Job Placement · Healthcare · Physician
A physician offer signed today does not produce a billing physician today. State licensure, hospital privileging and payer enrolment each run their own queue after acceptance. BEG runs the search and sequences those queues in parallel, on Tier V milestone billing at $22,640 to $27,168.
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TL;DR
Physician hiring has two clocks and most organisations only manage the first. The search finds and closes the candidate. The second clock, which nobody controls, is licensure, hospital privileging and payer enrolment, and it is what decides when the physician can actually see and bill a patient. Federal rules permit retrospective billing only thirty days before the enrolment effective date, so a late start is unrecoverable revenue rather than a scheduling inconvenience. BEG prices a physician search at $22,640 to $27,168 on milestones, against the $55,186 to $68,983 a contingency percentage would take at the national median.
Where The Shortage Actually Is
Because the national shortage is an average of very different markets. HRSA projects nonmetro supply adequacy at less than half the metropolitan level, and projects surpluses in some specialties while others sit well below need.
The Four Queues After The Signature
State licensure, hospital credentialing and privileging, Medicare enrolment, then commercial payer panels. They are sequential more often than parallel, and each has an owner who is not you.
| Queue | What it requires | What it does to revenue |
|---|---|---|
| 1. State medical licence | A full unrestricted licence from the board in the state of practice, with primary source verification of training and history. | Nothing else can start without it. For an out-of-state hire this is the item most likely to move a start date by a month or more. |
| 2. Hospital credentialing and privileging | Medical staff office review of education, training, certification, malpractice history and references, then privileges granted by the governing body. | Runs on committee calendars. Missing one meeting can add weeks regardless of how complete the file was. |
| 3. Medicare enrolment | Enrolment with the Medicare contractor for the practice location and reassignment of benefits where the physician is employed. | Under 42 CFR 424.521(a), retrospective billing reaches back only thirty days from the effective date, or ninety in a declared disaster. Earlier work is not recoverable. |
| 4. Commercial payer panels | Separate applications and effective dates per payer, each with its own processing time. | The long tail. A physician can be fully privileged and still be out of network for a meaningful share of the panel for weeks afterwards. |
Licensure belongs to the board, privileging to your medical staff office and enrolment to the payer. BEG does not file any of it. What we do is start the conversation about it during the search, so the offer letter carries a start date the organisation can actually keep. See the full healthcare placement service, or the chief medical officer search where the same queues apply to the executive seat.
A Fixed Fee Against A Share Of A Large Salary
Contingency pricing is a percentage of first-year compensation, and physician compensation is the largest in the clinical workforce. At the $275,930 median in BLS data for physicians and surgeons, 20% is $55,186 and 25% is $68,983, and a subspecialist package pushes both numbers far higher. BEG prices a physician search as a Tier V engagement at $22,640 to $27,168 against defined milestones, fixed when the search opens. At median that is roughly $32,500 to $41,800 less, and the recruiter has no financial interest in the size of the package you agree.
What The Vacant Physician Seat Costs
At the same median, the clinical work not being done is about $5,306 a week, and that understates it badly for a proceduralist whose absence closes lists and empties a downstream service. Add the referrals leaking to another system while the seat is open, which do not come back when it is filled. Then add the enrolment window: work performed before the effective date beyond the thirty day look-back is simply not billable. A 23 to 35 day search, on isolved placement data, is the number worth putting against your last physician vacancy.
