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As market forces converge, physician-first workforce models are reshaping specialty care delivery
A growing number of hospitals are rethinking how surgical and procedural care is delivered as more physicians move away from private practice, retention challenges intensify, hiring timelines lengthen, and reliance on temporary staffing increases operational and financial pressures.
Healthcare leaders say the strain is unlikely to ease. In its 2024 report, The Complexities of Physician Supply and Demand, the Association of American Medical Colleges (AAMC) projected a national shortage of up to 86,000 physicians by 2036, including a deficit of approximately 10,000 to 20,000 surgeons.
For hospitals, the implications extend far beyond unfilled positions. Coverage gaps can delay patient care, disrupt procedural schedules, burden hospital staff, and reduce access to essential services. When hospitals lack critical specialists — trauma surgeons, orthopedic surgeons, urologists, or gastroenterologists — the impact creates significant financial instability, particularly for community hospitals that rely on those service lines to support broader operations.
The challenge is compounding as the physician workforce itself ages. Approximately 25.6 percent of all U.S. surgeons are 65 or older, and most wish to retire by 70, according to a recent article in the American College of Surgeons publication. Very few surgical disciplines have sufficient residents to replace this wave of retirees.
“The traditional model of independent surgeons covering hospitals between clinic days has stopped working for hospitals, physicians, and patients alike,” said Dan Siegel, CEO of Synergy Health Partners. “What hospitals are experiencing today is not a temporary disruption. It’s a structural change in how physicians want to practice and how care needs to be delivered.”
The gap between supply and demand is widening
According to 2024 data from the Association for Advancing Physician and Provider Recruitment, filling a surgical vacancy takes an average of 18 months, while hospitals lose an estimated $200,000 per month during the search. Even after a hire is secured, hospitals may wait additional months before physicians are fully operational, losing substantial downstream revenue tied to admissions, imaging, and surgical procedures throughout.
“Coverage alone is not the same thing as stability,” said Nickolas Dirkes, CEO of Frances Mahon Deaconess Hospital in Glasgow, Mont. “You can fill a schedule temporarily and still struggle with consistency, communication, and operational alignment. Those things matter tremendously in specialty care.”
The result is a cycle many hospitals find difficult to escape: vacancies create instability, instability increases reliance on temporary staffing, and temporary staffing often fails to address the underlying causes of turnover and workforce dissatisfaction.
“Our responsibility as a community hospital is to ensure patients can access the specialty care they need, when and where they need it,” said James Suver, CEO and President of Ridgecrest Regional Hospital. “The traditional coverage structure was becoming increasingly difficult to sustain. Moving to an embedded fractional physician team helped stabilize our surgical program almost immediately and created a more consistent, reliable approach to caring for our community.”
Healthcare has adapted to workforce disruption before
Many in the industry see parallels between today’s specialty staffing challenges and the rise of the hospitalist model more than two decades ago. As fewer primary care physicians continued seeing patients in hospitals, dedicated inpatient physicians emerged to provide more consistent hospital-based care. Over time, the model became widely adopted because it created greater continuity for hospitals, more predictable schedules for physicians, and more reliable access to care for patients.
Some believe hospital-based procedural and specialty care may now be entering a similar transition.
Like hospitalists before them, surgicalists focus on hospital-based procedural and specialty coverage, including orthopedic surgery, general surgery, trauma, anesthesia, gastroenterology, and urology. Fractional specialty teams allow hospitals to maintain more consistent specialty coverage across multiple service lines without assuming the cost of full-time hires. Physicians work within structured schedules and dedicated team environments, enabling hospitals to predict staffing needs, maintain operational consistency, and manage costs over time.
“The most powerful argument for the surgicalist model is the hospitalist precedent,” Siegel said. “Healthcare has already demonstrated that when you align physician sustainability with operational consistency, the model becomes better for hospitals, better for physicians, and ultimately better for patients.”
Physician-first thinking benefits all
“Physicians want to care for patients and practice at the top of their skill set,” Richard Makowiec, MD, Chief Medical Officer for Synergy Health Partners, said. “When we have the support, predictability, and team structure to focus on our craft, everybody benefits. Hospitals gain stability, patients experience better care, and we, as physicians, are more likely to build sustainable, fulfilling careers.”
More hospitals are beginning to view physician sustainability as an operational advantage rather than simply a workforce concern. Predictable schedules and embedded specialty care teams can improve retention, reduce burnout, and create more consistent hospital operations, improving operating room utilization, reducing delays and cancellations, and strengthening coordination throughout perioperative workflows.
Siegel said many physicians are also drawn to the opportunity to bring advanced specialty expertise into rural, suburban, and underserved communities that might otherwise struggle to maintain access to those services. In turn, hospitals may be better positioned to control costs, reduce reliance on temporary staffing, and protect critical service lines within the communities they serve.
Synergy Health Partners’ physician-centered coverage approach has contributed to more than $1.4 billion in retained hospital partner revenue since the company’s founding, helping organizations maintain stability across critical surgical and specialty service lines.
Supporters of the fractional model say the figure reflects a broader shift across healthcare, as hospitals increasingly prioritize long-term operational consistency over temporary staffing fixes.
For many healthcare leaders, the answer may begin with rethinking hospital staffing from the physician’s perspective.