The ink is still wet on a senior partner’s retirement letter when the math turns ugly: The practice faces a 12- to 18-month runway to a new physician’s start date, six-figure replacement costs, and vacancy losses that will go even higher.

Practices are right to be wary when new-patient wait times start to climb, but the smartest response isn’t panic hiring; it’s to optimize the capacity you already have and recruit quickly and deliberately where the data proves a new physician will make the greatest impact.

That was the message of the Oct. 21 MGMA member-exclusive webinar with Tim Sheley, executive vice president of business development at Jackson Physician Search, and Jenny Hart, senior manager at ECG Management Consultants, who showed practice leaders how to surface hidden supply (promised by undelivered clinical effort, held versus unavailable time, scheduled-but-uncompleted visits) and when to pivot into a fast, aligned search for their next hire.

Market reality: Demand is rising, supply is tight (and slow to replace)

Sheley pointed to “the silver tsunami” — the high share of retirement-age physicians about to exit the labor market — and the growing difficulty of replacing a single retiree with equivalent FTE capacity.¹ New physicians typically require a 12- to 24-month ramp to stabilize a panel, and many leave their first job in under two years,² stretching the payback on every early-career hire.

The math is unforgiving for practice finances: In an average 12- to 18-month cycle from opening a search to start date, a practice can face up to $250,000 in replacement costs (recruiting, bonuses, relocation), and vacancy revenue loss can easily exceed $1 million.³ As Sheley and Hart detailed, these numbers should push leaders to plan succession early and understand what kind of hiring is right for each vacancy.

The physician shortage is getting worse

• How big is it? Up to 86,000 physicians by 2036. (AAMC - https://bit.ly/3WJfQSA)
• Where will gaps be sharpest? AAMC modeling points to primary care shortages of 20,200 to 40,400 and surgical specialty shortages of 10,100 to 19,900 by 2036, with most non-primary care specialties projected to face shortfalls. (AAMC - https://bit.ly/47P1dCp)
• Which specialties are hottest right now? Recruiter data show family medicine remains the most commonly searched specialty, followed by hospital medicine, OB/GYN, and internal medicine. (JPS/AAPPR December 2024 report - https://bit.ly/3JLlFMd)
• Why it matters? AMA well-being data indicate persistent intent-to-leave among physicians, reinforcing urgency of both capacity optimization and decisive, candidate-friendly hiring processes. (AMA - https://bit.ly/4hLlm0t)

Before you recruit: Find and fix hidden capacity

Hart urged leaders to measure capacity with discipline before adding headcount. She framed three pillars:

1. Provider clinical effort (supply): contracted/templated clinical FTE — the face-to-face clinic time that produces visits.
2. Provider availability: how much of that clinic time is truly open for booking (versus eroded by administrative work, meetings, or held time).
3. Patient preference (demand): when and how patients want to be seen; aligning supply to preference reduces leakage and improves experience.

Internal demand signals to watch

Declining referral completion, rising network leakage, lengthening new-patient lag times, and falling experience scores are each a red flag that you may be “short on access,” not necessarily short on providers.

Three places where capacity disappears

1. Promised but undelivered provider time. Contracts and templates often assume more clinic time than providers can deliver once inbox duties, committee work, and/or teaching duties are counted. Calibrate expectations to reality using benchmarks and productivity-to-comp ratios, then close the gap operationally or reset goals.
2. Available but unscheduled templated time. Distinguish unavailable (e.g., out of clinic) from held time (could be opened later). Because held time counts against utilization and unavailable time does not, mislabeling can mask fixable access. Audit designated but unused slots (e.g., new-patient blocks constantly overridden) and tune templates accordingly.
3. Scheduled but uncompleted appointments. Reduce no-shows and late cancels with early automated reminders, strategic overbooking where appropriate, and patient self-scheduling plus a dynamic waitlist so backfill happens in near-real time. As Hart put it, “we need to make it very easy for them to cancel that appointment” — counterintuitive, but essential to reclaim capacity.

