Why Traditional Staffing Approaches No Longer Work

A Modern Strategy to Strengthen Surgical Access, Improve OR Utilization, and Support Sustainable Workforce Models

Authored and reviewed by the DIN team, January 2026

Introduction

Health systems across the country are struggling to staff surgical services effectively using traditional hiring or locum tenens models. Demand for surgical care is rising as the U.S. population grows older, yet the supply and distribution of surgeons have failed to keep pace (HRSA, 2018). By the 2030s, workforce projections warn of significant surgeon shortfalls nationwide, which will worsen delays in care and strain operating rooms. These challenges are especially acute in rural and smaller community hospitals where conventional full-time recruitment or transient locum coverage often falls short. This paper examines why the status quo is breaking down. It highlights gaps in where surgeons live, underused OR capacity, clinician burnout, and continuity challenges, and explains why new solutions like fractional staffing networks are emerging to fill the void.

Geographic Gaps and Rural Surgical Need

America faces a persistent geographic imbalance in where surgeons practice. About 20 percent of Americans live in rural areas, but only about 9 to 10 percent of physicians practice there (HRSA, 2018). Highly specialized surgeons are even more concentrated in cities, leaving many rural communities with little or no access to surgical services. A federal analysis found that rural areas in 2017 had only 69 percent of the general surgeons needed to meet demand, while large metropolitan areas had more surgeons than needed for their populations (HRSA, 2018).

Rural patients often have higher surgical needs and must travel farther for care. Rural populations tend to be older and have a greater burden of chronic disease. Workforce modeling by HHS indicates that demand for general surgical services is about 13 percent higher per capita in rural regions because rural surgeons must manage cases that specialists would normally cover (HRSA, 2023). Long travel distances increase delays and reduce the likelihood that rural patients receive timely elective surgery (HRSA, 2018; HRSA, 2023).

Many rural hospitals have fully equipped operating rooms that sit unused simply because they cannot recruit or retain a surgeon. Traditional recruitment is slow and often unsuccessful in attracting younger surgeons who prefer metropolitan practice. Without a new approach, these access gaps will continue to widen.

Underused Operating Rooms and Lost Capacity

Even hospitals that have operating rooms and patients in need often fail to make full use of their surgical capacity. A major challenge is the inability to backfill open OR time when cases are canceled or when a surgeon’s schedule has gaps. Operating rooms are expensive to run, generating up to 50 to 60 percent of hospital revenue and costing 15 to 50 dollars per minute to operate (Abate et al., 2020).

A systematic review found that 18 percent of scheduled surgeries are canceled on the day of surgery (Abate et al., 2020). These lost time slots represent reduced access for patients, lower throughput, and wasted resources. For smaller facilities that rely on a single surgeon or occasional visiting specialists, just a few cancellations can result in half a day of unused OR time.

Improving OR utilization requires flexible staffing models that can help hospitals keep OR time “collectable,” meaning another case can be added when one falls through. Some hospitals have achieved this through better scheduling and backfilling, but traditional models rarely provide the adaptability needed. If a single full-time surgeon is unavailable or a locum is not scheduled that day, OR time is lost despite community demand.

Surgeon Burnout from Rigid Schedules

Traditional staffing models also take a toll on surgeons. Full-time employed surgeons often work under rigid schedules, high volumes, and have limited control over their time. Over months and years, this lack of autonomy contributes to burnout. A large multi-center study found that poor control over one’s clinical schedule and workload was strongly linked to higher burnout (Sinsky et al., 2025).

Burnout among surgeons is widespread, with more than 40 percent reporting emotional exhaustion. Contributing factors include long hours, frequent call, administrative tasks, and reduced flexibility in modern practice (Sinsky et al., 2025). Many full-time surgeons are locked into fixed OR days with little opportunity for adjustment. In underserved settings, surgeons may feel pressure to take on extra duties, raising burnout risk even more.

Burnout directly affects hospital operations. Surgeons experiencing burnout are more likely to reduce their hours, switch jobs, or leave the field altogether (Sinsky et al., 2025). Locum tenens work can offer some flexibility, but often removes continuity and team connection. Fractional or rotating staffing models can help by giving surgeons more control while still supporting hospital needs.

