This analysis synthesizes 8 sources published February 2026. Editorial analysis by the PhysEmp Editorial Team.
Time-to-Fill and Cost-to-Hire: Where Recruiting Breaks Down
Every open role on a staffing report tells a story — and more often than not, it isn’t a story about a scarce labor market. It’s a story about internal friction that nobody has bothered to fix.
Extended time-to-fill has become one of the most visible and costly symptoms of recruiting dysfunction in healthcare. The numbers are stark. Hiring an RN now averages 83 days and costs hospitals more than $61,000 per vacancy, according to Recruitics’ 2025 Clinical Talent Survey. Physician searches are even longer: the AAPPR’s 2024 benchmarking report found median search-launch-to-contract times ranging from 77 to 228 days depending on specialty. These aren’t outliers. They’re the new baseline.
And yet the instinct of most organizations is to treat slow hiring as a pipeline problem — a failure of sourcing, or a symptom of a tight labor market — rather than as a process problem hiding in plain sight.
The Bottlenecks Nobody Talks About
When recruiting slows down, the usual suspects get blamed: not enough candidates, too much competition, burnout-driven departures. These are real forces. But in the day-to-day reality of most hiring workflows, delays are just as often self-inflicted.
Role approval and intake processes are frequently the first point of breakdown. When a vacancy isn’t formally acknowledged and authorized until weeks after it opens — and when that request then has to travel through multiple layers of committee approval — the clock runs before a recruiter ever opens a requisition. High-performing organizations start the intake process the moment attrition is anticipated, not after it happens.
Ambiguous decision criteria are another quiet killer. When hiring managers, department chiefs, and administrative leaders each hold a different vision of what the ideal candidate looks like, interviews stall and offers don’t get made. Strong candidates — who typically have options — lose interest and accept positions elsewhere. Research from GoodTime’s 2025 Hiring Insights Report identified untrained hiring managers and misaligned stakeholders as persistent disruptors of healthcare hiring timelines.
Interview scheduling and site visit delays may seem like a logistics problem, but they carry real consequences in a competitive market. Sixty-two percent of candidates now expect a response within 72 hours of applying; when that threshold is missed, ghosting spikes by 31%, per the Recruitics survey. That responsiveness expectation extends through the entire process — slow scheduling signals organizational disorganization to the very candidates an employer most needs to impress.
Late-stage changes to compensation or role scope are particularly damaging because they tend to occur after a candidate has already emotionally committed to an offer. Revisiting salary bands, adjusting call schedules, or narrowing subspecialty expectations at the finish line doesn’t just lose individual candidates — it damages the employer’s reputation in a professional community where word travels fast.
Credentialing and privileging timelines deserve specific attention in healthcare. These processes are often treated as downstream from recruiting, when in practice they should run in parallel from the earliest stages. Credentialing alone can consume 60 to 90 days or more. Organizations that wait until an offer is accepted to begin this work are adding months to their effective time-to-fill — months during which they are paying for coverage they shouldn’t need.
The True Cost of a Vacant Chair
An unfilled position is not a neutral state. It is an active, compounding expense.
The most immediate costs are visible: locum tenens coverage, overtime distribution among existing staff, or redistribution of patient volume to other providers. Locum tenens physicians currently cost between $150 and $500 per hour depending on specialty, with additional expenses for travel, housing, and credentialing. While locum coverage serves a necessary short-term function — and in 2024, locum tenens were used in 16.4% of physician searches at the highest rates ever recorded, per CHG Healthcare’s State of Locum Tenens Report — it was never designed as a permanent budgetary strategy.
The less visible costs are more insidious. An empty role reduces downstream referral volume for ancillary services like imaging, lab, and rehabilitation — revenue that flows to competing health systems rather than staying internal. It increases burnout among existing staff who absorb the workload gap. It can trigger additional turnover, restarting the cycle. And it erodes an organization’s employer brand among the very professionals it is trying to recruit, in a market where candidates share experiences with their peers.
