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Facility Recources

What Hospitals Get Wrong When Using Multiple Healthcare Staffing Agencies

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Published on

February 23, 2026

TL;DR

Hospitals that work with too many healthcare staffing agencies simultaneously face four compounding problems: duplicated candidates, inconsistent communication, unreliable pricing benchmarks, and uneven clinician quality. These inefficiencies slow fill times and increase administrative overhead without meaningfully expanding the candidate pool. The primary staffing partner model, designating one agency as lead partner with full accountability and communication ownership, consistently outperforms fragmented vendor approaches on cost efficiency, fill quality, and clinical continuity. For mid-size hospitals with up to 150 beds, a trusted primary partner relationship is both operationally simpler and strategically stronger than managing a large, competing vendor roster.

What Hospitals Get Wrong When Using Multiple Healthcare Staffing Agencies

Most mid-size hospitals working with healthcare staffing agencies follow the same logic: the more vendors on the approved list, the faster an open shift will get covered. On paper, it sounds like risk mitigation. In practice, it often creates an entirely different set of operational problems that cost time, money, and clinical continuity. According to the U.S. Bureau of Labor Statistics, demand for physicians and advanced practice providers is projected to grow significantly over the next decade, which means competition for qualified clinicians will only intensify. The hospitals that learn to work smarter with their staffing partners, not just add more of them, will be the ones that maintain the quality and consistency their patients rely on.

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The Case for Diversification and Why It Breaks Down

Vendor diversification in healthcare staffing started as a practical response to shortages. If one agency could not fill a role in time, another one might. The strategy made sense when the locum and temporary staffing markets were smaller and more predictable. But the market has changed. With a projected shortage of over 60,000 physicians in the United States within the next several years, every staffing agency is fishing in the same limited pool. Spreading open roles across eight or ten vendors does not multiply the pipeline, it fragments it.

The result is a series of operational problems that compound each other. Below are the four most common failure points hospital administrators encounter when managing too many staffing relationships at once.

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1. Duplicate Candidate Submissions

When multiple agencies work the same open role, they frequently surface the same candidates. The same physician or advanced practice provider may appear in your inbox from three different firms within 48 hours. Each submission arrives formatted differently, sourced from different recruiters, sometimes at different proposed rates. Your team now spends hours sorting, cross-referencing, and managing confusion, work that was never budgeted for and adds nothing to the actual outcome of filling the role.

This is not a coincidence. The locum tenens and APP staffing markets are not infinitely large, and the most in-demand clinicians are known to multiple agencies simultaneously. The more vendors you engage for a single role, the higher the probability that your team is managing duplicate submissions rather than a genuinely expanded pool.

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2. Inconsistent Communication and Follow-Through

Managing five or more active staffing relationships means managing five or more communication styles, update cadences, and points of contact. One agency calls weekly with updates. Another sends a batch email every two weeks. A third changes account managers without notice. Over time, your internal team starts spending a disproportionate amount of energy just keeping track of who said what and when, instead of making faster decisions about clinical coverage.

Inconsistency in follow-through is equally costly. When a role is not filled and there is no clear owner, it is easy for every vendor to point to someone else. Accountability becomes diffuse. The open shift remains open.

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3. Pricing Confusion and Rate Benchmarking Failures

When agencies know they are competing against a large vendor pool, pricing behavior changes. Some firms inflate their rates in the early stages, banking on the fact that you have no reliable benchmark. Others lower their rates to win the initial placement but recover the margin through fees you did not anticipate. According to SHRM, organizations that manage vendor relationships without a structured governance model report significantly higher per-placement costs compared to those with consolidated vendor programs. Without a consistent partner relationship, you lose the ability to negotiate, verify, or compare fairly.

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4. Clinician Quality Inconsistency

Different agencies maintain different standards for how they vet, screen, and present candidates. One firm may have a thorough internal process that evaluates clinical experience, culture fit, and communication style before presenting anyone. Another may operate on speed and volume, sending every available profile in their database. When you are managing multiple vendors, you have no way to enforce a consistent quality standard across them all, and your team ends up doing the vetting work that the agency was hired to do.

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How a Fragmented Staffing Model Affects Speed and Clinical Quality

Speed and quality are the two outcomes hospital administrators care most about when evaluating temporary staffing relationships. Fragmentation undermines both, and it does so in ways that are easy to overlook when your attention is divided across multiple vendor relationships.

