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The Association for Advancing Physician and Provider Recruitment (AAPPR) is redefining recruitment to retention and is the only professional organization where physician and provider recruitment leaders and others who influence recruitment, onboarding and retention can connect, learn and advance their careers.
This month’s update highlights ongoing uncertainty around the $100,000 H-1B fee, which was struck down in court but remains temporarily in effect during appeal. It also covers potential changes to graduate loan caps, particularly for nursing programs, and new bipartisan legislation aimed at expanding physician placement in underserved areas. Additionally, Congress continues to support key workforce programs that strengthen healthcare access and provider training nationwide.
On June 8, a federal district court in Massachusetts vacated the federal policy implementing the $100,000 fee on certain new H-1B petitions, finding that the fee exceeded executive authority and was unlawful under the Administrative Procedure Act. The decision was a significant development for health care employers, physician and provider recruitment teams, and international medical graduates because the fee had created a major cost barrier for H-1B sponsorship in an already constrained workforce environment.
However, the practical effect of that ruling is now temporarily on hold. On June 12, the Massachusetts district court temporarily stayed its June 8 order while the First Circuit Court of Appeals considers the government’s expected request to keep the fee in place during the appeal.The government must file its stay request with the First Circuit by June 18 for the district court’s pause to remain in effect.
For now, USCIS may still require the $100,000 fee for approval of H-1B petitions that are filed. The next key milestone is the First Circuit’s decision on whether USCIS may continue collecting the fee while the government’s appeal proceeds.
AAPPR will continue to closely monitor this case and support efforts to permanently exempt health care professionals from the $100,000 H-1B fee so health care employers can recruit the physicians, IMGs, and other providers their communities need.
As you may know from last month’s update, the Education Department finalized a rule that caps most graduate borrowing at $20,500 annually and ends Grad PLUS in July. A recent House budget amendment could give advanced nursing programs a path back to higher federal borrowing limits by requiring the department to treat them as professional degree programs. If enacted, master’s- and doctoral-level nursing students could borrow up to $50,000 annually.
This would be a potential course correction for the nursing workforce, hospitals, and other organizations, but it is not final. The provision still must clear the House, Senate, and be signed into law, and it would not take effect until October 1 at the earliest. That means students and schools may still face several months of uncertainty, and financial aid offices could need to adjust midyear. Recruiters should stay engaged with nursing schools, especially in rural and underserved areas where workforce pipelines are already strained. AAPPR will continue tracking developments as the budget process moves forward.
AAPPR is supporting the bipartisan Physician Workforce Optimization Act, introduced by Sen. Kevin Cramer (R-ND) and Sen. Amy Klobuchar (D-MN), to strengthen the Conrad 30 J-1 Visa Waiver Program and help more communities access the physicians they need.
The bill would expand flex waivers from 10 to 15 per state and create a national secondary match portal to better connect J-1 physicians with states that have unused waiver slots. These updates would give states and healthcare organizations more flexibility to place physicians in rural and underserved communities where recruitment needs remain urgent.
For AAPPR members, this legislation is a practical step toward improving physician placement, supporting workforce planning, and strengthening access to care nationwide. AAPPR appreciates Sen. Cramer and Sen. Klobuchar’s bipartisan leadership and looks forward to continued work on policies that advance physician recruitment.
The House Appropriations Committee’s approval of the FY 2027 Labor, Health and Human Services, Education, and Related Agencies appropriations bill marks an important step in the annual federal funding process. Although the bill reduces overall HHS funding from last year’s enacted level, it continues to support key HRSA health workforce programs that help train clinicians and expand access to care. These include the Children’s Hospitals Graduate Medical Education (CHGME) program, the National Health Service Corps, and Title VII and Title VIII workforce programs.
At a high level, these programs help ensure that communities have access to the health professionals they need. CHGME supports the pediatric workforce by helping children’s hospitals train doctors and dentists. The National Health Service Corps helps bring primary care, dental, and behavioral health providers to communities with provider shortages. Together with Title VII and VIII programs, continued funding for these efforts would support the next generation of health professionals and help improve access to care nationwide, especially in rural and underserved areas.
Last Updated: June 10, 2026
On June 8th, the U.S. District Court for the District of Massachusetts vacated the $100,000 fee on new H-1B petitions, ruling it exceeded executive authority and violated the Administrative Procedure Act. This is a welcome but potentially temporary development. As appeal is expected and recruitment teams should stand by and consult with your immigration counsel before changing filing strategies.