The longer a role remains open, the more desperate — and expensive — the eventual hire tends to be. Inflated signing bonuses, accelerated salary negotiations, and compressed onboarding timelines are all predictable downstream effects of a process that moved too slowly.
What High-Performing Organizations Do Differently
Organizations that consistently outperform their peers on time-to-fill share a common characteristic: they treat recruiting as an operational discipline, not an administrative function.
This means tracking time spent at each stage of the funnel — from requisition approval through offer acceptance — and intervening where friction accumulates. If scheduling is the bottleneck, fix scheduling. If compensation approval requires three levels of sign-off that could be consolidated into one, change the policy. If credentialing isn’t starting until after offers are signed, run it earlier.
Technology plays an important supporting role. Healthcare organizations that have implemented modern applicant tracking systems and AI-assisted screening tools have seen meaningful gains. When Asbury Communities upgraded its recruitment platform, it reduced time-to-hire by 33% — from 46 days to 31 — while also expanding its candidate reach substantially. KinCare simplified its application process from 17 minutes to under five minutes and cut time-to-fill from 40 days to 18. These aren’t marginal improvements. They represent the difference between a process that serves candidates and one that loses them before they ever raise their hand.
Data-driven recruitment also matters. The Cleveland Clinic has used predictive analytics to anticipate staffing needs before vacancies open. HCA Healthcare has applied analytics specifically to reduce time-to-fill for critical positions. Kaiser Permanente uses AI-powered tools to predict offer acceptance likelihood, allowing recruiters to focus energy on the candidates most likely to convert.
The underlying principle is the same across all of these examples: visibility creates accountability. When leadership can see exactly where candidates are sitting idle in a process, they can fix it. When that data doesn’t exist, delays accumulate invisibly until a CFO asks why the locums spend line has tripled.
Shifting the Frame
The most important mindset shift available to healthcare organizations right now is treating time-to-fill as an operational metric — not a recruiting outcome — a shift that sits at the core of modern physician recruiting and staffing strategy. When it appears on the same operational dashboard as patient throughput, overtime hours, and margin per service line, it gets managed proactively.
That shift requires leadership buy-in, not just recruiter effort. Intake processes, credentialing timelines, scheduling workflows, and compensation approval chains all sit outside a recruiter’s control. Fixing them requires organizational will. But the alternative — continuing to fund an ever-growing locum tenens budget while permanent vacancies age — is a cost that compounds quietly until it becomes impossible to ignore.
The good news is that most of the friction is fixable. The candidate market is difficult. The internal processes don’t have to be.
Sources
- “Speed, Transparency, and Trust: The New Rules of Hospital Recruiting in 2025” — Recruitics, July 2025
https://info.recruitics.com/blog/recruitics-unveils-2025-healthcare-talent-survey - “State of Locum Tenens: 2025 Report” — CHG Healthcare
https://chghealthcare.com/chg-state-of-locum-tenens-report - “Locum Tenens Recruitment in 2025: Matching Short-Term Needs with Long-Term Data Strategy” — Alpha Sophia (citing AAPPR 2024 Benchmarking Report)
https://www.alphasophia.com/blog-post/locum-tenens-recruitment-in-2025-matching-short-term-needs-with-long-term-data-strategy - “Healthcare Hiring Trends: Stats, Challenges, and Strategies for 2025” — GoodTime
https://goodtime.io/blog/recruiting/healthcare-hiring-trends/ - “Healthcare Recruitment in 2025 – What You Need to Know” — SmartRecruiters
https://www.smartrecruiters.com/resources/article/what-you-need-to-know-about-healthcare-recruiting-in-2025/ - “How to Reduce Time to Hire in Healthcare: 4 Ways” — Cisive, June 2025
https://blog.cisive.com/reduce-average-time-to-hire-in-healthcare - “How Much Does Locum Tenens Cost (Really)?” — ERA Locums, December 2025
https://eralocums.com/blog/locum-tenens-cost/ - “Top Healthcare Recruitment Strategies for 2025” — SeeMeHired
https://seemehired.com/blog/top-healthcare-recruitment-strategies-for-2025/