Fragmented Care and Challenges with Locum Tenens

Many hospitals use locum tenens providers to fill staffing gaps, but this approach brings real tradeoffs. A key challenge is lack of continuity. Locum surgeons usually rotate in briefly and then depart, meaning they are not present for follow-up visits or postoperative complications. This disrupts continuity of care and can negatively affect outcomes.

Research shows that emergency surgical patients who are readmitted and treated by a different surgeon experience higher mortality and longer delays in care (Villatoro-Bonilla et al., 2025). Important details can be missed when care is handed off between temporary providers.

Locum physicians may also be less familiar with local workflows and protocols. A review in Missouri Medicine found that temporary physicians unfamiliar with a facility’s environment may face higher risks of errors or patient safety issues (Jotte et al., 2023). UK regulators similarly report higher complaint rates involving temporary doctors.

Locum coverage is useful for filling immediate gaps, but it does not create long-term relationships with staff or patients. Hospitals are increasingly looking for alternatives that provide greater consistency and reliability.

The Value of Team Familiarity in the OR

Surgery is a team effort, and growing evidence shows that teams who work together frequently achieve better results. Traditional staffing approaches rarely build this consistency.

A study of 8,500 cases found that when a surgeon and assistant performed more cases together, patients had fewer complications and fewer reoperations (Stelzl et al., 2025). Familiar teams also demonstrated smoother communication and shorter operative times. When OR teams know one another well, they can anticipate needs, reduce errors, and work more efficiently.

Doctors In Network’s staffing model supports this by bringing the same surgeons back to the same hospitals consistently. This builds trust, shared routines, and a stronger sense of teamwork. The resulting improvements in quality and efficiency benefit both patients and staff.

Gaps in Postoperative Follow-Up

Traditional staffing models often leave gaps in postoperative follow-up, an essential part of recovery. Full-time surgeons may be overloaded with new cases and have limited time for follow-up. Locum surgeons typically are not available once the operation is complete.

Research shows that inadequate postoperative follow-up leads to higher readmissions and poorer recovery (Villatoro-Bonilla et al., 2025). Strong discharge planning and early postoperative contact, ideally with the surgeon or a consistent team, significantly reduce 30-day readmissions. When follow-up is inconsistent or handed off without planning, preventable complications can escalate unnecessarily.

Recognizing this, some systems now integrate early follow-up into the surgical workflow. Telehealth visits or early check-ins help ensure that surgery is treated as a complete episode of care rather than an isolated procedure.

Conclusion
Traditional staffing approaches cannot keep up with today’s surgical workforce challenges. Full-time staffing often fails to attract surgeons to rural communities, leads to underused OR capacity, and contributes to burnout. Locum arrangements can fragment care and weaken continuity.

Doctors In Network (DIN) offers an updated approach through fractional staffing, allowing surgeons to serve multiple sites in coordinated rotations. Hospitals benefit by bringing specialists to communities that lack them, improving OR utilization, supporting surgeon autonomy, and creating stronger, more familiar OR teams. These advantages position DIN as an effective partner for hospitals seeking to expand access, increase productivity, and deliver consistent, high-quality surgical care.

Works Cited

• HRSA (2018). Report to the Senate Committee on Appropriations on the Nation’s General Surgery Workforce. Health Resources & Services Administration, U.S. Dept. of Health and Human Services.

• HRSA (2023). Technical Documentation for Health Workforce Simulation Model – Physician Specialties. Bureau of Health Workforce, U.S. DHHS.

• Abate et al. (2020). Global prevalence and reasons for case cancellation on the intended day of surgery: a systematic review and meta-analysis. Int J Surg Open, 26:55-63.

• Sinsky et al. (2025). Association of Work Control with Burnout and Career Intentions Among US Physicians. Ann Intern Med, 178(1):20-28.

• Jotte et al. (2023). Locum Tenens: An Evolving Paradigm of Care. Mo Med, 120(5):333-337.

• Stelzl et al. (2025). The influence of familiarity between the surgeon and their assistant on patient outcomes: a prospective observational study. Int J Surg, 111(3):2525-2534.

• Villatoro-Bonilla et al. (2025). The Impact of Surgical Continuity of Care on Postoperative Outcomes and Hospital Readmissions: A Review. Cureus, 17(8):e90207.