Healthcare organizations of all types occasionally feel the pain of a physician vacancy. However, as with most of the challenges that healthcare organizations face, the impact of a physician vacancy is often more extreme in rural and remote areas.
Not only do physician vacancies typically last longer in rural areas, but the impact of departures is far more significant, often putting entire service lines at risk. New research from Jackson Physician Search, LocumTenens.com, and Medical Group Management Association (MGMA) confirms this. According to the report, Rural Healthcare Specialty Priorities, most rural healthcare organizations describe the permanent local capacity of their most impactful specialties as insufficient or fragile, with no margin for losing one more person.
The specific numbers vary by specialty, and so should the response to a resignation. The plan that works for family medicine may be the wrong approach for general surgery, and the coverage that works for behavioral health can fall flat for OB/GYN. As Regional Vice President of Recruitment, I found this to be one of the clearest lessons from the new research. Rural physician recruitment should not be one-size-fits-all. In this post, I’ll focus on how rural leaders can decide which strategy does fit, one specialty at a time.
Rethinking the Rural Healthcare Workforce Approach
The study surveyed 227 clinicians and administrators with rural experience. For the individual specialties they ranked most important in their communities, respondents first rated what coverage looks like: adequate, insufficient, fragile/at risk, or alternative/absent. President of Jackson Physician Search Helen Falkner explored those ratings in an earlier blog post, noting that, in many cases, organizations are one departure away from losing a service line. But how are they addressing this risk?
After rating capacity in each specialty, respondents were asked to choose a workforce approach for each:
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- Protect: Focus on retention to preserve the physician capacity you have before it turns into a vacancy.
- Grow: Add physician or physician-led team capacity. In practice, this usually means rebuilding a thin service line rather than expanding a healthy one.
- Cover differently: Use locum tenens, care teams, telehealth, or visiting specialists as a bridge to a permanent hire or, where it fits, as a lasting model.
- Refer or Partner: Establish regional partnerships or referral arrangements to create long-term access in the community.
Respondents leaned toward “Grow” for most specialties, including half of those assessing family medicine (50%) and nearly half of those assessing OB/GYN (49%). But the answers rarely pointed to a single path. Family medicine drew a meaningful “Protect” vote (26%) alongside “Grow,” and general surgery split almost evenly between the two (36% Protect and 40% Grow). For many rural organizations, the job is to hold on to what they have while they build.
Same Shortage, Different Strategy
The report’s Rural Specialty Priority Map brings four measures together for each specialty: current local capacity, the consequences if local access were lost, the action respondents would take, and which coverage models they considered workable in the short or long term. The map illustrates how four high-impact specialties land in four different places.
Family medicine. In most cases, the service line is meeting community needs, but 68% of respondents described capacity as thin. Among those facing a coverage decision within a year, most saw both permanent recruitment and physician-plus-APP teams as viable long-term models. That points to building out the core team, with locum tenens as short-term support.
OB/GYN. Very few respondents (7%) rated capacity adequate, and nearly a third said access already depends on alternative coverage (19%) or is missing altogether (12%). Permanent recruitment was the clear long-term answer (72%), and locum tenens was the strongest short-term bridge (69%). Telehealth was not seen as a workable substitute.
General surgery. The pattern here is similar, with an additional short-term option in visiting surgeons (65%). Locum tenens also rated well (71%) as short-term coverage, while 82% said telehealth was not viable. Protect the surgeons you have while recruiting to expand the team.
Psychiatry and behavioral health. This is the outlier. Respondents saw several viable long-term routes, including physician-plus-APP teams (85%), permanent recruitment (80%), and telehealth (70%). Leaders here have more than one way to expand access.
Two service lines can be equally essential and equally thin and still call for different plans. While all involve recruiting permanent physicians, the other viable options and short-term strategies vary significantly.
Five Steps to Find the Right Path for Each Specialty
- Name the gap precisely. The term “shortage” is vague and often used to describe very different scenarios. Be specific about your starting point. Is local capacity adequate, insufficient, fragile, already dependent on temporary or virtual coverage, or absent? Each answer raises a different question. Insufficient capacity is a growth question. Fragile capacity is a protection and succession question. Reliance on temporary coverage is a coverage-design question. No local capacity at all points to a referral and partnership question.
- Weigh what is at stake. Ask what would happen if the service lost local access entirely: transfers, lost referrals, downstream volume, and the community’s confidence in your organization. When consequences are high, and capacity is fragile, protection moves to the top of the list.
- Check the clock. Only 12% of the most consequential vacancies in the study were anticipated more than a year in advance, yet 64% of administrators expect a physician retirement or significant reduction in hours within five years. If you can sense a departure coming — even if it’s not official — the time to start planning is now.
- Match the coverage model to the specialty. Telehealth may anchor a behavioral health plan, but it will not keep an operating room open. Locum tenens can carry OB/GYN or general surgery while a permanent search continues. Be cautious about leaning on internal cross-coverage, which adds stress to the very clinicians you need to protect.
- Give every interim plan an end point. Before a bridge begins, decide whether it is meant to last months or years. If it is buying time until you can find a permanent replacement, set a timeframe for reviewing its viability as a short- vs. long-term option. Temporary coverage works best when it is tied to a permanent decision rather than standing in for one.
Make Decisions Before the Vacancy Decides For You
When coverage decisions wait until a physician leaves, the remaining clinicians often absorb the additional load in the form of increased patient volume, additional call, or out-of-scope work. In the study, a lack of adequate backup and specialty coverage correlates with an increased likelihood that clinicians will leave. So, organizations that fall back on existing capacity in response to a vacancy are only putting the service line further at risk.
On the other hand, rural leaders who map out a plan for individual specialties now, deciding what to protect, where to grow, and what to cover differently, have more options and ways to support their current staff, giving them more reasons to stay. Download the complete report for the detailed Rural Specialty Priority Map and a worksheet to estimate what a vacancy costs your organization.
Whether your next move is to protect a fragile service line, rebuild a thin one, or plan a bridge to a permanent hire, the Jackson Physician Search team can help you match the recruitment strategy to the specialty. Reach out today.
About Neal Waters
Neal’s career in retained physician search began 20 years ago. Early on, he recognized the strain an entire community feels when there is a shortage of physicians to meet patient demand. Since his first successful placement, Neal’s passion for identifying the best providers for each healthcare organization with which he recruits has grown.
Neal serves as Regional Vice President of Recruiting. In his role, he serves as a mentor to a growing team of Jackson Physician Search recruiters. He also enjoys collaborating with in-house recruiters who are dedicated to optimizing their physician recruitment and candidate acquisition strategies. Likewise, Neal specializes in helping physicians, especially residents and those early in their careers, advance their professional careers by finding the right fit.
