The Cost of a 189-Day Physician Vacancy

A statistic surfaced at a recent congressional hearing on healthcare access, and it landed like a number that’s somehow both obvious and quietly alarming: it takes an average of 189 days to recruit a primary care physician. For specialists, that figure climbs to 226.

Most healthcare leaders have felt those timelines in their bones. Physician recruitment has always been slow. But the question worth asking is what’s actually happening to patients while the search is underway.

I’ve spent more than 25 years in staffing, with the last 16 focused on healthcare. I’ve seen how difficult physician recruitment can be, especially in highly specialized fields. The numbers themselves aren’t shocking. What got me thinking was something else: what happens during those 189 days? What is the physician vacancy cost?

The physician vacancy cost nobody talks about

When a physician position sits open for six months, the consequences extend well beyond HR metrics. Appointment wait times creep up. The physicians who remain absorb more patients, more call shifts, more of everything. Service lines run below capacity. The growth initiatives on the whiteboard stay on the whiteboard.

Think about what a vacant primary care position actually means in patient terms. A physician seeing 20 patients a day, out of rotation for a 189-day recruitment cycle, that’s potentially thousands of visits that have to be redistributed, delayed, rerouted, or simply lost.

For health systems already stretched thin, a single vacancy creates pressure that ripples.

The first month, most organizations can hold. Schedules get adjusted. People absorb the extra weight and assume the search will move quickly. It rarely does.

How the timeline unfolds

By 30 to 90 days, the cracks start showing — appointment backlogs, provider fatigue, access metrics starting to slide. By the three-to-six month mark, patients are often waiting longer, referral leakage is picking up, and operational leaders are spending their bandwidth on maintenance rather than momentum.

Past the six-month mark, the vacancy often begin shaping organizational strategy in uncomfortable ways. Burnout risk rises. Service line development stalls. What began as a recruitment problem starts looking like a patient access problem and then a reputation problem.

The longer a physician vacancy runs, the harder it is to contain.

Why almost 9 in 10 health systems have turned to locum tenens

Another number from the congressional hearing: 88% of healthcare organizations now use locum tenens providers to maintain patient access. That signals a structural shift in how healthcare systems think about the workforce.

Locum tenens has moved well past its reputation as emergency gap coverage. Today, health systems use temporary physicians, nurse practitioners, physician assistants, CRNAs, and dentists as deliberate tools – not to sidestep permanent hiring, but to protect patients while it happens.

The use cases have matured alongside the practice: filling gaps during recruitment, managing seasonal demand, covering parental leaves and unexpected departures, supporting service line continuity, and giving organizations the runway to evaluate long-term needs without sacrificing short-term access.

The workforce reality sitting underneath all of this is significant. The Association of American Medical Colleges projects persistent physician shortages across multiple specialties over the next decade. More than 100 million Americans already live in federally designated Health Professional Shortage Areas. Many healthcare leaders are being asked to serve more people with fewer providers, while maintaining quality, access, and financial performance.

Traditional workforce planning wasn’t built for that math.

The organizations finding their footing

The health systems navigating this environment most successfully aren’t treating permanent recruitment and contingent staffing as competing strategies. They’re using both permanent hiring for long-term stability, flexible staffing for operational resilience.

At Barton Associates, we’ve worked with healthcare organizations across this spectrum. In many cases, a qualified locum tenens provider can be secured in a fraction of the time a traditional physician search requires. Patients continue receiving care. Permanent providers don’t burn out absorbing impossible loads. Leaders retain the flexibility to make the right long-term hire rather than a rushed one.

The metric that gets overlooked

Workforce conversations in healthcare have long centered on time-to-fill. It’s a clean number. It’s trackable. It shows up in dashboards and board presentations.

But it tells only part of the story.

The more revealing measurement might be the cost of the vacancy itself — the impact on patient wait times, on provider workload, on the community that depends on access to care. A health system can fill a position in record time and still have hemorrhaged patient volume for months before the new hire walks in the door.

The organizations that thrive in the years ahead won’t just get faster at recruiting. They’ll build workforce strategies designed to protect patients during the 189 days between identifying a need and filling it.

In today’s healthcare environment, resilience may matter just as much as recruitment.