Hiring a physician takes 4 to 12 months from start to finish, costs $30,000 to $90,000 per hire, and requires navigating credentialing, contract negotiation, and a historically tight labor market. The United States faces a projected shortage of up to 86,000 physicians by 2036, which means the process demands more planning and strategy than ever. Here’s how to approach each stage.
Start Planning Early
Physician recruitment timelines have been getting longer. In 2023, the average time to fill a specialty care position was 138 days, up from 126 the year before. Surgical positions averaged 147 days. Some subspecialties take far longer: urology positions averaged 344 days to fill, and neurosurgery averaged 254 days. Even relatively high-supply fields like gastroenterology averaged about four months.
These numbers only count the active recruitment window. Before that, you need to define the role, set a compensation range, secure budget approval, and build your sourcing plan. After you extend an offer, credentialing and state licensing can add another two to six months. For most organizations, the realistic planning horizon is 9 to 18 months from identifying a need to having a physician seeing patients.
If you’re replacing a departing physician, start recruiting the moment you receive notice. If you’re adding a new position, begin at least a year out. Every week a position stays vacant costs real money. A single unfilled general surgeon position can represent roughly $550,000 in lost charges over a 46-week period.
Define the Role and Compensation
Before you post a single listing, get specific about what you need. Clarify the clinical scope, expected patient volume, call schedule, administrative responsibilities, and whether the role involves teaching or research. Physicians evaluating opportunities compare these details across multiple offers, and vague descriptions get ignored.
Compensation structures generally fall into a few categories. A straight base salary offers predictability but doesn’t reward productivity. A model built around work Relative Value Units (wRVUs), which measure the time, effort, and skill required for each service a physician performs, ties pay directly to volume. Many organizations use a hybrid: a guaranteed base salary plus productivity bonuses triggered when wRVU thresholds are met. Some also layer in quality metrics, administrative pay, and call pay.
Be cautious with pure productivity models. When compensation is tied solely to wRVU production without quality counterweights, it tends to increase physician stress and burnout, encourage unnecessary visits, and prioritize volume over patient-centered care. A compensation plan that balances productivity incentives with quality measures and a reasonable base salary is more attractive to candidates and more sustainable long term.
Where to Find Candidates
Your sourcing strategy should match the urgency and difficulty of the search. Each channel has different cost, speed, and quality tradeoffs.
- Physician-specific job boards like PracticeLink, DocCafe, PracticeMatch, Health eCareers, and JAMA Career Center cost $2,000 to $10,000 per posting and work well for primary care and general positions. They cater to healthcare-specific requirements like licensure and board certifications, which general job sites don’t handle well.
- Recruitment agencies charge $25,000 to $50,000 per placement and typically fill positions in three to six months. They’re most valuable for hard-to-fill subspecialties and rural locations where passive candidates need to be actively pursued.
- Residency program outreach is the least expensive channel ($1,000 to $5,000) but takes the longest (6 to 18 months). It’s the strongest approach for building a long-term pipeline and finding candidates who are a genuine culture fit.
- Conference recruiting runs $5,000 to $20,000 and works particularly well for subspecialties and academic positions where physicians gather at specialty-specific meetings.
- Locum-to-permanent conversion costs $15,000 to $30,000 in conversion fees but lets you evaluate a physician’s clinical skills and cultural fit before making a permanent commitment. Time to fill is often just one to three months since the physician is already working with you.
Most successful recruitment strategies use two or three channels simultaneously rather than relying on a single source.
Consider Locum Tenens as a Bridge
If a position is already vacant or your recruitment timeline is long, temporary (locum tenens) physicians can keep revenue flowing and prevent burnout among your existing staff. The cost comparison is worth understanding.
For a general surgeon in the north central U.S., a permanent hire costs roughly $600,000 annually when you add salary (around $440,000) to benefits, malpractice insurance, retirement contributions, signing bonuses, licensing fees, continuing education, and relocation, which together total about $160,000. A locum tenens surgeon for the same 46-week period costs approximately $432,000 total, including the bill rate plus travel, housing, transportation, and malpractice coverage. That’s a savings of roughly $168,000.
Locum physicians also improve patient satisfaction through shorter wait times and reduce stress on your permanent staff. The tradeoff is less continuity of care and no long-term organizational commitment. Many organizations use locum tenens strategically: filling gaps while recruiting permanently, or testing whether a new service line generates enough volume to justify a full-time hire.
Navigating Credentialing
Credentialing is the process of verifying a physician’s education, training, licensure, board certification, malpractice history, and references before granting them privileges to practice at your facility. It’s required by accreditation bodies, insurance payers, and state law, and it’s the stage where timelines most often stall.
The process typically follows these steps: the physician submits a completed application (which must be signed within 30 days of receipt), your medical staff office verifies all information against primary sources, the file is reviewed for completeness and any discrepancies are resolved, and then the application moves through clinical evaluation, a credentials committee review, and governing body approval. The entire process can take up to 180 days. If it’s expected to run longer, most organizations file a formal extension.
If there’s clinical urgency, temporary privileges can be granted for up to 60 days while the full credentialing process continues. This is useful when you’ve made a hire and need the physician seeing patients before the paperwork clears. Start credentialing as early as possible, ideally the moment a signed offer letter is in hand. Delays in gathering references, verifying training, or obtaining state licensure are common, and each one pushes back the physician’s start date.
Getting the Contract Right
The employment agreement is where many physician hires are won or lost. Candidates compare contract terms carefully, and a poorly structured agreement can drive away top choices or create legal problems later.
Total compensation should be clearly defined, including base salary, productivity incentives, quality bonuses, administrative pay, and call pay. Beyond salary, the contract needs to address malpractice premium payments, health insurance, life and disability coverage, retirement plan contributions, vacation policies, and continuing education funding.
Pay special attention to these areas:
Malpractice tail coverage. If your organization carries “claims-made” malpractice insurance, there’s a gap in coverage when the physician leaves unless someone pays for “tail” insurance covering claims filed after departure for care provided during employment. This can cost tens of thousands of dollars. The contract should specify who pays for it. Many physicians will not sign an agreement that makes them responsible for tail coverage.
Non-compete clauses. These typically prevent a departing physician from practicing within a specific radius (often 10 miles) for a set period (often two years). Non-competes are illegal in some states and only enforceable if deemed “reasonable” in others. The more specialized the physician, the larger the geographic restriction you can typically expect. Overly broad non-competes are a red flag for candidates and may not hold up legally.
Termination provisions. Most contracts include a “without cause” provision allowing either party to end the agreement with written notice, typically 30 to 180 days. Fair contracts give the physician the same termination rights as the employer. The notice period should be long enough for the physician to secure other employment and for your organization to begin a replacement search.
Physicians increasingly hire their own attorneys to review employment agreements, and you should expect this. A transparent, well-structured contract builds trust and signals that your organization treats physicians as partners rather than interchangeable labor.
Retention Starts at Recruitment
Given that replacing a physician costs $30,000 to $90,000 in direct recruitment expenses alone, not counting lost revenue during the vacancy, retention deserves as much attention as recruitment. The factors that drive physician turnover, including burnout, compensation dissatisfaction, poor administrative support, and lack of autonomy, are all things you can address during the hiring process.
Be honest about call expectations, patient volume targets, electronic health record burdens, and organizational culture during interviews. Physicians who feel misled during recruitment leave faster. Structured onboarding that includes mentorship, gradual ramp-up of patient volume, and regular check-ins during the first year significantly improves retention. A compensation model that rewards quality alongside productivity, rather than volume alone, helps prevent the burnout that pushes physicians toward the exit.