In September 2025, a presidential proclamation imposed a $100,000 payment requirement on new H-1B visa petitions filed on or after September 21, 2025. The fee was a one-time charge at filing for those not currently in country, with potential for exceptions if deemed in the national interest, which the Administration never exercised. It did not apply to renewals, previously filed petitions, or current H-1B holders. You can read previous updates on the H-1B policy here.
International medical graduates (IMGs) make up about one in four U.S. physicians and disproportionately serve underserved communities. The American Hospital Association found that more than 70% of hospitals expected the fee to impact patient care, 64% planned to pause or limit H-1B recruitment, and 57% of affected positions were clinical roles. For many rural and safety net facilities, H-1B sponsorship is essential for maintaining access to primary care and specialty services.
U.S. District Judge Leo Sorokin sided with 20 states, finding the fee constituted a tax on H-1B petitions not directed by Congress. The court vacated the policy as exceeding executive authority and violating the APA.
While the ruling is a significant development, the policy landscape remains unsettled. The federal government is expected to appeal the Massachusetts decision, and other litigation over the $100,000 H-1B fee remains pending in different federal courts.
AAPPR continues to support the bipartisan H-1Bs for Physicians and the Healthcare Workforce Act, which would exempt health care professionals from the $100,000 fee. Legislative action remains essential to provide meaningful relief regardless of litigation outcomes. Recruitment teams should continue to monitor this space closely, preserve documentation of any pending applications or fees paid, and monitor DHS/USCIS for guidance and court developments.
Please reach out if you have any questions.
Explore five shifts shaping provider recruitment after Advancing Connections 2026, from smarter data and retention strategies to policy pressures, proactive sourcing and the role of AI in strengthening human connection.
Provider recruitment is no longer just about filling vacancies. Recruitment teams are being asked to play a larger role in solving workforce challenges that affect access, retention, operations and long-term organizational stability.
The work is becoming more strategic, data-driven and connected to business outcomes. During the 2026 Advancing Connections Conference, five key themes stood out and here’s how they’re shaping provider recruitment in the years to come.
Recruitment teams have more data than ever, but it’s often scattered across ATS platforms, CRMs, onboarding systems and other tools. The result is plenty of reporting, but not always enough actionable insight.
Executives need to know whether searches are on track, where candidates are dropping off, which roles are creating the greatest risk and what should be fixed first. Metrics like time-to-source, time-to-interview, time-to-fill, cost-per-hire, vacancy cost and offer acceptance rates become more valuable when they help leaders make decisions.
Retention can no longer be treated as separate from recruitment. Every departure creates a new search, and every unsupported provider experience adds pressure to an already strained pipeline. Staffing shortages, burnout, disengagement and competition for talent are long-term challenges, which means the require structural, organization-wide solutions.
Recruitment teams have an important role to play because they often hear early signals from candidates and providers about misaligned expectations, unclear onboarding, administrative burden or culture concerns. Hiring success does not end with a signed contract. Recruitment, onboarding, engagement and retention must work together to help providers stay. At the same time, many of these challenges are being shaped by forces outside the organization.
Provider recruitment is increasingly influenced by policy decisions outside the recruitment office. Policy decisions – from immigration and GME funding to licensure pathways and Medicare reimbursement – are increasingly shaping candidate supply, hiring timelines and workforce planning.
The provider pipeline remains constrained, even as interest in medical education grows. GME capacity, visa pathways, and changing state and federal policies can directly affect who is available to hire, where providers can practice and how quickly organizations can move. Recruiters do not need to become policy experts, but policy fluency is becoming part of the job.
In a competitive market, posting a role and waiting is not enough. For niche specialties, academic roles and leadership searches, recruitment teams need to move from passive awareness to proactive engagement.
That means identifying prospective clients earlier and building relationships before they are actively looking. Associations, professional communities, physician ambassadors and referral networks can all become powerful sourcing channels when supported by targeted messaging, consistent follow-up and long-term relationship-building.
AI and automation are changing recruitment, but they are not a cure-all. Technology can improve efficiency and reduce administrative burden, but it cannot replace the judgment, trust and relationship-building required in provider recruitment.
