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Most healthcare leaders can agree that an open physician role is expensive. But far fewer can tell you what it costs per day, by specialty, with the math written out. That gap matters, because it tends to make the vacancy cost argument live as a vague worry rather than an actual line item. And a vague worry rarely wins a budget conversation.

This guide walks you through the math, step by step. By the end, you should be able to build a defensible per-day estimate for your own openings, the kind of number you can put in front of a CFO during your next budget conversation.

Why per-day calculations & why now

Vacancies are not getting shorter. According to the 2025 AAPPR Physician and Provider Recruitment Benchmarking Report, the median time to fill a physician role reached 118 days, with surgical and specialty searches running longer (oncology required a median of 332 days). On top of this, the report found that roughly half of all physician searches were still open at the end of 2024. Layer in another four to six months for licensing and credentialing, and a single opening can shadow your bottom line for the better part of a year.

The future outlook may make it worse. The Association of American Medical Colleges projects a shortage of up to 86,000 physicians by 2036. As the candidate pool keeps shrinking, vacancies will likely stretch even longer, and every one of those days carries a cost. Counting it per day turns an abstract worry into something you can actually plan around.

Layer one: direct revenue loss per day

Start with the most visible piece. When a physician is not seeing patients, that revenue does not show up. The estimate is straightforward once you gather three figures specific to the role.

• Average revenue per patient encounter for that specialty. An interventional cardiologist’s visit is worth far more than a primary care visit, so use the specialty, not a hospital-wide average.
• Average daily patient volume for the role. How many patients would this physician typically see in a normal day?
• Provider contribution margin. The revenue from those encounters minus the costs you only pay when the physician is actually working, like nursing support and medical supplies.

Now do the math: multiply what one visit brings in by how many visits happen in a day, then subtract those working costs. Put simply, that is the money walking out the door every day the chair sits empty. For a busy surgeon or proceduralist, this one number alone can be enough to make a CFO wince, which is exactly why procedural vacancies deserve your fastest attention.

Layer two: downstream revenue loss

Here is where most internal estimates stop short and badly understate the damage. A physician is rarely a standalone revenue source. They are the front door to a whole chain of billable activity downstream.

A surgeon who is not operating is not ordering the imaging, the labs, the anesthesia, the implants, and the inpatient days that surround a procedure. A specialist who is not in clinic is not generating the referrals that feed other service lines. An idle operating room does not just lose the surgeon’s fee; it loses everything that room would have set in motion.

To capture this layer, estimate the extra revenue each visit or procedure normally sets off downstream, then add it to your layer-one figure. This number is often bigger than the direct one, and skipping it is the top reason homegrown vacancy estimates come in too low to take seriously.

Layer three: the staff cost layer

The third layer is the sneaky one. It does not show up as lost revenue, but as rising expense and quiet attrition, both of which are easy to miss until they have already done their damage.

• Overtime and locum premiums. Covering an open role almost always means paying someone more, whether that is overtime for your existing staff or a premium rate for temporary coverage.
• Burnout risk. Colleagues absorbing the extra load get tired, disengaged, and eventually start looking elsewhere. One vacancy left open too long has a way of becoming two.
• Replacement cost if a permanent provider walks. If the strain pushes another physician out the door, you inherit a brand-new search, with all the recruitment expense, lost revenue, and ramp-up time that comes with it.

These costs can feel fuzzy, but here are some suggestions for how to put them in real numbers:

• For overtime and locum premiums, pull the actual hours logged to cover the opening and multiply by the gap between the premium rate and a regular one. That represents the monthly cost of leaving the role open.
• For burnout risk, watch the leading indicators on the covering team: overtime hours per person, PTO requests, and engagement or turnover-intent survey scores. A climbing trend line during a long vacancy is a warning, and you can attach a dollar figure by estimating the replacement cost of added departures.
• For replacement cost, look for market benchmarks. The American Medical Association estimates that replacing a physician often costs two to three times that physician’s annual salary once you fold in recruitment, sign-on bonuses, onboarding, and the lost billings that pile up while a replacement ramps to full productivity.

These costs may not pin neatly to a single day, but they are real, and they compound the longer the role stays open. Handle them honestly by flagging them as a multiplier at the end of your calculation.

Now bring it all together

Pull the three layers together and you have a back-of-the-envelope model that holds up under scrutiny:

• Daily direct cost = encounter value x daily volume x contribution margin.
• Daily downstream cost = estimated additional revenue per day tied to that role.
• Total daily vacancy cost = direct + downstream (you can also layer on a risk premium for vacancies that stretch past your specialty’s median time-to-fill).
• Long-term cost = Multiply daily cost by the number of days the role is open (you can use your own history, or the AAPPR medians when building an estimate).

The point is not to produce a single perfect figure. It is to replace “vacancies are expensive” with a defensible number that makes the case for moving faster, whether that means bridging with locum tenens coverage or investing more in the permanent search. A printed estimate showing a vacancy costs four or five figures per day tends to change a budget conversation in a way that a worried hunch never will.

The bottom line

An open physician role is not a neutral pause while you search. It is an active, compounding drain across three layers: the revenue the physician would have generated, the downstream activity that revenue would have triggered, and the rising staff costs of covering the gap. Counting only the first layer, which is what most internal estimates do, can understate the true cost by a wide margin. Build the full picture once, keep the model handy, and you will walk into your next budget conversation with the one thing that actually moves it: a real number.

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