Blended Workforce Models in Healthcare: How to Combine Permanent Staff and Locum Tenens

A blended workforce model is a staffing structure that combines a permanent clinical core with a pre-planned flexible layer of locum tenens, per diem, and internal resource pool providers. It is not a contingency plan. It is a deliberate operational design that high-performing health systems are building now to protect revenue, reduce burnout, and stop treating every vacancy as a crisis.

The number of locum tenens professionals has grown more than 23% since 2022, according to Definitive Healthcare's 2026 Providers: Industry Pulse report. Contingent staffing is no longer emergency coverage. It is becoming structural. This guide explains what a blended model looks like in practice, how to build one, and what it costs versus the alternative.

Last updated: June 2026

Key Takeaways

• A blended workforce model combines a permanent clinical core with a planned flexible staffing layer. It is not reactive agency use — it is a designed structure.
• Many organizations are adopting blended workforce models that combine core permanent teams with locum tenens providers to improve staffing stability and operational resilience.
• Healthcare facilities made an intentional shift toward hybrid models in response to increasing operational costs.
• The flexible layer should cover 15-25% of total clinical capacity for most health systems. Below 10% leaves no buffer for attrition. Above 30% drives costs up without proportional benefit.
• The U.S. locum tenens staffing market is projected to grow at a CAGR of 7.74% through 2034, meaning the supply of flexible providers is expanding alongside demand.
• Organizations using blended models report shorter time-to-fill, lower overtime spend, and lower per-episode agency costs than those using reactive staffing.

Why the Old Model Is Breaking

The traditional healthcare staffing approach had two modes: hire permanent staff, and call an agency when desperate. That model worked when physician supply was adequate and vacancies filled in weeks. Neither condition holds in 2026.

The U.S. faces a projected shortfall of up to 86,000 physicians by 2036, making the integration of locum tenens and permanent physicians essential to meet patient demand and manage costs.

When organizations rely entirely on reactive agency use, three things happen. First, they pay crisis pricing. An agency placement made under pressure in week eight of a vacancy costs more than a placement arranged through a pre-negotiated relationship at week two. Second, credentialing timelines are compressed, which creates compliance risk. Third, the permanent team absorbs the gap through overtime and extended hours, which accelerates burnout and raises the probability of the next vacancy.

Traditional reliance on short-term travelers, per-diem staff, or locum tenens can increase overall labor spending by 30 to 40 percent when factoring in housing, stipends, and rapid onboarding — but only when that reliance is reactive rather than planned. A blended model with pre-credentialed providers on an internal roster eliminates most of that premium.

What a Blended Workforce Model Actually Looks Like

A functional blended model has three layers. The ratio between them depends on your specialty mix, patient volume, and vacancy history.

Layer 1: Permanent Core (70-85% of clinical capacity)

Full-time employed physicians, NPs, and PAs. These providers anchor continuity of care, referral relationships, and institutional knowledge. The permanent core should be sized to cover baseline patient volume at sustainable hours — not sized to cover baseline plus projected vacancies on overtime.

Layer 2: Internal Resource Pool (10-15% of clinical capacity)

Pre-credentialed providers who are affiliated with your organization and available for scheduled and on-demand coverage. They are not employees but they have completed your credentialing process, hold privileges at your facilities, and can be deployed without going through an agency for each shift.

This is the layer most organizations are missing. Without it, every departure or leave triggers a reactive agency call. With it, coverage is a scheduling decision, not a procurement decision.

Layer 3: External Locum Tenens (5-15% of clinical capacity)

Agency-placed locum providers for extended vacancies, seasonal volume spikes, subspecialty needs, and situations where the internal pool cannot cover. This layer should be planned, not improvised. Pre-negotiated rate agreements with one or two staffing partners eliminate the pricing volatility that makes reactive locum use expensive.

The Core-Periphery Design Principle

Resilient teams are built on a core-periphery structure. Leadership must formally dedicate a portion of the operational budget to a flexible staffing buffer — not as a crisis strategy but as a way to address known vulnerabilities: scheduled vacation blocks, predictable seasonal surges, and planned leave for continuing education.

In practice, this means two things. First, the flexible layer is budgeted proactively, not approved reactively. Second, providers in the flexible layer are onboarded in advance, not at the moment of need.

The onboarding point is critical. A locum physician who arrives at your facility without having completed your EHR training, privilege verification, and department orientation adds friction to patient care and compliance exposure to your organization. Providers in the flexible layer should complete a standardized onboarding process before they are needed, not as the gap is opening.

How to Build a Blended Model: A Practical Framework

Step 1: Audit your current staffing structure

Map your clinical capacity across all sites and specialties. Identify: what percentage of your current coverage comes from permanent staff, what percentage from agency or locum use, and what your average time-to-fill has been by specialty over the past 24 months.

This baseline tells you where your vulnerability sits. Most organizations find 2-3 specialties or service lines that account for the majority of their reactive agency spend.