The most effective recruiters will use technology thoughtfully while continuing to prioritize the human side of recruitment. AI may help work move along, but it cannot replace the relationships that ultimately move searches forward.
The takeaways from Advancing Connections 2026 point to a broader evolution in provider recruitment. The profession is becoming more strategic, more connected to retention, more influenced by policy, more proactive in how talent is identified and engaged.
Provider recruitment is not only about filling vacancies. It is about helping healthcare organizations protect access, support clinicians and build more resilient workforces for the communities they serve.
Stay connected with AAPPR for year-round resources, peer learning, and updates on Advancing Connections 2027, taking place March 23–25 in Louisville, Kentucky. Through membership, you’ll gain the tools, insights and network needed to strengthen your recruitment strategy and stay ahead of what’s next. Interested in joining? Become a member today!
The 10 findings shaping physician & APP retention in 2026
Physician and advanced practice provider (APP) retention has become one of the defining workforce challenges in healthcare. As competition for clinical talent intensifies, the organizations that stabilize their workforce, ease recruitment pressure, and build sustainable staffing models will be the ones that treat retention as a deliberate strategy rather than a reaction to turnover.
To understand how organizations are actually approaching this work, AAPPR partnered with Industry Insights to field the Physician & Advanced Practice Provider Recruitment & Retention Strategy Survey. The resulting 2026 Physician & Advanced Practice Provider Retention Strategy Report draws on responses from 158 recruitment professionals and healthcare leaders, the overwhelming majority of whom work on internal, in-house recruitment teams.
The picture that emerges is more encouraging than you might expect. Most organizations aren’t starting from zero. They’re doing meaningful retention work already — they just haven’t formalized, aligned, or measured it yet.
Fewer than four in ten organizations (39%) report having a formal, documented retention strategy. But here’s the part that reframes the conversation: a nearly identical share are already engaged in active, retention-related work without a formal structure in place. Only 16% report having no strategy or retention activities at all.
In other words, the gap isn’t usually between organizations that care about retention and those that don’t. It’s between organizations that have named and structured their efforts and those doing the work informally. That distinction matters, because it changes what “progress” looks like. For most organizations, the path forward isn’t a complete overhaul — it’s documenting what already exists, clarifying who owns it, and beginning to measure outcomes.
One of the most useful frameworks in the report is the idea that organizations sit somewhere along a retention maturity spectrum, ranging from no strategy, to informal activity, to a formal documented strategy, to a fully optimized approach with governance and ROI tracking.
What’s striking is the distribution. Roughly 39% of organizations are actively doing retention work that hasn’t yet been formalized, and an equal share have reached the formal-strategy stage but still wrestle with execution gaps. Together, those two groups represent nearly 80% of respondents — meaning most organizations are neither at the starting line nor fully optimized. They’re in the productive middle, with a clear next step available to them.
Movement between stages doesn’t require starting over. It builds on what’s already in place.
If there’s a single theme that surfaces again and again, it’s ownership. Retention responsibility tends to be spread across recruitment, HR, clinical leadership, and executives. That broad involvement reflects how far-reaching retention is, but it can also blur accountability.
The data makes the cost of that ambiguity clear. Among organizations without a strategy, unclear ownership is the single most commonly cited barrier (51%). And even among organizations that do have a strategy, more than a third (36%) still point to unclear ownership as an implementation challenge.
The report also surfaces what it calls the “Recruitment Team Paradox.” Recruitment teams are often closest to the realities of turnover — they see the patterns firsthand and frequently support retention efforts — yet they tend to have limited influence over the broader strategy. Closing that gap, by connecting recruitment insight to retention strategy, is one of the most actionable opportunities the report identifies.
A particularly practical insight: organizations don’t all face the same obstacles at different intensities. They face different types of obstacles depending on their maturity.
Organizations that already have a strategy are mostly navigating execution constraints — competing priorities (61%) and limited budget (61%) top their list. They’ve made the decision to invest; the challenge is doing so effectively within existing resources. Organizations without a strategy face more foundational barriers — unclear ownership (51%) and lack of executive buy-in (48%). For them, the most effective first moves are establishing accountability and securing executive sponsorship.
Recognizing which set of challenges applies to your organization is what makes the next step the right step.
The report digs into the gap between what organizations include in their formal strategies and what they actually offer in practice — and the findings cut in both directions.