On speed: when a role is posted with ten agencies simultaneously, no single agency treats it as a priority. Each one knows it is competing against nine others and that the probability of filling any individual role is low. This lowers the urgency and effort allocated to each open position. Paradoxically, having more vendors often increases fill time, because none of them have the accountability or incentive to prioritize your open role.

On quality: the fastest submission wins the assignment in most high-volume vendor environments. Agencies that know they are being evaluated primarily on speed will optimize for speed, not fit, not culture alignment, not the kind of patient care your facility expects. The result is higher turnover in temporary placements, more onboarding friction, and greater disruption to your care teams.

Harvard Business Review research on vendor consolidation strategy has documented similar dynamics across B2B supplier management broadly: organizations that consolidate vendor relationships consistently outperform those with fragmented pools on both cost efficiency and delivery quality. Healthcare staffing is no exception.

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Vendor Consolidation vs. Primary Partner Model: Understanding the Difference

Not all approaches to reducing vendor complexity are the same. Two of the most common frameworks are vendor consolidation and the primary partner model. Hospitals often confuse them, but the operational outcomes are meaningfully different.

Vendor consolidation typically means reducing the total number of approved agencies on your roster, from twelve to four, for example. The goal is to simplify the administrative burden. It helps, but it does not fully solve the accountability or quality consistency problem, because the same competitive dynamics still apply across multiple vendors.

The primary partner model goes further. It designates one agency as the lead relationship for a category of staffing need, for example, locum tenens and advanced practice provider coverage, while maintaining a secondary vendor as backup for overflow or niche specialties. The primary partner is given full visibility into your staffing patterns, culture, and coverage needs. In return, they take ownership of fill rates, communication standards, and candidate quality.

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Comparing Staffing Models: At a Glance
The table below outlines how three staffing model approaches compare across the operational dimensions that matter most to mid-size hospital administrators.

Challenge Area	10+ Agency Model	2–3 Agency Model	Primary Partner Model
Candidate duplication	Very high — same CVs from 5+ firms	Moderate	Minimal — coordinated pipeline
Response time	Slow — competing priorities	Varies by vendor	Fast — dedicated account focus
Rate consistency	Inconsistent, hard to benchmark	Some variation	Transparent, agreed upfront
Communication overhead	High — multiple contacts weekly	Manageable	Low — one point of contact
Clinician quality	Inconsistent vetting standards	Mixed	Uniform standards, culture fit focus
Accountability	Diffuse — easy for agencies to deflect	Partial	Clear — direct responsibility

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What a Primary Staffing Partner Relationship Actually Looks Like

A well-structured primary partner relationship does not mean exclusivity in all cases. It means that one agency has earned a deeper level of trust, integration, and accountability through consistent performance. At Frontera Search Partners, this looks like a dedicated point of contact who understands your facility's culture, your patient population, your care standards, and the specific types of clinicians who have worked well in your environment in the past. That context compounds over time, which is something a rotating pool of competing vendors can never provide.

For mid-size hospitals with 150 beds or fewer, this model is particularly well-suited. Smaller facilities do not have the administrative infrastructure to manage complex multi-vendor programs. They need staffing relationships that are easy to manage, responsive, and built on clear communication, not vendor portals, competing account managers, and inconsistent follow-through.

The characteristics of a productive primary partner relationship include:

A single point of contact who is accountable for both communication and outcomes
Transparent rate structures agreed upon upfront, without hidden fees or surprise adjustments during shortage periods
Proactive outreach where the agency brings you candidates before you have to ask, because they know your pipeline needs
Cultural alignment where the agency takes time to understand what type of clinician works well in your specific environment, not just what is available
Consistent quality standards applied uniformly across every candidate presented, regardless of how urgent the fill need is

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Steps to Transitioning Toward a Primary Partner Model

Transitioning away from a fragmented vendor pool does not have to happen overnight. The following steps allow you to move methodically without disrupting active coverage.

Audit your current vendor roster. Identify which agencies have produced quality placements that resulted in completed assignments, and which have delivered duplicated, low-fit candidates or poor follow-through.
Measure the true cost of your current model. Include administrative time, re-fills after early departure, onboarding disruption, and rate inconsistency. The full cost of a fragmented model is typically higher than the line-item agency fees suggest.
Select one or two primary partners based on demonstrated performance, communication quality, cultural alignment with your facility, and transparent pricing practices.
Establish a formal service agreement that outlines communication standards, fill time expectations, rate structures, and escalation processes.
Maintain a secondary vendor for overflow and specialty coverage, but ensure the primary partner relationship is clearly designated.
Review the relationship quarterly. A good primary partner will welcome performance reviews because they are confident in their results.

