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For years, physician recruitment has largely operated around a familiar cycle: a vacancy opens, a requisition is approved and the recruiting team begins searching for candidates.
That approach made sense when there was more flexibility in the physician labor market. Today, however, healthcare organizations are recruiting in a very different environment.
There are fewer candidates available for each open position, reaching those candidates requires more effort, and some of the most difficult specialties remain highly competitive across nearly every market.
The result is that waiting for a vacancy before beginning the search can put a recruiting team behind before the search even starts.
Instead, health systems may need to think beyond individual searches and begin building what PracticeMatch Chief Client Officer Clint Rosser calls a workforce engine: a recruiting model designed to anticipate needs, continuously develop candidate relationships and connect recruitment activity more directly to organizational priorities.
The Physician Recruiting Market Has Changed
The challenge is bigger than a temporary slowdown in applications.
PracticeMatch data discussed during the webinar shows an average of approximately 0.4 applicants for every physician position and 0.2 applicants for every advanced practitioner position. The exact ratio varies by specialty and geography, but the broader trend is clear: organizations are competing for a limited candidate pool.
Recruiters are also having to work harder to create candidate connections.
In 2023, it took an average of 13.6 connections to generate a candidate submittal. By 2025, that number had increased to 16.6, with 2026 data continuing to trend upward.
That changes the economics of recruiting. The same number of hires now requires more sourcing activity, more follow-up and more time from the recruiting team.
It also makes a purely reactive strategy increasingly difficult to sustain.
From Filling Vacancies to Anticipating Them
Transactional recruiting typically begins when a need becomes official.
A workforce engine begins earlier.
Instead of asking, “What positions do we need to fill today?” recruiting teams begin asking:
- Which specialties do we repeatedly struggle to fill?
- Where are we seeing persistent turnover?
- What growth is expected over the next 12 to 24 months?
- Which physicians may be approaching retirement?
- Where does our organization consistently have coverage challenges?
Not every future vacancy can be predicted. But many recruiting teams already have years of internal data showing which specialties, locations and positions repeatedly return to their requisition lists.
Using that information can give recruiters a head start instead of forcing them to rebuild the search from zero every time.
The Four Parts of a Workforce Engine
Moving toward a workforce-engine model does not necessarily mean purchasing new technology or adding headcount. It begins with changing how existing recruiting activity is organized.
1. Forecasting
Start by looking ahead.
Recruiting leaders can work with clinical and organizational leadership to identify anticipated growth, attrition and historically difficult-to-fill positions by specialty.
Even when a formal workforce plan does not exist, recruiting teams can examine their own history. If the organization has recruited for cardiologists in the same market four of the last six years, for example, that pattern can help inform what the team prepares for next.
The goal is to recognize predictable needs before they become urgent vacancies.
2. Building Continuous Candidate Pipelines
Every closed search contains candidates who may still have future value.
Some candidates were interested but not ready to relocate. Others entered the process after another candidate was already selected. Some may have liked the organization but simply could not make a move at that particular time.
Those relationships do not have to disappear when the requisition closes.
Maintaining relevant communication with prospective candidates can create a warmer starting point when the next opportunity opens. Career fairs, conferences, sourcing campaigns and previous searches can all contribute to a long-term candidate pipeline.
The objective is not to continuously send job advertisements. It is to remain useful and relevant enough that candidates remember the organization when their circumstances change.
3. Connecting Recruiting to Business Impact
Recruiting teams understand how difficult the market has become because they experience it every day.
Executives may see the same challenge differently.
That is why recruiter workload alone may not be enough to support a request for additional budget or resources. Recruiting metrics become more meaningful when they are translated into the outcomes leadership already tracks.
For example:
Days to fill can become lost clinical revenue, locum coverage costs or reduced patient access.
Applicant-to-job ratios can demonstrate market competition and hiring risk.
Offer declines can identify potential issues related to compensation, workload, scheduling or organizational culture.
Increasing sourcing requirements can demonstrate how much more effort is required to generate the same candidate pipeline.
The goal is for recruiters and organizational leadership to be looking at the same numbers and understanding what those numbers mean for the health system.
A recurring report using consistent metrics can also help turn recruiting from a staffing update into an ongoing workforce conversation.
Recruiting and Retention Cannot Be Separate Conversations
The workforce engine does not end when an offer is made.
During the webinar, Rosser shared that approximately 71% of physician offers are accepted, meaning nearly three out of every 10 physician offers may still result in a decline.
The reasons behind those decisions matter.
Workload expectations, compensation and work-life balance are among the factors candidates consider when deciding whether to accept an opportunity. Those same issues can also influence whether physicians remain with an organization after they are hired.
Recruiting teams are in a unique position to capture that information.
If candidates repeatedly raise concerns about call schedules, workload or another part of the opportunity, that feedback should not disappear when the search closes. Feeding candidate and turnover insights back into sourcing, recruitment messaging and organizational conversations can make the next search stronger.
In that sense, retention begins much earlier than a physician's first day.
It begins with the first conversation.
Building the First 90 Days
Transitioning to a workforce-engine model does not have to happen all at once.
A practical starting point is to build it in stages.
Days 1–30: Build the forecast.
Review anticipated needs and historical recruiting patterns. Identify specialties and locations where vacancies or retention issues are most predictable over the next 12 to 24 months.
Days 31–60: Start building continuous pipelines.
Focus first on your highest-priority or hardest-to-fill specialties. Identify previous candidates, event contacts and other prospective physicians who could remain part of a long-term talent pool.
Days 61–90: Build a consistent business report.
Connect days to fill, offer declines, candidate availability and other recruiting metrics to organizational outcomes such as revenue, patient access, coverage or community need.
After 90 days: Close the feedback loop.
Begin incorporating candidate decline and turnover information into your sourcing strategy and recruitment messaging.
The goal is not to build a perfect workforce engine overnight. It is to reduce how often the recruiting team has to start from zero.
Start Building Before the Next Vacancy Opens
Physician recruiting is unlikely to become less competitive simply by continuing to work the same searches harder.
Health systems have an opportunity to shift from reacting to individual openings toward anticipating workforce needs, developing candidate relationships earlier and showing leadership the broader business impact of recruitment.
The full webinar, The End of Transactional Recruiting: Why Health Systems Must Build Workforce Engines, explores the market data behind this shift, the four components of a workforce engine and practical ways recruiting teams can begin putting the model into place.