Some organizations are quietly doing more than their strategy reflects. Flexible scheduling, clinical autonomy, and mentorship programs all show up more often in practice than in documented strategy, suggesting many organizations are already investing in high-impact initiatives they haven’t formally captured. Others show the reverse: compensation and benefits, along with work-life balance, appear more often in formal strategies than they’re consistently delivered — a reminder that intention and execution can drift apart under resource and operational pressure.
Neither pattern is a failure. Both point to the same opportunity: align what’s being done with what’s being measured.
Work-life balance (92%) and compensation and benefits (82%) remain the foundation of most retention strategies. But the report highlights a set of high-impact tools that only about half of organizations currently use — career development pathways, clinical autonomy, mentorship programs, diversity and inclusion initiatives, and flexible scheduling.
Notably, larger organizations are more likely to lean on development, mentorship, and wellness programs, while smaller organizations rely more heavily on compensation. That points to a real opportunity for smaller organizations to diversify their approach with levers that don’t always carry the same financial weight. Compared to AAPPR’s 2022 study, the broader trend is clear: organizations are moving beyond compensation and bonuses toward a more intentional focus on long-term engagement and provider experience.
Most organizations track outcome metrics like employee satisfaction (81%) and turnover rates (78%). Valuable as those are, they’re lagging indicators — by the time they shift, the underlying issues are often well established.
Fewer organizations track the operational and financial diagnostics that offer earlier, more actionable insight. Days-to-fill (41%), cost-per-hire (22%), and internal promotion rates (8%) remain underutilized. The report makes a focused recommendation: pairing first-year retention, days-to-fill, and cost-per-hire helps connect retention efforts directly to recruitment performance and workforce efficiency — and helps demonstrate the financial value of retention investment.
For recruitment professionals especially, the report reframes retention as a recruitment strategy. Recruitment and retention challenges tend to travel together, and each provider retained reduces recruitment demand, supports faster time-to-fill, and contributes to a more stable workforce. Left unaddressed, low retention can fuel a self-reinforcing cycle: more turnover drives more open roles, which drives recruitment costs up, which squeezes the budget available for the very retention efforts that would break the loop.
The good news is that the appetite to break that cycle is strong. Among organizations without a formal strategy, 74% are interested in developing one — including 42% who are very interested. What they most often need isn’t convincing; it’s capacity, executive sponsorship, dedicated resources, and leader training. The case for retention is largely already made. The work now is enabling organizations to act on it.
Whether your organization has no strategy, an informal one, a formal one, or a mature program, the report offers concrete, profile-based recommendations — along with a simple guide to the next step, the first metric to track, who should lead, and a realistic timeframe for each stage. The throughline is reassuring: progress doesn’t require waiting for a perfect, fully developed strategy. It starts with practical steps that build on what you already have.
The 2026 AAPPR Physician & Advanced Practice Provider Retention Strategy Report explores how healthcare organizations are developing, implementing, and evaluating retention strategies — and where the clearest opportunities lie. Includes detailed data breakdowns by organization size, a retention maturity model, and actionable recommendations for every stage.
Special thanks to our Signature Partner CHG Healthcare for sponsoring this research.
Several health workforce pipeline issues are actively moving in both Congress and the Administration, even as Congressional Republicans focus on a reconciliation package addressing immigration and FY27 appropriations negotiations remain underway. With roughly six weeks of legislative session before the July 4th recess and a compressed calendar through November, the window to shape these measures and other issues requires sustained engagement.
Earlier this month, the Trump Administration quietly reversed policy permitting foreign doctors to receive visas to practice in the United States. A Department of Homeland Security policy stemming from a travel ban that was put in place in January had frozen decisions on visa extensions, work permits and green cards for citizens of 39 countries. Some physicians were subsequently placed on administrative leave by hospitals, and many others faced the imminent threat of being forced to stop working. Foreign physicians make up 25 percent of all doctors working in the United States, and more than 60 percent practice primary care.
While international medical graduates from the 39 affected countries should be able to move forward with visa processing, it may take a few weeks for the Administration to clear those backlogs. Please reach out if you are experiencing delays for impacted physicians or have any questions.
The Education Department issued a final rule last week that limits how much graduate students can borrow each year. Graduate nursing students will be capped at $20,500 annually, while medical students can access up to $50,000. The Grad PLUS program, which lets students borrow up to the full cost of attendance, ends in July.
