Why market access beats agency size in today's healthcare staffing environment
For years, healthcare organizations have gravitated toward the largest locums staffing agencies. The reasoning was straightforward: larger firms had bigger recruiting teams, larger provider databases, more infrastructure, and broader geographic reach. If you needed urgent coverage, partnering with a national agency felt like the safest option.
At the time, that assumption was largely correct.
But healthcare staffing has changed dramatically, and many organizations are still making staffing decisions based on a market that no longer exists.
Today, the question is no longer:
"Who is the biggest?"
The better question is:
"How do I access the largest provider market possible?"
Those are not the same thing.
The Biggest Myth in Locums Staffing
One of the most common assumptions in healthcare staffing is that large agencies provide access to physicians that other firms simply can't reach.
In reality, locum tenens physicians are independent contractors, not employees. Most actively work with multiple staffing agencies at the same time.
A gastroenterologist working locums assignments may be represented by three agencies. An emergency medicine physician may be credentialed with five. A CRNA might regularly receive opportunities from a dozen recruiters across the industry.
They do this for a simple reason: it helps keep their schedules full and gives them access to more opportunities.
That means the physician on a large national agency's roster is often the exact same physician appearing on the rosters of several mid-sized or specialty-focused firms.
This is a critical distinction.
Declining to work with a particular agency does not remove access to that agency's providers. In many cases, those providers remain available through other recruiting partners.
The industry has become far more transparent than it was ten or fifteen years ago. Physicians can be reached through professional networks, referral relationships, specialty societies, conferences, online platforms, and modern recruiting technology available throughout the market.
The differentiator is no longer exclusive access.
It's execution.
Why Hospitals Consolidated with Large Agencies
Many organizations look back at their staffing strategy and wonder why so many health systems became heavily reliant on a handful of national firms.
The answer is simple.
It wasn't because smaller agencies couldn't deliver quality candidates.
It was because managing multiple staffing partners created tremendous administrative complexity.
Every vendor relationship requires:
- Contract management
- Credentialing oversight
- Rate negotiations
- Invoice reconciliation
- Performance monitoring
- Compliance verification
- Ongoing communication
Most internal teams can effectively manage only a limited number of vendor relationships before administration starts consuming valuable time and resources.
Faced with that reality, healthcare organizations did the rational thing.
They consolidated.
Working with two or three large agencies reduced operational burden while still providing reasonable access to the physician market.
The strategy made sense.
But it was solving a bandwidth problem, not a physician access problem.
The Infrastructure Gap Has Closed
Historically, large staffing firms held a meaningful advantage because they could invest in technology that smaller firms couldn't afford.
That advantage has largely disappeared.
Modern applicant tracking systems, credentialing platforms, CRM tools, digital sourcing technologies, and communication systems are now widely available across the industry.
The tools that were once exclusive to large national firms have become standard operating infrastructure.
As a result, many small and mid-sized agencies now identify, recruit, credential, and place physicians using processes that look remarkably similar to those of their larger competitors.
Technology has largely leveled the playing field.
Today, agency performance is far more dependent on recruiter effectiveness, provider relationships, and specialty expertise than on company size.
More Recruiters Doesn't Mean Better Results
Physicians are among the most heavily recruited professionals in the workforce.
Most are contacted constantly through phone calls, emails, text messages, LinkedIn outreach, and referrals.
At a certain point, additional recruiter volume stops creating additional value.
What actually drives placements is relationship quality.
Recruiters who deeply understand a specialty, know what motivates a provider, and have developed long-term trust often outperform significantly larger teams operating at higher volume.
This is where specialized and mid-sized firms frequently excel.
An agency focused on anesthesia, emergency medicine, behavioral health, or rural medicine often develops provider relationships and market expertise that are difficult to replicate through a generalized recruiting model.
The question isn't:
"How many recruiters does an agency have?"
The question is:
"Is the right recruiter working on my job?"
Why MSP Models Change the Equation
The emergence of MSP and VMS solutions fundamentally changes the staffing conversation.
Historically, healthcare organizations had to choose between:
- Managing many staffing agencies themselves, or
- Limiting access to a small number of vendors
MSP programs remove that trade-off.
Through a managed staffing program, healthcare organizations maintain:
- One contract
- One point of contact
- One invoicing process
- One credentialing standard
- One reporting structure
Behind that single relationship sits an entire network of qualified staffing partners.
Rather than relying on whichever agency happens to hold the contract, each requisition can be distributed across a broader supplier network, allowing agencies to compete based on their ability to deliver results.
The administrative effort remains the same.
The market access expands dramatically.
And that is the key distinction.
A network of agencies will almost always provide broader provider reach than any individual agency, regardless of how large that agency may be.
What About Large Agencies That Don't Participate?
Prospective clients often ask why some large agencies choose not to participate in MSP programs.
The answer is relatively straightforward.
MSP models introduce greater transparency and accountability through measurable performance indicators such as:
- Fill rate
- Submission quality
- Time-to-fill
- Provider retention
- Credentialing turnaround time
Some organizations prefer operating through direct-client relationships rather than competitive supplier environments. That's a perfectly reasonable business decision.
What matters for healthcare organizations, however, is understanding what that choice does and does not mean.
It does not mean physician access disappears.
The physicians themselves remain active participants in the broader locums marketplace and frequently maintain relationships with multiple staffing firms.
The objective is not access to a specific agency.
The objective is access to the best available physicians.
The Metric That Matters
Ultimately, none of these arguments matter if outcomes don't improve.
This is where organizations should focus on measurable results:
- Overall fill rates
- Time-to-fill performance
- Coverage of difficult specialties
- Rural and hard-to-fill assignment success
- Cost visibility and rate transparency
- Provider quality and retention
Lee Health provides a clear example of what measurable workforce performance can look like. Working with HWL, Lee Health gained greater visibility into contingent labor, access to market-rate intelligence, and streamlined processes for screening, onboarding, credentialing, timekeeping, invoicing and reporting. The result was a 96% fill rate across the health system, improved on-time start rates, and a 93% compliance rate. Lee Health also reduced bill rates back to pre-pandemic levels while increasing competition among staffing suppliers.
The lesson is that workforce management should be evaluated by what it actually delivers, not simply by the size of a staffing network or the number of vendors in a marketplace. Fill rates, speed, cost, visibility and quality are the metrics that demonstrate whether a workforce strategy is working.
The Better Question
Healthcare staffing has matured.
Technology is no longer a differentiator. Provider information is no longer scarce. Recruiting tools are widely available. Performance can be measured with greater accuracy than ever before.
As a result, healthcare leaders should stop asking:
"Which agency is the biggest?"
And start asking:
"Does my staffing model give me access to the broadest and most effective provider market possible?"
Because in today's locums environment, the size of an individual agency is rarely what determines whether a shift gets filled.
Access to the market does.
And no single agency can compete with the reach of an entire network.