If You Were Comparing Against Locum Tenens
A locum firm rents you a credentialed clinician by the day and carries the employment relationship. A permanent search ends with a physician on your medical staff, your payer contracts and your call rota.
| Model | Who holds the physician | How you pay | Right when |
|---|---|---|---|
| Locum tenens agency | The agency, as contractor | Daily rate plus travel, lodging and malpractice cover, for the length of the assignment | You must keep a service running through a gap, a leave or a resignation, and closing the seat is a separate project. |
| Contingency physician recruiter | You | Percentage of first-year compensation, $55,186 to $68,983 at the national median | You want no fee until someone starts and accept that the fee scales with the package you agree. |
| BEG permanent placement | You | Tier V milestone fee of $22,640 to $27,168, fixed at the start | The seat is permanent, the credentialing work is worth doing once, and you want the cost known before sourcing. |
BEG does not employ or contract physicians and does not bill hourly, so we are not an alternative to a locum firm and do not pretend to be. Health systems routinely run locum cover while a permanent search is live, and that is often the correct answer. What it is not is a substitute for closing the seat, because every month of cover is a month of locum rate against no credentialing progress. Compare the nurse practitioner and physician assistant routes, which carry shorter enrolment tails.
FAQ
23 to 35 days from discovery call to signed offer on BEG searches, based on isolved placement data. The honest caveat is that signature and first clinic day are different events for this role: credentialing, privileging and payer enrolment run after the offer and they, not the search, usually set the start date.
Because three separate queues run in sequence. State licensure if the physician is coming from out of state, then hospital credentialing and privileging through the medical staff office, then Medicare and commercial payer enrolment. None of them begin until the offer is signed and none of them are on your calendar.
Only within a narrow window. Under 42 CFR 424.521(a), affected suppliers may bill retrospectively for services furnished at the enrolled location for up to thirty days before the effective date, or ninety days where a Presidentially declared disaster prevented earlier enrolment. Outside that window the work is not billable, which is why enrolment belongs on the project plan from day one.
HRSA projects a shortage of 141,160 full-time equivalent physicians nationally in 2038, with 30 of the 35 specialties it models projected to be short. Overall supply adequacy is projected at 88%, meaning the supply covers about 88% of projected demand.
No, and this is the number that should shape your recruiting plan. HRSA projects supply adequacy of 42% in nonmetro areas against 95% in metropolitan areas in 2038. A rural or small-town search is competing in a fundamentally different market from a metro search, and the offer has to reflect that.
HRSA projects the lowest 2038 supply adequacy in vascular surgery at 66%, ophthalmology at 72%, thoracic surgery at 73%, plastic surgery at 74% and family medicine at 76%. At the other end it projects emergency medicine at 116% and critical care and pulmonology at 112%, which are projected surpluses rather than shortages.
A physician is a Tier V search at $22,640 to $27,168, billed against defined milestones. A 20% to 25% contingency fee on the $275,930 BLS median for physicians and surgeons would be $55,186 to $68,983 for the same hire, and would rise with every increment you add to close the candidate.
No. A locum firm contracts the physician and bills you a daily rate for as long as the assignment runs. BEG places a permanent physician your organisation employs and credentials directly. If you need theatre lists or clinic sessions covered next month, locum is the correct tool and we will say so rather than open a search.
It is the baseline your medical staff bylaws and most payer contracts assume. ABMS reports 1,025,104 diplomates actively certified by a member board as of 30 June 2025, across 24 member boards covering 38 specialties and 89 subspecialties. Certification status is verified on the shortlist, not after the offer.
BLS reports a median of $275,930 for physicians and surgeons in May 2025, but that single figure pools every specialty. Benchmark to your specialty and your region, because the spread between specialties is wider than the spread between employers, and a candidate will arrive at the table with their own specialty survey.
Slowly in headcount terms. BLS projects 4% employment growth for physicians and surgeons from 2025 to 2035, about as fast as average, with roughly 22,100 openings a year. The pressure in this market comes from attrition and geographic maldistribution rather than from rapid expansion.
A 45-day replacement guarantee plus 50% off a repeat search for the same seat. For this role the more useful protection is front-loaded: scoping call burden, practice model, partnership or employment track and spousal relocation before sourcing, because those are what unwind physician hires in year one.
Building the wider medical staff? See chief medical officer and CNO, physician assistant, nurse practitioner and VP clinical operations, or all healthcare placement.
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