Executive Summary: Recruitment, locum tenens, retention, and residency expansion solve workforce development challenges on different time horizons. Recruitment fills a permanent role. Locums protect coverage. Retention prevents avoidable turnover. Residency expansion can create high quality and culturally aligned physicians within your recruiting/workforce development pipeline. . A health system with recurring specialty vacancies should model all four together.
Use recruitment for an immediate permanent need
Permanent recruitment remains the direct response to an open attending position.
The constraint is time and supply. AAPPR reported a median physician time to fill of 118 days in its 2025 benchmarking report. Oncology searches reached a median 332 days. [1]
Use your own recruiting data for financial planning. Track time to fill, offer acceptance, recruiter cost, signing incentives, and vacancy-related service effects.
Use locums to protect near-term coverage
Locum tenens clinicians can preserve schedules, call coverage, and patient access while recruitment continues.
Treat locums as a coverage decision. Record the actual hourly or shift cost and compare it with alternatives.
A recurring locum requirement may indicate a long-term supply problem. It does not mean locums caused the problem.
Use retention to preserve physicians you already have
A retained physician removes the need for a replacement search.
Measure turnover by specialty, site, tenure, schedule, compensation, practice environment, and leadership. Then target the causes the health system can change.
Retention also matters during residency. Programs can introduce future attending roles early, build mentorship, and connect residents with the communities they may later serve.
Is a recurring physician vacancy becoming a long-term workforce problem?
BeaconGME can help fund residency expansion and support post-residency retention though our early-career track programs.
Use residency expansion for predictable multi-year shortages
While residency expansion may not solve an immediate attending vacancy, it can create future physician supply for your health system. 55.7% of physicians who completed residency training between 2015 and 2024 remained to practice in the same state where they trained, according to data from the Association of American Medical Colleges (AAMC). In states with massive healthcare infrastructures like California, the retention rate surges to 75.7%. Primary care specialties show the tightest geographic anchoring. Roughly 64.6% of Family Medicine and 60% of Pediatrics residents choose to stay in-state.
HRSA projects a national shortage of 141,160 physician FTEs in 2038. The model projects shortages in 30 of 35 specialties. [2]
Training location also matters. AAMC reports that 55.7% of physicians who completed residency from 2015 through 2024 practice in the state where they trained. [3]
That statistic does not predict a hospital’s retention rate. It supports the use of training location as one factor in workforce planning.
Match each strategy to the time horizon
| Strategy | Primary purpose | Time horizon | Creates new physician supply? |
|---|---|---|---|
| Permanent recruitment | Fill an open role | Months | No |
| Locum tenens | Preserve coverage | Days to months | No |
| Retention | Prevent replacement need | Ongoing | No |
| Residency expansion | Build future supply | Years | Yes |
A mature workforce plan can use all four at once.
Identify specialties that warrant an upstream strategy
Residency expansion deserves analysis when several conditions are present:
- repeated vacancies in the same specialty
- long recruiting cycles
- persistent locum use
- predictable retirements
- growing service demand
- existing GME infrastructure
- adequate clinical volume and faculty
- a feasible accreditation path
- a plausible funding plan
The specialty must also make educational sense. Service needs alone do not justify an expansion.
Compare five-year cost, not annual budget lines
For recruitment, include vacancy time, recruiter expense, incentives, onboarding, and turnover risk.
For locums, include the actual coverage spend.
For residency, include training costs, incremental GME support, clinical effects, and expected graduate retention. Learn more about how to plan the financials of a residency expansion in our article here or by chatting with our team for free.
Use the same five-year horizon for all strategies. That makes the trade-offs visible to finance and workforce leadership.
BeaconGME
BeaconGME evaluates investing in residency expansion for health systems like yours, get in touch with our team to learn more.
Sources
[1] Association for Advancing Physician and Provider Recruitment. 2025 benchmarking report: physician recruitment demand and time to fill.
[2] Health Resources and Services Administration. Health Workforce Projections: Physicians.
[3] Association of American Medical Colleges. 2025 Report on Residents: Executive Summary.
