hospital leadership, reinforce expectations, and create accountability around performance, communication, and culture.
This role is especially important during periods of transition. Clinicians need a leader who is visible, accessible and able to explain what is changing. Hospital executives also need a trusted clinical partner who can translate strategic priorities into daily practice.
Without that connection, small operational frustrations can grow into disengagement, burnout, and turnover.
Recruiting and operations must work together
Recruiting cannot operate in a vacuum.
A recruiter may successfully identify a qualified clinician, negotiate the contract, and get the position filled. But what happens after the clinician says yes? That is where long-term stability is won – or lost.
Thoughtful onboarding, schedule transparency, and regular communication helps clinicians become part of the team rather than simply names on a schedule. Data also plays an important role. Examining patient volumes, arrival patterns, acuity, and clinician productivity can help leaders build coverage models that support both performance and sustainable workloads.
The most effective approach combines experienced recruiting with strong local leadership, operational support, and ongoing clinician engagement.
What this approach can achieve
Core Clinical Partners applied these principles during the transition of Emergency Medicine programs across a regional health system. Despite leadership turnover, persistent physician and APP vacancies, and years of reliance on locums coverage, the goal was not simply to fill open shifts. It was to restore stability and rebuild trust.
Core retained 95% of full-time physicians and 98% of full-time Advanced Practice Providers during the transition. The recruiting team hired 36 new clinicians within the first 90 days and onboarded another 17 during the following quarter.
Recruiting was supported by a broader stabilization strategy. Core strengthened system and regional leadership, recruited trusted Medical Directors, engaged clinicians with ties to the communities, and introduced regional float roles that could support multiple facilities. Clinical and operational leaders worked together to establish clearer priorities and more consistent communication.
As the permanent team grew, locums utilization fell to 4%, producing an estimated $5 million in annual savings compared with the previous group’s supplemental coverage costs.
Core saw similar results at another Emergency Department where recruitment was paired with leadership development, improved onboarding, schedule changes, and stronger clinician engagement. Physician turnover decreased by 30%, while monthly locums shifts fell from 66 to three – a 95% reduction.
The path forward
The takeaway is not that recruiting is less important. It’s that recruiting performs better when it is part of a larger strategy.
A full schedule may solve today’s coverage need. It does not necessarily solve tomorrow’s. A stable clinical team protects access, strengthens performance, and reduces the recurring cost of turnover. For hospital leaders facing persistent vacancies, the first step may be looking beyond the open positions to understand not only what will make clinicians choose to join, but also what will make them choose to stay.
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