The Real Cost of a Physician Vacancy: What Healthcare Employers Are Losing Per Open Position

A physician vacancy does not cost your organization nothing. It costs approximately $8,000 per day in lost revenue, patient leakage, and downstream billing impact. Leave a position open for six months and you are looking at a $1.4 million problem before you factor in overtime, burnout on your existing staff, or the compounding hit to your referral network.

The $2.6 million figure that circulates in healthcare HR conversations is not a worst-case estimate. For high-revenue specialties, it is a realistic mid-range. This post breaks down what that number actually includes, how it varies by specialty, and what the decision to delay filling a vacancy actually costs in real dollars.

Last updated: June 2026

Key Takeaways

• An unfilled physician position costs an average of $8,000 per day in lost revenue.
• The average physician vacancy lasts 189 days for primary care and 226 days for specialists.
• Replacing a physician costs between $1.8 million and $2.8 million when total costs are added up, depending on specialty.
• Referral leakage from a single vacancy costs health systems $821,000 to $971,000 per position.
• Locum tenens coverage placed within weeks of a vacancy opening protects revenue while permanent recruitment runs its course.
• The cost of a locum tenens placement is almost always lower than the cost of leaving a position open.

Why the $8,000 Per Day Figure Is the Right Starting Point

Most healthcare finance conversations start with salary. The physician earns $X per year, so the vacancy costs $X divided by 250 working days. That math is wrong, and it significantly understates the actual exposure.

A physician does not just generate their own billing revenue. They admit patients who need labs, imaging, and specialist referrals. They anchor a referral network that brings volume to your surgery, oncology, and cardiology departments. When that chair is empty, none of those downstream billings happen.

The $8,000 per day figure is the blended average across specialties for combined direct billing loss and downstream revenue impact. For high-revenue specialties, it is higher. For primary care, it varies by patient volume and payer mix. But $8,000 per day is the number that holds up across independent analyses from CompHealth, Weatherby, and multiple health system CFO surveys.

At 189 days of average vacancy time for a primary care physician, that is $1.5 million in lost revenue before a single permanent hire starts. For a specialist at 226 days average vacancy, the number climbs further.

What the Full Vacancy Cost Actually Includes

The total cost of a physician vacancy has four components. Most organizations only track one or two of them.

1. Direct Billing Loss

This is the revenue your organization does not collect because no provider is seeing patients in that role. Monthly gross billings from a vacant physician position range from $300,000 to $800,000 depending on specialty. Family medicine at the lower end, invasive specialties at the higher end.

SpecialtyEstimated Monthly Revenue LossFamily Medicine / Primary Care$175,000 - $300,000Internal Medicine (Hospitalist)$200,000 - $350,000Psychiatry$150,000 - $250,000Cardiology (Non-Invasive)$380,000 - $575,000Gastroenterology$420,000 - $700,000Orthopedic Surgery$550,000 - $820,000Neurosurgery$650,000 - $900,000

Sources: AMN Healthcare 2025 Physician Revenue Survey; Medical Group Management Association; Stout Hidden Economics of Physician Turnover, 2026.

2. Referral Leakage

When a specialist clinic runs short-staffed, patients who cannot get timely appointments go elsewhere. Referring physicians who cannot count on reliable access start routing patients to competing systems. That referral volume, once lost, is difficult to recover.

Each physician vacancy costs health systems $821,000 to $971,000 in referral leakage alone. Of all the costs in this list, this is the one that takes the longest to stop after a position is filled. It takes months to rebuild referral patterns after an extended vacancy.

3. Overtime and Burnout on Existing Staff

Remaining physicians absorb the workload. That means overtime, extended hours, and administrative burden. The AMA estimates that physician burnout costs organizations $500,000 to $1 million per doctor who leaves as a result. At a 48% burnout rate nationally, a prolonged vacancy is directly adding to that risk for your existing staff.

The overtime cost itself is calculable. If a hospitalist costs $900 to $1,000 per effective daily work cost, and colleagues are covering an extra 20% of shifts to manage the vacancy, that overhead shows up on your payroll before it shows up in your turnover numbers.

4. Recruitment and Replacement Cost

This is the cost most HR teams track, and it is usually the smallest component. Search firm fees run 20-30% of first-year salary. Sign-on bonuses range from $30,000 to $100,000 depending on specialty and market. Relocation, credentialing, and onboarding add further cost.

Replacing a physician costs $1.8 million to $2.8 million in total when recruitment fees, signing bonuses, lost revenue during the vacancy period, and the ramp-up period are combined. A newly placed physician typically operates at 50-75% capacity for the first six months while building referral relationships and learning the EHR.

That ramp-up tax is a cost most organizations do not model but consistently experience.

The 189-Day Problem

The average time to fill a primary care physician vacancy is 189 days. For specialists, it is 226 days. After a physician accepts an offer, it takes an additional 120 days on average before they start seeing patients.

That is not a recruiting failure. That is the structural reality of physician hiring in 2026. The AAMC projects a shortage of 37,800 to 124,000 physicians by 2034. The pool is not getting larger.

