On days to fill, cost to hire and developing a physician retention strategy

A physician retention strategy must be intentional and it needs ownership within an organization.

But even before that can happen, it needs to exist.

Finding and hiring a new physician costs money. How much? It’s one of the basic metrics that physician executives and recruiters can use to develop a physician retention strategy. It’s also probably not measured enough, said Carey Goryl, MSW, CAE, CPRP, chief executive officer of the Association for Advancing Physician and Provider Recruitment (AAPPR).

Goryl spoke with Medical Economics about this year’s 2026 Physician & Advanced Practice Provider Retention Strategy Report, an analysis with Industry Insights and CHG Healthcare. Here she expands on key metrics, how artificial intelligence is beginning to reshape the administrative side of recruitment and retention, and a simple framework practices can use to start measuring their own retention progress.

Another helpful metric is days to fill an open position. If you don’t know the answer to that, AAPPR offers this online calculator to get started with that measure.

This transcript has been edited for length and clarity.

You mentioned continuity of revenue. Can you expand on how that fits with a recruitment and retention strategy?

Carey Goryl, MSW, CAE, CPRP: In the report, we asked what metrics organizations are tracking, whether that's for an activity or a more formal strategy, and we're never quite satisfied with how much data is being tracked. Data isn't pass or fail. It tells you where you need to drill down to understand what part of the process isn't working.

At AAPPR, one of the longest-running metrics we encourage every health organization to track is days-to-fill. That's very much a recruitment metric. We've been tracking it for 15 years and publish national benchmarks every year by specialty, and you can even drill down by region or by urban, rural or suburban location, to get a baseline for how long it takes to at least get to contract. Days-to-fill runs from when you open a position to when you have a signed contract. It could be another three to six months, sometimes longer, before the physician actually starts seeing patients. That long runway costs your organization money.

If you're using locum tenens coverage, you need enough insight into that workforce to know what you're paying, which is going to be higher than an employed physician, and you need to make sure you're billing properly for that work. That's a common misstep we see: Organizations take the loss because the system is too complicated internally to catch it. Whether you have a locums provider or a vacant position where you've asked your current workforce to take on more, you end up with unrealistic workload expectations, longer wait times for patients, and potentially permanently lost patients if care becomes harder to access. All of that ties back to an open position and a recruitment process that may be taking longer than the national benchmark. That costs money, and with compensation being what it is, and candidates zeroing in on it, every time you fill a position, your costs escalate.

We want organizations to look at cost-per-hire, which most are not tracking. That doesn't include the physician's compensation. It looks at the cost of your recruitment staff or agencies, marketing, sourcing, the interview process, and any additional benefits you're offering outside of compensation, including retention bonuses, which a lot of organizations are now using. All of that is far more expensive than what it costs to fund a champion to create and monitor a formal retention strategy, and to make the internal changes that build a healthy workplace culture where clinicians have the resources, autonomy and voice they need. It's cheaper than having to keep recruiting.

Related coverage: ‘Someone needs to own the retention strategy’ — keeping physicians on the job, or not

Electronic health record training and clinical autonomy both came up in the report as workplace conditions connected to burnout. Why do those matter so much for retention?

Carey Goryl, MSW, CAE, CPRP: The electronic health record has a long history of being cumbersome, and there's been a misalignment between what it was expected to do and what it actually did. I think that's changing, though I'm not on the front lines working in electronic health records myself.

Whether you're a large organization with massive amounts of data and legacy systems, or a small program without the funds to invest in a robust system, you have to work with what you have. In your retention programs, it helps to talk regularly with clinical providers about what's working with your EHR system and what's not, especially given how quickly technology and AI capabilities are changing. That might need to be a monthly or quarterly conversation. It doesn't mean you're making a change every time, but that dialogue helps build a strong workplace culture where clinicians feel they have a voice.

Clinical autonomy is harder in larger organizations, which need to limit risk given their size, but the risk exists no matter your size. Clinical autonomy allows physicians and APPs to practice to the top of their license, in conjunction with their physician colleagues, depending on the state and licensing requirements. It all connects: workplace culture, technology, autonomy. None of these pieces stand alone.

On the administrative side, how is AI being used for retention and recruiting?

Carey Goryl, MSW, CAE, CPRP: We should be using it for data, and for tools that help us figure out how to track data. If you don't know how to calculate cost-per-search, AI is another source of information, the way the internet or a library always has been, whether it's built into your applicant tracking system or you're working in an Excel spreadsheet that now has AI layered into it.

I'm not saying you have to trust everything AI tells you, but it's a momentum builder. If you're using AI in your administrative processes, feed your current activities into a tool and have it help you shape a strategy, give you feedback on what's missing and what you need to measure. It gives you momentum, which hopefully gives you the excitement to make improvements and keep improving patient access and your workplace culture, so physicians and providers want to stay.

For smaller to medium-sized practices working on retention, if you think in terms of one week, one month and one year, what are three steps they can take to improve retention?

Carey Goryl, MSW, CAE, CPRP: Understand where you're starting from. In the first week, do an audit. Write down everything you're currently doing. In the first month, convert that into a plan. You've documented what you're currently doing, so identify the gaps, maybe pick one gap to address starting in month one, and know how you're going to measure whether that activity is having any impact on retention.

Then, a year from now, look beyond just turnover and employee satisfaction, which a lot of organizations already track, and decide what you're going to do with what you've learned. That's the momentum that grows your retention strategy and, hopefully, makes your organization a more attractive place to stay.

What didn't I ask about that you'd like our audience to know?

Carey Goryl, MSW, CAE, CPRP: People should know the report is free to the public. Anyone reading or listening to this conversation is welcome to go to aappr.org, under our research page. Follow us if you want help understanding recruitment, onboarding or retention. We're invested in that for all of health care.

We do more for our members, and we'd welcome anyone to join, but you don't have to be a member to benefit from the work we're doing. We hope you'll check out our days-to-fill calculator, which is also public.