The urgent care sector grew faster than almost any other segment of ambulatory medicine over the past decade, and the staffing infrastructure never quite kept up. That gap — between the demand urgent care centers are absorbing and the supply of qualified providers available to staff them — has been widening for years. It is now, by most industry measures, a structural problem rather than a temporary labor market imbalance.
The Urgent Care Association reported that the number of urgent care centers in the United States surpassed 14,000 by 2022, roughly doubling from about 7,000 a decade earlier (Urgent Care Association, Industry White Paper, 2022). Clinician supply has not doubled alongside it. The Association of American Medical Colleges (AAMC) projects a national physician shortfall of between 37,800 and 124,000 physicians by 2034, with primary and emergency care specialties — the disciplines most relevant to urgent care — bearing a disproportionate share of that gap (The Complexities of Physician Supply and Demand: Projections from 2019 to 2034, AAMC, 2021).
For urgent care operators, these numbers are not abstract. They translate directly into unfilled shifts, rising per-diem costs, overstressed permanent staff, and degraded patient experience. The clinics that are navigating this environment successfully are not waiting for a recovery in physician supply that may not come during this decade. They are building staffing systems that work within the shortage — and the centerpiece of those systems is a strategic, proactive approach to locum tenens staffing.
Why the Shortage Is Getting Worse, Not Better
Understanding the direction of the trend matters before deciding how to respond to it.
Physician burnout is accelerating exits from the workforce. The American Medical Association's 2023 National Burnout Benchmarking report found that 48.2% of U.S. physicians reported experiencing burnout — up from 38.2% in 2020 (AMA, 2023 National Burnout Benchmarking, 2023). Urgent care is particularly exposed: the specialty combines the unpredictability of emergency medicine with the volume pressure of primary care, without the institutional support resources of a hospital setting. Burned-out clinicians are leaving full-time positions, reducing hours, or leaving clinical medicine entirely. The locum tenens model has emerged as one of the most effective responses to this dynamic, giving clinicians schedule control that full-time urgent care employment rarely offers.
The retirement wave is ongoing. The AAMC estimates that more than two in five currently active physicians are over the age of 55 (AAMC, Physician Workforce Reports, 2022). In a field where demand is growing and pipeline replenishment takes a decade from medical school entry to independent practice, retirement attrition at this scale cannot be offset by graduation rates alone.
Demand for urgent care services continues to expand. The pandemic accelerated consumer adoption of urgent care as a first point of contact for a widening range of conditions. Employer-directed occupational health programs have added volume. Behavioral health integration, telehealth hybrid models, and extended service menus have expanded what urgent care centers are being asked to do. More visits per day, more complex visits, longer documentation requirements — all of it without a corresponding increase in the number of qualified providers who want to work this specialty.
APP shortages are compounding the problem. Nurse practitioners and physician assistants have absorbed much of the urgent care staffing load, particularly for lower-acuity visits. But APP supply is not unlimited. The Bureau of Labor Statistics projects NP employment to grow 45% through 2032 — but that demand signal is pulling from every corner of healthcare, not just urgent care (BLS, Occupational Outlook Handbook: Nurse Practitioners, 2023). Urgent care operators competing for NPs and PAs are finding that flexibility — specifically the kind that locum arrangements offer — is now a primary factor in APP career decisions.
What the Shortage Looks Like in Operations
Provider shortages manifest in operational terms before they show up in financial reports. Clinics experiencing staffing pressure tend to show a characteristic pattern:
- Door-to-provider time trending upward across all shifts, not just peak hours — a reliable signal that coverage density is falling behind demand
- Shift completion rates declining — providers consistently finishing well after scheduled end time as volume absorbs the available staff
- Call-out rates spiking on high-demand shifts — Friday afternoons, weekend mornings, holiday weeks — as the permanent team struggles to sustain the pace
- Increasing per-visit cost as overtime, premium shift pay, and last-minute agency fees compound
- Growing permanent staff turnover as the workload that falls on remaining clinicians accelerates exit decisions
These patterns are self-reinforcing. When permanent staff leave or reduce hours in response to workload pressure, the remaining team absorbs more, which accelerates burnout, which drives more exits. Operators who do not interrupt this cycle early find that it becomes significantly more expensive to stabilize later.
