Executive summary: Physician workforce planning needs several time horizons. Locums protect immediate coverage. Recruitment fills open roles. Retention prevents replacement demand. Residency and fellowship expansion add future supply. Health systems should allocate resources across all four instead of managing GME and physician recruitment as separate problems.
Use coverage tools for immediate gaps
When a physician leaves, preserve patient access and call coverage first. Locum tenens, internal redistribution, moonlighting, and telehealth can protect operations while a permanent plan develops.
Track the actual monthly cost of coverage. Repeated temporary coverage should appear in workforce planning, not only in departmental variance reports.
Recruit for current permanent openings
Recruiting remains necessary even for systems that train physicians. AAPPR’s 2025 benchmarking report reported a median physician time to fill of 118 days in 2024 data, with longer cycles in some specialist fields.
Measure time to fill, acceptance, recruiter fees, incentives, vacancy effects, and first-year retention by specialty.
Retain physicians to reduce replacement demand
Turnover creates another vacancy before the underlying supply problem changes. Analyze departures by specialty, site, tenure, schedule, compensation, practice environment, leadership, and family or community factors.
Retention is a separate workforce investment. It can produce faster results than training new physicians.
Train for predictable multi-year shortages
HRSA projects a national shortage of 141,160 physician FTEs in 2038 and shortages in 30 of 35 modeled specialties. A health system with recurring vacancies should evaluate whether it can produce part of its future workforce through GME.
Residency expansion requires educational capacity, faculty, accreditation approval, and sustainable funding. It is not a short-term coverage tactic, although an established program can offer additional flexibility for coverage needs.
Connect workforce and GME strategy
Review training capacity alongside recruitment, coverage, and retention instead of treating each budget in isolation.
Treat training geography as a workforce benefit
The AAMC 2025 Report on Residents reports that 55.7% of physicians who completed residency from 2015 through 2024 practice in the state where they trained. While that figure is not a hospital retention rate, it shows that training geography belongs in long-term workforce models.
Health systems can strengthen local retention through early employment conversations, mentorship, community integration, partner career support, and competitive practice environments. Programs such as BeaconGME can create a structured pathway and reduce the cost and time associated with physician departures.
Prioritize specialties with one scorecard
- Persistent vacancy count.
- Time to fill.
- Locum dependence.
- Projected retirements.
- Service-line importance.
- Patient access.
- Clinical training capacity.
- Faculty capacity.
- Accreditation feasibility.
- Funding gap.
- Graduate retention potential.
The strongest GME opportunity sits where educational feasibility, workforce need, and sustainable finance overlap.
Put the four budgets together
- Recruitment.
- Temporary coverage.
- Physician retention.
- Residency and fellowship training.
Review them in one workforce portfolio. A system paying repeated premium coverage for the same specialty should examine whether some resources belong upstream in training.
Use a five-year workforce view
- Current physicians.
- Expected departures.
- Projected demand.
- Open searches.
- Locum need.
- Trainees completing locally.
- Expected hires from local training.
- Remaining shortage.
Choose the mix of recruitment, coverage, retention, and training that closes the gap at an acceptable cost.
Build a physician workforce plan
BeaconGME helps health systems evaluate qualifying residency investment as part of physician workforce planning.