Step 2: Define your target ratios

For most health systems, a starting target is:

• Permanent core: 75-80%
• Internal resource pool: 10-15%
• External locum buffer: 5-10%

Adjust by specialty. Emergency medicine and hospitalist programs benefit from larger flexible layers because shift-based scheduling creates predictable gaps. Surgical specialties with lower vacancy frequency can run with smaller flexible buffers.

Step 3: Build your internal resource pool

Identify providers in your market who are credentialed in your specialty areas and open to flexible arrangements. Retired or semi-retired physicians, early-career providers building experience, and providers who have left full-time employment but want ongoing clinical work are all viable pool candidates.

Credential them through your standard process. Set up a scheduling mechanism that gives them visibility into available shifts. The goal is a roster of providers who can say yes to a shift within 48-72 hours rather than a search that starts from zero each time a gap opens.

Step 4: Pre-negotiate your external locum relationships

Do not wait for a vacancy to contact a staffing partner. Establish a rate agreement and preferred vendor relationship with one or two agencies before you need them. Define your credentialing requirements, your typical specialty needs, and your expected volume. This eliminates the negotiating-under-pressure dynamic that inflates reactive locum costs.

Step 5: Budget the flexible layer as a fixed operational cost

The flexible staffing layer is not an overage. It is part of your clinical staffing budget, planned annually alongside permanent headcount. Organizations that treat it as an overage consistently underallocate and end up in reactive mode. Organizations that budget it proactively consistently report lower total labor costs because they eliminate crisis pricing and overtime accumulation.

Blended Model vs. Reactive Agency Use: The Cost Comparison

What Blended Models Do Not Solve

A blended model reduces the cost and disruption of vacancies. It does not eliminate the need for permanent recruitment. Organizations that shift too heavily toward flexible staffing risk eroding continuity of care and losing the referral relationships that anchor patient volume.

The blended model works best when permanent recruitment remains the primary goal and the flexible layer provides the runway to recruit without financial pressure. Locum tenens can act as a strategic bridge to finding the right permanent physicians rather than a permanent substitute for them.

There is also a credentialing maintenance cost. Providers in your internal resource pool need ongoing credential verification, license renewal tracking, and privilege maintenance at your facilities. This administrative function is manageable with the right platform but it is not zero-cost.

Where DirectShifts Fits

DirectShifts helps healthcare employers build and manage both layers of the flexible workforce: the internal resource pool and the external locum coverage when needed.

On the internal resource pool side, DirectShifts handles provider sourcing, credentialing, compliance tracking, and renewal alerts so the pool stays deployable without dedicated administrative overhead on the employer side.

On the external locum side, DirectShifts operates as a direct-hire platform rather than a traditional markup agency, which means the bill rate reflects the provider's compensation rather than a significant agency margin on top.

For organizations building a blended model from scratch, the starting point is a conversation about your specialty mix, your current vacancy patterns, and what your internal pool needs to look like to cover those gaps. That conversation is available without a commitment.

Talk to our team about building your blended workforce model

Frequently Asked Questions

What is a blended workforce model in healthcare?A blended workforce model combines a permanent clinical staff core with a pre-planned flexible layer of locum tenens, per diem, and internal resource pool providers. The flexible layer is budgeted proactively and activated on a schedule, not improvised in response to vacancies.

How much of my clinical capacity should be flexible staff?Most health systems target a flexible layer of 15-25% of total clinical capacity. The right number depends on your specialty mix, vacancy history, and patient volume variability. Service lines with shift-based scheduling typically benefit from larger flexible buffers.

Is a blended model more expensive than hiring permanent staff only?Permanent-only staffing appears cheaper until you account for the cost of vacancies, overtime, and reactive agency placements. A planned flexible layer adds 10-15% above a permanent-only labor cost. Reactive agency use adds 30-40%. The blended model is consistently cheaper than reactive use when total cost is measured.

What is an internal resource pool and how is it different from locum tenens?An internal resource pool is a facility-managed roster of pre-credentialed providers available for on-demand coverage. Locum tenens are agency-placed external providers. The internal resource pool eliminates the agency margin and reduces credentialing time because providers have already completed your onboarding process.

How long does it take to build an internal resource pool?Building a functional pool from scratch typically takes 60-120 days depending on your specialty requirements and market. Credentialing is the primary variable. DirectShifts can compress the sourcing side of that timeline significantly.

Can small practices or telehealth operators use a blended model?Yes. The ratios differ from large health systems but the principle is the same. A telehealth operator with 5 NPs can maintain a flexible layer of 1-2 pre-credentialed backup providers. The administrative overhead is low and the protection against a single provider departure disrupting patient access is significant.

Does DirectShifts manage both the internal pool and external locum placements?Yes. DirectShifts handles sourcing, credentialing, compliance tracking, and scheduling support for internal resource pools, and also places locum tenens providers when external coverage is needed.

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