Just 10% of the physician and advanced practitioner search engagements AMN Healthcare conducted took place in communities of 100,000 or more, down from 70% a year earlier, according to a Sept. 16 white paper from the healthcare staffing firm.
The “2026 Review of Physician and Advanced Practitioner Recruiting Incentives” report includes data from a representative sample of the 1,293 permanent physician and advanced practitioner search engagements that AMN Healthcare’s Physician Solutions division had ongoing or conducted between April 1, 2025, and March 31, 2026. The figures reflect AMN’s own client work, not hiring across the whole market.
Here are eight things to know:
- Recruiting moved sharply toward small and midsize communities. About two-thirds of searches were in communities of 25,001 to 100,000, up from 20% year over year, and 22% were in communities of 25,000 or fewer, up from 10%. The report attributed the shift to efforts to address shortages in traditionally underserved rural areas and at midsize hospitals without the resources of larger health systems.
- Hospitals and academic medical centers accounted for about two-thirds of searches. Hospitals made up 38% of search engagements, academic medical centers made up 30% and medical groups accounted for 24%. Solo, partnership and concierge searches rose to 5% of engagements from 1% the year prior.
- Hospital financial pressure could affect recruiting, according to the report. AMN, citing the American Medical Association, wrote that the One Big Beautiful Bill Act’s Medicaid changes are projected to cause an estimated 11.8 million people to lose coverage. AMN wrote that financial pressures have led some hospitals to close or limit low-revenue service lines, which may affect recruiting activity. Nearly 150 rural hospitals have closed in the past 15 years, and roughly 700 more are at risk of closure, the report said.
- Academic medical centers are focused on clinical roles. AMN said their recruiting is largely for clinical faculty, as research funding becomes more uncertain and clinical work helps generate revenue. Some academic centers have imposed hiring freezes amid financial pressures that include cuts to National Institutes of Health grant budgets, according to the report. Academic physicians were offered an average starting salary of $362,000 across the specialties tracked, compared with $452,000 for non-academic physicians.
- AMN said private equity investment continues to drive consolidation and growth among medical groups, expanding their capacity to recruit across specialties. Private equity-backed groups are likely to keep recruiting as long as the investments pay off, the firm said.
- Nurse practitioners topped the list of most-requested searches for the sixth consecutive year. AMN conducted 209 nurse practitioner searches, down from 222 the prior year and 426 two years ago. Family medicine was the most requested physician search for the 20th consecutive year at 117, followed by anesthesiology (92), internal medicine (78) and radiology (76).
- Adjusted for supply, oncology and gastroenterology lead demand. When AMN ranked specialties by job openings as a percentage of active providers, which it calls absolute demand, the top 10 physician specialties were hematology/oncology, gastroenterology, interventional cardiology, endocrinology, noninvasive cardiology, radiology, urology, anesthesiology, neurology and obstetrics/gynecology.
- Certified registered nurse anesthetist searches keep falling. They dropped to 23 from 25 the prior year and from 86 in the 2021-22 review period, falling every year across the five-year table. AMN suggested the decline is partly the result of nurse anesthetists moving to locum and 1099 contract roles for higher pay and flexibility, which raises costs for organizations that want to employ them.
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