What Smart Operators Are Doing Now
The clinics navigating the provider shortage most effectively are not all doing the same things. But they share a common orientation: they treat locum tenens staffing as a strategic resource to be managed deliberately, not a last-resort option to be triggered by a crisis.
Building a Dedicated Locum Network Before They Need It
The most common mistake in locum tenens utilization is waiting until a shift is unfilled to engage the market. By that point, the options are limited, the cost is high, and the quality filter necessarily narrows. Operators who are ahead of the shortage are building pre-credentialed locum relationships in advance — identifying providers who are familiar with the clinic's EMR, understand the patient population, and have demonstrated the competency profile the clinic needs.
This approach requires upfront investment in the relationship — working with a staffing platform to vet and credential locums before an urgent vacancy exists — but it pays operational dividends immediately. Building a reliable locum tenens talent pipeline for a health system or multi-site urgent care group is essentially the same exercise as pipeline development in any other operational discipline: you don't wait for demand to spike before you build supply.
The distinction between a clinic that can fill a vacancy in 24 hours and one that cannot is almost always a function of relationship infrastructure, not just market conditions. In a tight market, the operators with pre-established locum networks are filling shifts that operators without them cannot.
Using Locums to Protect Permanent Staff
One of the less-discussed but operationally significant uses of locum providers is coverage buffering — using locum shifts not to fill emergent vacancies, but to deliberately protect the permanent team from the volume and shift concentration that drives burnout.
If your permanent physicians are covering 100% of your Friday-Sunday shifts because those are the hardest to fill, you are burning through your most valuable human capital faster than the staffing budget acknowledges. Strategic insertion of locum providers on those high-demand slots — even when the permanent team is technically available — extends the career duration of your permanent clinicians and reduces the probability of the catastrophic departure events that disrupt operations for months.
The math on this is often more favorable than operators initially assume. The premium cost of a locum shift on a Friday afternoon may be less than the recruiting and onboarding cost of replacing a permanent physician who burns out and exits. The true cost of urgent care turnover is consistently underestimated because the direct recruiting cost is visible but the indirect operational costs — degraded throughput during vacancies, overtime, reduced patient satisfaction, and the load absorbed by remaining staff — are diffuse and hard to attribute.
Prioritizing Credentialing Speed
In a tight provider market, credentialing timelines directly affect competitive access to the best locum clinicians. Providers who are available to work can choose which facilities they accept assignments from. Facilities with fast, predictable credentialing processes — and clear communication about what is required and when — attract higher-quality candidates than facilities with opaque, slow, or inconsistent processes.
Smart operators are investing in credentialing infrastructure: standardized intake documentation, primary source verification workflows that don't require manual follow-up, and a clear commitment to timeline (industry best practice is five days or fewer for an expedited urgent care credentialing track). Facilities that cannot credential in under a week in the current environment are losing access to providers who have multiple options.
Expanding the APP-to-Physician Ratio Strategically
Operational response to physician shortages often includes increasing the proportion of APPs in the provider mix — but this only works if it is done with clinical supervision structure and scope-appropriate patient assignment. Clinics that add NP and PA coverage without clarifying how higher-acuity presentations will be escalated, or without ensuring physician backup availability during APP-only shifts, are creating quality and liability exposure that the staffing savings do not offset.
The effective approach is a calibrated model: APPs handle the majority of lower-to-moderate acuity volume (which is the bulk of urgent care presentations), with physician oversight structured for escalation and with physician-staffed shifts during the hours when the acuity distribution is highest. Locum physicians can fill the physician-presence requirement for expanded APP models without requiring a full-time physician hire for every additional location or shift extension.
Engaging a Platform That Matches on Fit, Not Just Availability
The traditional locum tenens agency model — post a need, receive a roster of available providers, negotiate rates — has significant limitations in a market where provider supply is constrained. When demand exceeds supply, availability becomes the dominant selection criterion, which means facilities may be accepting providers who are not well-matched to their specific patient population, service scope, or EMR environment.
