Locums Digest #141 | All Star Names New CEO, Locum Tenens and Delayed Hiring, Surgeon Access Gaps & More

Editor’s Note

Across the US, many rural communities don’t have enough doctors. New research on surgeon supply makes the problem clear. Nearly 10 million people live in counties with no identified surgeon in any of 12 surgical specialties. This issue extends beyond surgery, with specialties including ophthalmology and family medicine set to be hit especially hard by physician shortages.

The effects reach beyond patient care. Open positions can cost facilities money, and more than 40% of rural hospitals already operate at a financial loss. Recruiting is shifting too, with one national staffing firm reporting that far more of its searches are now in smaller communities. At the same time, more physician searches are staying open, and new hires often start many months after a job is posted.

As access to care comes under pressure in rural areas, staffing firms are preparing for what comes next. This edition of Locums Digest also covers leadership changes that reflect an evolving industry. Together, these stories show the challenges agencies and their clients face as they plan around ongoing staffing shortages, and where early planning can help.

– The Locumpedia Editorial Team

Lead Story

15 Million Americans Live in a County With No General Surgeon

September 28, 2026 | American College of Surgeons

About 15.1 million Americans live in a county with no general surgeon. That’s 1,180 of the nation’s 3,144 counties, or 38%. Meanwhile, 951 have no identified surgeon across any of 12 surgical specialties studied. About 9.6 million people live in those counties.

Every one of the 306 hospital referral regions has at least one general surgeon. But those regions are big, so a surgeon somewhere in one doesn’t mean care is nearby. Supply across the 12 specialties varies greatly, from 20.8 per 100,000 people in Harlingen, Texas, to 250.4 per 100,000 in Rochester, Minnesota. In counties with no identified full-time surgeon, there are 475 hospitals and surgical facilities. Of those, 434 are critical access hospitals.

The data has limits. It doesn’t measure travel time, surgical volume, or where surgeons hold privileges. A pending federal bill, H.R. 7198, would have HRSA develop a way to identify general surgery shortage areas. Locum tenens staffing agencies that place general surgeons can use this county-level data to identify areas where additional coverage may be needed.

La Vida Locum

The True Cost of Delayed Provider Hiring

October 13, 2026 | ConnectHealth

An open clinical role can cost more than it first appears. It can lead to fewer billable visits, procedures, and patients staying with the system. Specialty vacancies can be even more expensive when the provider drives procedures, imaging, or follow-up care. Slower access also means fewer new patients and more no-shows and same-day cancellations.

Repeated scheduling delays can also cause facilities to lose referrals as clinicians send patients elsewhere. Locum tenens can help maintain patient access while permanent positions remain unfilled. The article also emphasizes the importance of streamlining the hiring process to shorten vacancies and limit their financial consequences.

Credentialing 101: How Provider Credentialing Works at a Healthcare Facility (Plus Expert Tips)

September 30, 2026 | CompHealth

Credentialing is one of the most important parts of healthcare staffing. At its core, it’s checking a provider’s identity, education, training, licenses, certifications, and work history. The facility confirms each item by going to the source. The process can take anywhere from several weeks to several months. Missing information is a leading cause of delays, so agencies that send complete files remove a common problem.

Two related processes are privileging and payer enrollment. Privileging confirms a provider can perform specific procedures at a facility, and payer enrollment allows billing through insurance plans, Medicare, and Medicaid. Finishing one step doesn’t make a physician ready to practice. Background checks use national data banks to surface sanctions some clinicians don’t disclose. Staffing firms that keep credential records current give healthcare organizations less to chase before a start date.

Locum Leaders

• All Star Healthcare Solutions named Kelly Rakowski chief executive officer, effective October 26, after she most recently led AHSG.
• VeloSource received a strategic investment from UPMC Enterprises, which will hold a board seat, and UPMC vice president Richard Wadas, MD, will become its chief medical officer.

Hire Power

Physician Recruiting Shifts to Smaller Communities: 8 Things to Know

October 8, 2026 | Becker’s Physician Leadership

Only 10% of 1,293 permanent physician and advanced practitioner searches handled by one national staffing firm were in communities of 100,000 or more, compared with 70% a year earlier. About two-thirds were in communities of 25,001 to 100,000, up from 20%. Another 22% were in areas of 25,000 or fewer, up from 10%. The searches ran from April 2025 through March 2026 and cover one firm’s client work, not the whole market.

Hospitals and academic medical centers made up about two-thirds of searches, and family medicine and anesthesiology led physician demand. Nurse practitioner searches fell to 209 from 426 two years earlier, while CRNA searches dropped to 23, partly because more CRNAs are moving into locum tenens practice. Staffing leaders should expect demand to keep shifting toward smaller communities and check that their APP and CRNA pipelines still match what clients are asking for.

Physician Hiring Challenges Persist as Recruitment Budgets Decline, AAPPR Report Finds

September 16, 2026 | AAPPR

The Association for Advancing Physician and Provider Recruitment’s new benchmarking survey of more than 10,000 searches tracks how long in-house recruiting teams take to fill roles. Physician searches took a median of 119 days to fill, and the typical doctor started work 229 days after the job was posted. Half of physician searches were still open at the end of 2025, up from 49% in 2024 and 47% in 2023.

Urology was just 28% filled by the end of 2025, and neurology and cardiology were each about one-third filled. These figures come from in-house recruiters, so they show the conditions clients are working in. Locum staffing firms can use the long gap between posting and start date to talk with clients about interim coverage.

Making the Rounds

AMA Offers Resources as Major Provisions of H.R. 1 Take Effect

October 8, 2026 | AMA

Changes to Medicaid and other federal health coverage programs under H.R. 1, also known as the One Big Beautiful Bill Act, could affect how patients maintain coverage and access care. Limits on noncitizen eligibility for Medicaid and CHIP, Medicare, and the Health Insurance Marketplace began October 1. Medicaid work and community engagement requirements begin taking effect January 1, 2027.

A September 10 amicus brief backed 25 states seeking summary judgment against parts of a CMS interim final rule on work requirements. CMS guidance also calls for states to recheck some Medicaid beneficiaries’ eligibility every six months instead of yearly. Staffing agencies serving safety-net facilities should be aware that changes in patient coverage could affect clients’ finances and staffing needs.

AHA Report Warns Access to Care Is Increasingly at Risk in Rural Communities

October 13, 2026 | AHA

More than 46 million Americans rely on rural hospitals, but over 40% of them operate at a financial loss. More than 150 have closed or converted since 2010. Core challenges include low patient volumes, geographic isolation, and inadequate reimbursement. Medicaid cuts, the end of enhanced premium tax credits, and growing Medicare Advantage pressure add to the strain.

Seven policy priorities are on the table to potentially reduce harm. Options include sending Rural Health Transformation Program funds to rural hospitals, keeping telehealth access, and investing in the rural workforce. Locum staffing companies placing clinicians in rural facilities may want to track the effects of the bill and remedial policies as they move forward.