Why this matters: Health systems are already facing shortages. Tighter borrowing limits may make it harder for future nurses, nurse practitioners, nurse anesthetists, and nurse midwives to pay for school, which could slow the pipeline, especially in rural and underserved areas. Recruiters should watch for enrollment shifts and consider whether scholarships, tuition support, or partnerships can help keep candidates on track. AAPPR will continue tracking the impact on the workforce in the months ahead.
Support is growing for the bipartisan H 1Bs for Physicians and the Healthcare Workforce Act (H.R. 7961), which would exempt physicians and other health professionals from the $100,000 H 1B filing fee. International medical graduates are often the backbone of care in rural and underserved communities, filling primary care and specialty gaps where recruitment is hardest. Slapping a $100,000 H 1B filing fee onto each new hire would strain hospital and practice budgets, leading to fewer hires, longer wait times, and deeper shortages for patients who already face limited access.
Reps. Mike Lawler (R NY), Sanford D. Bishop, Jr. (D GA), Maria Elvira Salazar (R FL), and Yvette Clarke (D NY) are leading the House effort, with a bipartisan Senate introduction expected soon.
Last week’s webinar gave a high-level walkthrough of the Big Beautiful Bill (BBB), its biggest Medicaid and care-delivery changes, key implementation timelines, and what healthcare recruiters need to know now. We covered how BBB will shape workforce needs and recruitment strategies over the next several years, with practical guidance to prepare organizations for these changes. You can view the webinar by clicking here.
Hear from AAPPR board members on why your experience matters and how participating in the compensation and search surveys helps create the benchmarking insight recruitment leaders need.
In physician and provider recruitment, leaders are being asked to make important decisions in an environment that continues to shift. Search timelines are changing, staffing needs remain high, compensation expectations are evolving and recruitment teams are being asked to show strategic value in ways that go beyond placements alone. That is why benchmarking data matters.
AAPPR’s Recruitment Team Compensation Survey and the Physician and Provider Search Survey help turn day-to-day recruitment experience into a clearer picture of what is happening across the field. The result is an annual Physician and Provider Recruitment Benchmarking Report to help leaders evaluate performance, compare trends and make more informed decisions about strategy, staffing and operations. But that insight is only as strong as the participation behind it.
The value of the report comes directly from the people who contribute to it – YOU! When recruitment leaders complete the surveys, they are not just reporting numbers – they are helping create the data leadership needs right now.
— Carol Sullivan, CPRP – AAPPR Board Member & Senior Director of Physician, Advanced Practice Provider, and Executive Physician Recruitment at Rochester Regional Health
Every organization that contributes helps create a more complete view of the physician and provider recruitment landscape. That matters because recruitment leaders need data that reflects real operational conditions, not assumptions.
When participation is strong, the benchmarking report becomes more meaningful for everyone. Leaders can better understand how their teams compare with peers, where market realities are shifting and what trends may be shaping recruitment performance across the country.
By contributing to the surveys, members help build a shared resource that strengthens decision-making across the profession.
— Allan Cacanindin CPRP, CDR – AAPPR Board President & Vice President of Physician, Advanced Practice Provider, and Executive Talent Acquisition at SSM Health
Participation does more than strengthen the report. It strengthens the quality of the decisions leaders can make with it.
Recruitment leaders are often asked to explain timelines, justify staffing models, evaluate sourcing strategies and advocate for team resources. Those conversations become more productive when they are grounded in credible, field-informed data. Benchmarking gives leaders the ability to move beyond isolated experience and see their work in the context of broader industry patterns.
That perspective helps organizations better understand what is realistic, what is competitive and where there may be opportunities to improve.
— Logan M. Ebbets, MS, CPRP – AAPPR Board Treasurer & Principal Recruiter at Signify Health
Metrics such as time-to-fill, recruiter productivity, candidate pipeline activity and recruiter capacity become far more useful when leaders can compare them against national benchmarks. That baseline helps organizations set more realistic expectations, especially for difficult searches and evolving market conditions.
It also helps leaders move conversations beyond anecdotal feedback and toward a clearer, more strategic understanding of performance.
— Fayeann Hauer, MHS, CPRP – AAPPR Board Member & Director of Physician and Provider Recruitment and Retention at Schneck Medical Center
Benchmarking data is not just useful for assessment. It is also essential for advocacy.
