When a physician in a small, rural town announces retirement — or resigns for any reason — it’s far more than a recruitment headache. While administrators scramble to find and hire a suitable replacement, the physicians who remain are often asked to pick up the slack. However, depending on the departing physician’s specialty, that may not be enough. The loss of even one physician can put an entire service line at risk, threatening the community’s access to care. If the service line closes, patients will spend hours in the car traveling to appointments. That is, if they choose to go at all.
This fragility is often palpable. Rural healthcare administrators understand the risks, but hiring an additional provider “just in case” is unlikely to be in the budget. So, when a physician resigns, the clock starts ticking on a search timeline that will no doubt extend long past the departing physician’s last day.
What happens to their patients in the interim? And how long can the organization keep the department going without a physician? These are just a few of the questions the new joint research from Jackson Physician Search, LocumTenens.com, and the Medical Group Management Association (MGMA) set out to answer. What’s more, we wanted to know how these answers vary by specialty. That is, which specialties are most impactful to the community, and how are rural leaders preparing to fill inevitable vacancies in both the short and long term?
As President of Jackson Physician Search, I wish I could say I was surprised by our findings. The fact that just one in five rural administrators and clinicians rated their most important specialties “adequately staffed” should be shocking, and yet, it is reality for most organizations. Even if patient volume suggests a department is fully staffed, when an entire service line depends on a single individual, no one rests easy. It certainly doesn’t feel “adequately staffed.” It feels like an ongoing risk, and the data suggest it’s far more common in rural health care than a vacancy count would suggest.
The Shortage You Can’t See
The new study, Rural Health Care Specialty Priorities, surveyed 227 rural administrators and clinicians about the specialties that matter most in their communities and how secure that coverage really is. Respondents were asked to rate specialty coverage into one of three categories:
- Adequate: enough permanent local capacity.
- Local but thin: physicians are still there, but one more departure or reduction in hours could create a serious gap.
- Alternative or absent: access depends mainly on temporary, visiting, or virtual coverage, or there is little local capacity at all.
Adequate coverage turned out to be the exception. Only 21% of respondents rated family medicine adequately staffed. The shares were even lower for internal medicine (13%), psychiatry (9%), and OB/GYN (7%).
The more telling number sits in the middle. Among respondents who named family medicine a high-impact specialty, 68% described it as local but thin. Internal medicine came in at 76%, and OB/GYN and general surgery at 61% each. These aren’t services that have failed. They’re services that work today but would not survive the next retirement, resignation, or reduction in hours.
Why the Risk Stays Hidden
Thin coverage stays out of sight for a simple reason: the measures most organizations are watching don’t capture it. A full schedule looks the same whether it has a comfortable margin or none at all. Until someone leaves, a fragile service line and a healthy one can be hard to tell apart.
The survey shows how often this catches organizations off guard. When describing their most consequential physician vacancy in the past three years, only 12% of administrators saw it coming more than a year ahead. More than half had less than six months’ notice or none at all, and just 19% had a contingency plan in place for the transition.
The cost of being caught unprepared often goes uncounted, too. Only 25% of administrators had formally estimated the financial effect of their most consequential vacancy.
The Risk of Asking Others to Carry the Extra Load
There’s another layer to this risk, and I’d encourage every rural leader to take it seriously. Behind every “local but thin” rating is a physician still showing up, often without much support.
Nearly two-thirds of current rural clinician respondents (65%) said they lack adequate specialist and colleague backup. That’s more than the percentage who said compensation is unfair (42%) or that workload is unsustainable (39%), suggesting lack of backup is the most significant source of dissatisfaction with rural work. When the local surgeon, obstetrician, or psychiatrist is missing, the family physician down the hall is usually the one who absorbs the difference. Or in a two-person surgical department, when one surgeon moves away, the one left behind carries the weight indefinitely.
That strain shows up in retention data. Clinicians who report lacking adequate backup were more likely to say they planned to leave their position within two years than clinicians who report having adequate backup (38% vs. 25%, respectively). The survey can’t prove one causes the other, but the pattern is hard to ignore.
How to See It Sooner
You can’t eliminate the risk of a physician departure, but you can find out where risk is concentrated and plan how you will address it. The full report, including the Rural Specialty Priority Map, offers a detailed analysis and framework for making those decisions, but it boils down to the following:
Ask the “one more departure” question. For each priority specialty, look beyond whether the positions are filled. Ask what would happen if one physician left or cut back. If the honest answer is a serious gap, that service line demands attention.
Turn known departures into recruiting timelines. If you can name a physician likely to retire in the next few years, that’s the starting point for a permanent search, not a reason to wait. More than four in ten of the consequential vacancies in the study had already been open seven months or longer. Starting early gives you more options.
Treat backup as part of the plan. Call schedules, cross-coverage, and access to specialist support dictate whether or not your current physicians stay. Designing them deliberately is as much a retention strategy as a staffing one.
Put a rough number on the risk. The full report includes a worksheet for estimating what a vacancy costs each month. Even an approximate figure lets you weigh the cost of recruiting earlier against the cost of leaving a position open.
Don’t Wait for the Vacancy
Rural organizations are working hard to keep essential services running with limited resources. This research shows how much of that work rests on a few physicians with little room for departures. The organizations best positioned to sustain local care will be the ones that recognize thin coverage for what it is and start planning before the next resignation, not after.
Read the Full Report: Rural Healthcare Specialty Priorities
At Jackson Physician Search, we partner with rural healthcare organizations to ensure rural physician recruitment success. If your coverage is thin and you are bracing for the resignation, our team has the experience and expertise to help you build and execute a recruitment plan that minimizes vacancies and protects the continuity of care for your community. Reach out today.
About Helen Falkner
Helen Falkner is president of Jackson Physician Search, the nation’s largest privately held permanent physician recruitment firm and a member of the Jackson Healthcare® family of companies. With more than a decade of experience in retained physician search, she moved into senior leadership roles, bringing proven expertise in recruitment strategy, team development, and the evolving dynamics of today’s healthcare workforce.
The daughter of a physician and a native of West Des Moines, Iowa, Helen has long understood the profound impact that physicians have on the well-being of both patients and communities. That early perspective continues to shape her leadership approach and her commitment to helping healthcare organizations connect with mission-aligned clinicians who will fit, succeed, and stay.
Helen joined Jackson Physician Search in 2012, quickly distinguishing herself as an award-winning recruiter recognized for excellence and alignment with the company’s core values of Others First, Wisdom, and Growth. She later became a partner in the business and regional vice president of the firm’s Western division. There, she led one of the largest recruiting teams and served as a strategic partner to healthcare organizations seeking not just to fill positions but to build sustainable, high-performing clinical teams.
A recognized thought leader and frequent speaker at regional and national healthcare conferences, Helen addresses the changing expectations of today’s medical workforce, emerging trends in strategic candidate sourcing, and the critical connection between effective recruitment and long-term retention.
Helen has been named “recruiter of the year” twice, earned multiple “recruiter of the quarter awards, and received a 2023 “career achievement” distinction for her sustained contributions to the firm and its clients. She holds a bachelor’s degree in business and marketing from the University of Iowa. She and her family reside in Atlanta.