If you are evaluating what a primary partner relationship might look like for your facility's locum tenens or APP staffing needs, the Frontera team works exclusively with mid-size healthcare organizations and approaches every engagement as a long-term partnership rather than a transaction.

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What the Healthcare Staffing Market Tells Us About Consolidation

The structural case for consolidating staffing relationships is supported by how the locum tenens market itself is evolving. The shortage of clinical talent, particularly in advanced practice providers, nurse practitioners, physician assistants, and specialty APPs, is expected to intensify. Facilities that have built consistent, trusted relationships with staffing partners who specialize in this segment will be better positioned to maintain clinical coverage than those who rely on a fragmented, competitive vendor model.

Mid-size hospitals, which often lack the dedicated talent acquisition infrastructure of large health systems, are especially vulnerable to the inefficiencies described in this article. The Frontera healthcare blog covers workforce trends and staffing strategy relevant to smaller hospital environments, including insights on APP utilization as a response to the physician shortage.

The goal is not to reduce your options, it is to build relationships with partners who perform consistently, communicate clearly, and bring enough expertise to the table that you are not spending your own bandwidth managing the complexity that a fragmented vendor pool creates.

FAQ: Managing Healthcare Staffing Agency Relationships in Mid-Size Hospitals

How many staffing agencies should a mid-size hospital work with at one time?

There is no universal number, but most mid-size hospitals with 150 beds or fewer benefit from working with one to three staffing agencies at any given time, with one designated as the primary partner. Beyond three vendors for the same role category, hospitals typically see diminishing returns and increasing administrative overhead. The value of additional vendors is rarely additional candidates; it is usually additional complexity and duplicated submissions from the same overlapping clinician pool.

What is the difference between locum tenens staffing and contract-to-hire in healthcare?

Locum tenens staffing refers to short-term clinical coverage arrangements, typically ranging from a few weeks to several months. Clinicians are placed to fill gaps caused by turnover, leave, or facility growth. Contract-to-hire begins as a temporary arrangement but includes the option for a permanent offer if both parties are satisfied. Locum tenens is generally the preferred model for facilities that need coverage quickly and consistently, without the long recruitment timeline associated with other hiring approaches.

Why do hospitals often receive duplicate candidate submissions from multiple agencies?

The locum tenens and advanced practice provider markets are not unlimited. In high-demand specialties, the same clinicians are typically known to multiple staffing agencies. When a hospital posts the same role with several vendors simultaneously, it creates a race to submit, and because they are all pulling from an overlapping pool, the same candidates appear multiple times. Each duplicate submission creates administrative work for the hospital's internal team without adding new talent to the pipeline.

How should a hospital evaluate the true cost of working with multiple staffing vendors?

Total cost of a multi-vendor staffing program should include more than agency fees. Hospitals should account for: internal administrative time spent managing vendor communication; re-fill costs when a temporary placement ends early due to poor fit; onboarding and orientation time for clinicians who are unfamiliar with facility workflows; and the cost of coverage gaps that occur during re-fills. When all of these factors are included, the true cost of a fragmented vendor model is often significantly higher than the consolidated alternative.

What should a service agreement with a primary staffing partner include?

A clear service agreement with a primary staffing partner should outline defined fill time expectations by role type, rate structures and transparency on how rates are calculated, communication cadence and escalation protocols, quality standards for candidate vetting, and a framework for quarterly performance review. Agreements do not need to be exclusive, the hospital should retain the right to use secondary vendors, but the primary partner should have clear accountability for the roles they own.

6. How does the primary staffing partner model apply to advanced practice provider (APP) hiring?

APP staffing covering nurse practitioners, physician assistants, and similar roles, is one of the areas where the primary partner model delivers the most consistent value. APPs are increasingly being asked to take on expanded clinical responsibilities as health systems respond to physician shortages. The facilities best positioned to fill these roles quickly are those with a dedicated staffing partner who has built a strong network in this specialty segment, understands the clinical nuances of the role, and can present vetted, culturally appropriate candidates without the delays of a competitive multi-vendor process.