Recruitment leaders often need to make the case for staffing support, fair compensation and operational improvements that strengthen team performance. Objective benchmarking data helps validate those needs in a way that internal observations alone often cannot.
It also helps leaders identify areas where their teams may need additional support, whether that means adjusting workloads, refining processes or ensuring compensation aligns with the broader market.
— Doug Lewis, MS, CPRP – AAPPR Board Secretary & Vice President of Talent Acquisition at Sentara
When leaders have stronger data, they are better positioned to improve recruitment strategies, allocate resources more effectively and demonstrate the value of talent acquisition to executive leadership. Those improvements can strengthen recruitment infrastructure and help organizations remain competitive in attracting and retaining physician and provider talent.
In a field where strong recruitment directly affects workforce stability and patient access, that kind of clarity matters.
AAPPR’s benchmarking reports are valuable because they are built from the lived experience of physician and provider recruitment professionals. The more leaders who participate, the more useful, representative and actionable the data becomes.
If you have ever used data to explain a difficult search, advocate for more resources, assess compensation or evaluate team performance, you already understand why benchmarking matters. Participating in the Recruitment Team Compensation Survey and the Physician and Provider Search Survey is an opportunity to strengthen that resource for your organization and for the broader recruitment community.
Although the window to participate in the 2026 Recruitment Team Compensation Survey has closed, there is still time to participate in the 2026 Physician and Provider Recruitment Survey, closing May 19, 2026.
To learn more about the Benchmarking Report or view last year’s report, please visit our Benchmarking web page. Not a member, but want to be a part of this industry-changing report? Join now.
Congress is back in session after a two week recess with attention turning to a potential reconciliation bill to fund the Department of Homeland Security, and activity on the FY 2027 budget in full swing. As we celebrate Physician and Provider Recruitment Week, we want to take a moment to thank you for your hard work and dedication to upholding patient access.
AAPPR joined over 40 national medical associations and patient advocacy groups this month as cosigners of a coalition letter in support of H.R. 7961, the H-1Bs for Physicians and the Healthcare Workforce Act. The bipartisan legislation is in response to the Trump Administration’s September 2025 proclamation imposing a $100,000 fee on each new H-1B visa application, which is disproportionately harming the healthcare industry.
The H-1Bs for Physicians and the Healthcare Workforce Act would exempt physicians and other health professionals from the new $100,000 H-1B fee, ensuring employers can continue to fill critical access gaps. The legislation drew international attention, from the New York Times to the Times of India, highlighting the urgency around this issue. AAPPR thanks Reps. Mike Lawler (R-NY), Sanford D. Bishop, Jr. (D-GA), Maria Elvira Salazar (R-FL), and Yvette Clarke (D-NY) for their leadership on this issue.
New legislation impacting locum tenens was just introduced in the House. H.R. 8347, the “Reinforcing Underserved, Rural, and Local Healthcare Act” (the “RURAL Healthcare Act”), would create a clear federal rule that certain temporary locum tenens physicians and advanced care practitioners (meeting conditions including a written contract and a limit of no more than one continuous year at a single site) are treated as independent contractors, not employees, under federal pay-and-overtime laws and federal labor/union rules.
This proposal follows the “Health Care Provider Shortage Minimization Act” approach, which would amend the Internal Revenue Code to clarify that qualifying locum tenens physicians and advanced care practitioners are treated as independent contractors for federal tax purposes.
Taken together, the bills aim to provide clearer federal rules for when locum tenens clinicians can be treated as independent contractors.
AAPPR continues to partner with stakeholders across our federal priorities and will be sharing more resources on AAPPR’s website in the coming weeks. Be sure to take a look and let us know if you have any questions!
As the healthcare workforce landscape continues to evolve in 2026, in-house physician and provider recruitment professionals are carrying a larger load than ever. The demand for care remains high, yet the path to hiring and retaining clinicians has grown more complex. Last year brought new pressures from policy shifts, locums competition and compensation expectations, and it demanded more creativity and stamina from already stretched teams.
Candidates are in the driver’s seat and their expectations have shifted. Early-career physicians and advanced practice providers increasingly ask for four-day workweeks at full-time pay, part-time options and paid time off and candidates are willing to decline offers when their schedule preference can’t be accommodated.
More seasoned providers are putting greater emphasis on work-life balance and culture. Many are open to trading some compensation or additional shifts for more control over their schedules and more time away from clinical practice.