Just as important is how you change templates. “[Physicians’] templates are their last bastion of autonomy,” Hart noted. Data should guide the redesign, but durable change requires codesign with clinicians to preserve clinic flow and intent.

If your average new-patient wait is drifting toward the 38-day national average⁴ (or worse in high-demand specialties), your fastest “new provider” is reclaiming time already on your books.

When recruitment is the answer: compress the timeline

When your data shows a capacity gap, move with urgency. Sheley contrasted two real-world searches. In the slower case, stakeholders weren’t aligned, the interview sequence dragged, and offers waited on “one more candidate,” stretching nearly 300 days to sign and multiplying costs. In the faster case, expectations and compensation were calibrated upfront, interviews were focused, and the team made a single, decisive offer — start-to-finish success with far fewer touches.

 “This can’t be a beauty pageant,” Sheley said. Top candidates “go from groceries to garbage, literally, in 72 hours.” Build a same-day (or next-day) decision path and be ready with a letter of intent (LOI) before the candidate boards the flight home.

In the example of a slower recruitment in anesthesiology, delays added $17,500 in extra recruiting costs and $728,620 in lost revenue over five months when a hire slipped — on top of growing burnout on the remaining team and reputational risk in the community.

Design interviews to “sell the why”

• Tailor the team to the candidate (executive vision, clinical peers, community ambassadors).
• Orchestrate the community tour for the whole family (schools, coaches, activities) so they can imagine life there.
• Leave no questions unanswered — benefits, call burden, APP support, and path to leadership should be crystal clear.

“And between searches? Always be recruiting,” Sheley said. Build relationships with residents and passive candidates years in advance so you’re not starting from zero when a resignation hits.

Build a modern sourcing engine for passive candidates

Most physicians aren’t active on job boards, but many are open to the right nudge. Sheley emphasized a diversified digital mix — professional networks, targeted email, and thoughtful, multi-touch content about your practice and community — to reach passive seekers at scale.

A practice leader’s checklist

1. Map true capacity: For each provider, reconcile contracted cFTE versus actual delivered clinic time.
2. Audit templates: Reclassify held versus unavailable time; right-size designated new-patient blocks; fix chronic overrides.
3. Tighten your access levers: Automate reminders, enable self-scheduling, activate a rolling waitlist, and apply data-driven overbooking.
4. Watch demand signals: Track referral completion, leakage, new-patient lag, and patient experience scores monthly.
5. Protect autonomy in change: Co-design template tweaks with providers; measure, iterate, and communicate wins.
6. Plan succession now: Identify near-retirement risk and start cultivation tracks (fellows/residents) early.
7. Quantify ROI: Use vacancy cost and ramp assumptions to justify recruitment.
8. Align stakeholders pre-search: Agree on compensation, screening criteria, and a one- to two-day interview cadence.
9. Shorten time-to-offer: Empower the team to issue a same-day LOI when fit is confirmed.
10. Market continuously: Stand up a digital sourcing strategy to build a slate of receptive candidates.

The strategic pivot for administrative leaders is to treat capacity as a managed asset. Measure it precisely, protect it relentlessly, and recruit where the data demands — quickly, decisively, and with a compelling story about purpose, growth, compensation, and work-life balance. That’s how you expand access, steady your clinician team, and keep the practice solvent in a tough market.

Notes:

1. Jackson Physician Search. Preparing for the Wave of Physician Retirements. March 16, 2023. Available from: https://bit.ly/45oOBRJ 
2. Jackson Physician Search and MGMA. From Contract to Connection: How Authentic Relationships Foster Early-Career Physician Loyalty and Retention. Sept. 25, 2025. Available from: https://www.mgma.com/jps25 
3. Jackson Physician Search. From Physician Recruitment to Retention. June 26, 2024. Available from: https://bit.ly/4qAM1k5 
4. Moody J, McMillen S, Petroff N. The Waiting Game: New-Patient Appointment Access for US Physicians. ECG Management Consultants. Available from: https://bit.ly/3SQ3RjZ