AI-enabled staffing platforms change this dynamic by matching on fit dimensions beyond availability: clinical competency for your patient mix, EMR proficiency, prior experience in similar facility settings, and performance history from previous placements. For urgent care operators, this means faster time-to-effective-coverage — a provider who is matched well is productive on day one, while a provider who is simply available may require additional onboarding support that consumes staff time and generates quality risk during the ramp period.
The difference between a transactional locum fill and a high-fit locum placement compounds over time. An operator who consistently places well-matched locums builds a pool of providers who know the operation, require less onboarding, and are more likely to accept future assignments — effectively building the pre-credentialed network described above through the matching quality of each placement.
Quantifying the Locum Staffing Advantage
The business case for strategic locum utilization in a shortage environment is more favorable than it is sometimes presented. The comparison is not "locum cost per shift vs. permanent salary per shift." The comparison is "operational outcomes with a well-managed locum strategy vs. operational outcomes in a shortage without one."
When patient volumes cannot be served because of coverage gaps, the revenue impact is direct. When permanent staff burn out and leave because they are absorbing an unsustainable load, the recruiting and replacement cost is significant — industry estimates for physician replacement run $500,000 to $1 million when all direct and indirect costs are included (Merritt Hawkins, Survey of Physician Inpatient/Outpatient Revenue, 2022). When patient satisfaction scores decline because door-to-provider times are too long, the downstream effects on patient retention and reputation are real.
Against that backdrop, the premium on a locum shift is not a staffing line item to minimize. It is an investment in operational continuity, permanent staff retention, and clinical quality — each of which has measurable value that exceeds the per-shift differential.
Practical Starting Points
For operators who recognize the shortage dynamic in their own operations but are not yet using locum staffing strategically, the practical starting point is not complex:
Audit your current coverage stress. Which shifts consistently run over? Where is door-to-provider time trending? Which days generate the most call-out risk? Map the pattern before deciding how to address it.
Define the provider profile you actually need. Not a generic locum physician or APP — a provider with the specific competencies, acuity comfort, and schedule preferences that match your clinic's operational reality. The more precisely you can articulate this, the more effectively a staffing platform can match.
Start the credentialing conversation before you have an emergency. Credentialing takes time. Initiating the process for two or three pre-identified locum providers now means they are available when you need them, rather than unavailable because the credentialing clock starts on the day the need becomes urgent.
Evaluate your current agency relationships honestly. If your existing locum placements are not well-matched — if providers are not familiar with your EMR, are not comfortable with your patient mix, or are not available reliably — that is an argument for platform quality and matching rigor, not for avoiding locums. The solution to poor locum placement outcomes is better locum placement, not fewer locums.
The urgent care provider shortage is a long-cycle structural problem. It will not resolve this year, and probably not this decade. The operators who will perform best through it are the ones who build durable staffing infrastructure now — before they are in a crisis — and who use locum tenens not as a stopgap but as a core component of a flexible, resilient coverage model.
The shortage is getting worse. The right response is not to wait for it to get better.
Rediworks is an AI-enabled locum tenens staffing platform built for urgent care and ambulatory medicine. Our matching engine pairs facilities with pre-credentialed clinicians based on fit, not just availability — so you get providers who are productive on day one. Learn more about how Rediworks works.
References
- Association of American Medical Colleges (AAMC). The Complexities of Physician Supply and Demand: Projections from 2019 to 2034. 2021.
- Association of American Medical Colleges (AAMC). Physician Workforce Reports. 2022.
- American Medical Association (AMA). 2023 National Burnout Benchmarking. 2023.
- Bureau of Labor Statistics (BLS). Occupational Outlook Handbook: Nurse Practitioners, Midwives, and Physician Assistants. 2023.
- Merritt Hawkins. Survey of Physician Inpatient/Outpatient Revenue. 2022.
- Urgent Care Association. Industry White Paper: Urgent Care Center Benchmarking Report. 2022.