Across specialties, AAPPR members are seeing longer decision timelines, more extensive negotiations and more frequent use of attorneys to review contracts. Hard-to-recruit areas such as hospital medicine, women’s health, oncology, GI, urology, anesthesiology and radiology, remain under heavy pressure, particularly where locums rates far outpace compensation for permanent roles.
Policy and regulatory changes around loans, visas, graduate medical education and licensure continue to add complexity where these shifts could constrain the long-term pipeline, especially for candidates who rely on loans or immigration pathways.
With that in mind, success focuses less on filling every opening quickly and more on building a sustainable, resilient workforce strategy. That direction includes:
As recruitment challenges continue to evolve, organizations can shift from reactive hiring to more deliberate, long-term workforce planning. The strategies below highlight where focused effort can make the greatest impact.
Compensation models faced real pressure in 2025. Candidates often wanted larger up-front payments, longer guarantees and faster access to bonus funds. Some organizations attempted these changes and then reversed course after candidates withdrew or guarantees exceeded what volumes could support. The lesson is clear: recruitment leaders must explain total compensation, not just base salary or sign-on dollars, so candidates understand how guarantees, productivity, incentives and benefits fit together. It is important to set expectations about what happens after guarantees end, since short-term payouts can create long-term disappointment if productivity is not there.
With compensation becoming more competitive across markets, relationships are a key differentiator. Acceptance rates improve when leaders and potential colleagues engage early, when communication is timely and candid, and when candidates can picture daily life in the role. Inside organizations, sharing each signed contract with leaders can demonstrate recruitment’s strategic value and reinforce team morale.
The complexity of the current market makes internal alignment more important than ever. It costs time and revenue when recruiters juggle inconsistent and varied processes across the enterprise, when decisions are made without their input or when handoffs across teams are unclear. Bringing recruitment leaders into higher-level discussions can ensure plans reflect real market conditions, and consistent processes can reduce confusion for candidates and internal partners.
Teams that track more than days-to-fill are better equipped to drive change. Metrics on decision timelines, decline reasons and negotiation trends help recruitment leaders make stronger cases for updated compensation structures or garnering support for process improvements. When paired with external benchmarks, this data gives organizations a clearer, more realistic view of what to target today.
As organizations navigate the year ahead, this is a good time to review your internal processes, reconnect with your peers and use AAPPR’s research and resources to guide next steps. Together, we can help strengthen the recruitment profession and build a more resilient workforce.
Every March, Match Week and Match Day shine a spotlight on the future of medicine. For medical students, it marks the culmination of years of hard work and the training years ahead. In 2025, the Match was the largest in the National Resident Matching Program’s history, with 43,237 positions offered. It was an important milestone, and one worth celebrating.
But for physician and provider recruitment leaders, Match Day should also prompt a bigger question: is the system creating enough training opportunities to meet workforce needs in the years ahead? Matching into residency is a major step, but it is only one step in the physician pipeline. If there are not enough residency positions, or if those positions are not located in the specialties and communities where need is greatest, shortages will continue to affect both recruitment efforts and access to care.
Graduate medical education (GME) is the bridge between medical school and independent practice. Federal policy plays a major role in determining how many residency slots are available, which means policy decisions directly shape how many physicians can move through the pipeline and into practice.
This has been a challenge for years. The Balanced Budget Act of 1997 capped the number of Medicare-funded residency positions, and although some additional slots have been added in recent years, growth has not kept pace with need. At the same time, medical school enrollment has grown by more than 35% since 2002. The result is a bottleneck at one of the most important stages of physician training.
This challenge is not only about the total number of physicians entering the workforce. It is also about where those physicians train and where they ultimately practice.
Primary care remains one of the clearest pressure points, with psychiatry and some surgical specialties also facing growing strain. Rural and underserved communities are especially affected, where shortages are often more severe and recruitment is already more difficult. These communities should be central to the story, not a side note.
Where physicians train matters, too. Residency location is often a strong predictor of where physicians ultimately practice. That means residency slot policy has a direct impact not only on the size of the workforce, but also on whether high-need communities gain access to care.
For physician and provider recruiters, this challenge is not abstract. It shows up in longer searches, more competition for the same candidates and persistent difficulty filling roles in high-need specialties and markets.