What that timeline means in financial terms, using a primary care vacancy at $8,000 per day:

• 30 days open: $240,000 lost
• 90 days open: $720,000 lost
• 189 days open (average): $1,512,000 lost
• 365 days open: $2,920,000 lost

These figures do not include referral leakage, overtime costs, or the recruitment spend to make the permanent hire. They are the direct revenue impact only.

How Locum Tenens Coverage Changes the Math

A locum tenens physician placed within two to four weeks of a vacancy opening changes every number in the calculation above.

The objection most healthcare finance teams raise is that locum tenens bill rates are higher than the daily cost equivalent of a permanent physician salary. That is true when compared against salary alone. It is not true when the comparison is made against the full cost of vacancy.

A hospitalist locum covering at $1,500 per day protects $8,000 per day in revenue. That is a straightforward calculation. The cost of coverage is lower than the cost of the gap.

The indirect benefits compound this. Referral patterns stay intact. Existing staff do not go into overtime-driven burnout. Credentialing for the locum, handled by the staffing partner, takes weeks rather than the months required for a permanent hire. And in 46% of cases, locum arrangements convert to permanent placements, eliminating recruitment cost entirely.

What Delays the Decision to Use Locum Coverage

The most common reason healthcare operators delay filling a vacancy with locum coverage is budget-line friction. The locum bill rate appears on a different line item than the permanent hire would. Finance teams see the cost of the locum clearly. The revenue lost from the vacancy is harder to see on a single report.

This is a reporting problem, not a math problem. The daily revenue loss from an open physician position is measurable and it exceeds the daily cost of locum coverage in almost every specialty. Organizations that model this side by side consistently find the case for early locum placement is straightforward.

The second most common delay is the expectation that the permanent hire will close quickly. Physician recruitment timelines have been consistently longer than expectations for the past decade. Modeling around the average timeline rather than the optimistic timeline is the more defensible financial position.

How to Calculate Your Own Vacancy Cost

Use this framework to build the number for your specific position:

Step 1: Calculate daily billing lossAverage annual physician revenue for the specialty / 250 working days = daily billing loss baseline

Step 2: Add downstream revenue impactFor specialists with strong referral networks, add 30-50% to the direct billing number to account for downstream labs, imaging, and in-network referrals.

Step 3: Estimate the vacancy durationUse the AAPPR benchmark for your specialty (primary care: 189 days; specialty: 226 days) unless you have facility-specific data showing faster fill times.

Step 4: Add referral leakage estimateFor specialist roles: add $821,000 to $971,000 to the total vacancy cost.

Step 5: Compare against locum coverage costGet a locum bill rate for the specialty and market from your staffing partner. Multiply by the expected vacancy duration. Compare to Steps 1 through 4.

In most cases, the comparison makes the decision for you.

Frequently Asked Questions

What is the average cost of a physician vacancy per day?The average across specialties is $8,000 per day in lost revenue. High-revenue specialties like orthopedic surgery and neurosurgery run higher. Primary care is lower but still significant at $5,000 to $7,000 per day depending on patient volume and payer mix.

How long does the average physician vacancy last?Primary care vacancies average 189 days to fill from the opening date. Specialist vacancies average 226 days. After a physician accepts an offer, add another 120 days before they see their first patient.

Does locum tenens coverage actually cost less than leaving a position open?In most specialties, yes. A locum bill rate of $1,500 to $2,500 per day protects $6,000 to $10,000 per day in revenue. The comparison is not against permanent physician salary. It is against the cost of the vacancy itself.

What is referral leakage and how much does it cost?Referral leakage happens when patients and referring physicians route volume outside your system because a specialty slot is unavailable or wait times are too long. Each specialist vacancy costs $821,000 to $971,000 in referral leakage. Some of that volume does not return even after the position is filled.

What is included in the $2.6 million physician replacement cost figure?That figure combines direct billing loss during the vacancy period, recruitment and search fees, sign-on bonus, relocation, and the ramp-up period where a new physician operates at 50-75% productivity for the first six months. The range across specialties is $1.8 million to $2.8 million.

When should we place a locum versus waiting for a permanent hire?As soon as the vacancy is confirmed. The cost of waiting accumulates daily. The question is not whether the locum is expensive. It is whether the vacancy is more expensive. For most specialties, the answer is yes within the first two weeks.

Can DirectShifts place a locum physician quickly enough to protect revenue?DirectShifts can typically source and begin credentialing a locum physician within days of a request. Time to first patient contact depends on credentialing timelines at the facility and state licensing, but the sourcing side of the process is measured in days, not weeks.

How DirectShifts Approaches Vacancy Coverage

DirectShifts works with healthcare employers to place physicians, NPs, and PAs in both locum and permanent roles. The platform handles credentialing, licensing, and compliance tracking so coverage starts as soon as the provider is ready.

For operators who want to reduce dependency on reactive locum placements, DirectShifts also builds internal resource pools: pre-credentialed rosters of providers available for on-demand coverage without going through an agency for each shift.

The goal in both cases is the same: close the revenue gap as fast as possible and build a staffing model that does not require a crisis to activate.

Talk to our team about vacancy coverage