It also comes at a time when demand for care is rising and much of the current physician workforce is nearing retirement age. By 2036, the population age 65 and older is projected to grow by 34%, while 20% of today’s clinical physician workforce is already 65 or older and another 22% is between 55 and 64. In other words, recruitment teams are feeling the effects of both a constrained pipeline and an aging workforce at the same time.
That broader context matters. Recruitment leaders may not control federal policy, but they are often among the first to feel its impact.
AAPPR is paying close attention to this issue because GME policy has a direct effect on physician recruitment and access to care. AAPPR has supported federal efforts to expand residency training, including legislation designed to add Medicare-supported GME positions and strengthen rural residency programs.
This is also an area where members’ voices matter. Physician and provider recruiters bring an important perspective to the conversation because they see, every day, what happens when physician supply does not keep pace with patient need. Their experience helps connect policy decisions to the real-world challenges facing healthcare organizations and the communities they serve.
Match Day will always be an important milestone as it represents the promise of a new generation of physicians entering training, but it should also serve as a reminder that strengthening the physician workforce requires more than successful matches. It requires enough residency capacity, smart distribution of training opportunities and continued investment in the communities that need physicians most.
For AAPPR members, that makes GME policy more than a policy issue. It is a workforce issue, a recruitment issue and, ultimately, an access issue. AAPPR will continue following and advocating on the policy decisions that shape the physician pipeline and the future of physician and provider recruitment.
Last Updated: March 23, 2026
As we covered in the March Legislative Update, after several bipartisan letters from Congress regarding exempting health care workers from the $100,000 H-1B fee, AAPPR worked alongside national medical organizations, including the American Medical Association and American Hospital Association, to secure the bipartisan introduction of the H-1Bs for Physicians and the Healthcare Workforce Act.
We applaud Reps. Mike Lawler (R-NY), Sanford D. Bishop, Jr. (D-GA), Maria Elvira Salazar (R-FL), and Yvette Clarke (D-NY) for their leadership on this important bipartisan effort.
The legislation would exempt all physicians and other healthcare workers from the new $100,000 H-1B filing fee upon enactment. The legislation defines “healthcare worker” to include, but not be limited to, physicians, nurses, nurse practitioners, primary care providers, preventive medicine physicians, optometrists, ophthalmologists, physician assistants, pharmacists, dentists, dental hygienists, other oral healthcare professionals, and other allied health professionals.
Under the Presidential Proclamation, the Secretary of the Department of Homeland Security (DHS) has the authority to exempt certain individuals, or entire professions, when it is in the national interest. Unfortunately, no physicians or other healthcare workers have been granted exemptions to date.
By introducing this legislation, we are hopeful Congressional support will coalesce around this bill and demonstrate to the Administration that exempting healthcare workers is in the national interest and does not undermine the broader policy goals of the Administration. We are encouraging Members of Congress to cosponsor the legislation. Please reach out if you have any questions.
Outside of this legislative effort, we await an update in the Global Nurse Force litigation. During a hearing last month on a motion for preliminary injunction, the government argued that the new fee is not a tax, while the plaintiffs argued that Congress authorized immigration fees only to cover the costs of administering the programs. We expect an update in the next few weeks.
You can read our previous updates from October 28, 2025, December 22, 2025, and Janurary 6, 2026.
AAPPR is aware and closely following the hold on HHS Clinical Waivers and its impact on physician recruitment. The HHS Exchange Visitor Program allows foreign-trained physicians on J-1 visas to remain in the United States without returning to their home country for two years, provided they agree to serve in underserved areas. Since fall 2025, the Office of Global Affairs (OGA) at HHS, which is responsible for issuing the recommendation letters necessary to advance waiver applications, paused the process with hundreds of cases now in the backlog. HHS has reportedly stated that changes are being made to the criteria for the clinical waiver program, but no timing for those changes has been shared.
The consequences of this freeze are serious and far-reaching. The waiver process operates on a tight timeline and physicians generally must have their recommendations forwarded to the State Department by mid-March to complete the transition to H-1B status by the typical July 1 start date. It is not clear if physicians whose J-1 status expires before their waiver is processed will have to leave the country, further disrupting their path to employment.
Given the severity of this issue, we are engaging congressional offices to share our concerns with the Administration and urge immediate action to resume processing. If you are experiencing these delays or have any follow-up questions, please reach out and let us know.
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