Locum Tenens, Locums-to-Perm, RPO, or Direct Hire? How to Choose the Right Recruiting Model for Your Organization

Locum Tenens, Locums-to-Perm, RPO, or Direct Hire? How to Choose the Right Recruiting Model for Your Organization

If you have several open clinical positions right now, you are probably not asking, “Which recruiting model is theoretically best?”

You are asking something much more practical:

What will actually work for us, right now, without creating more problems six months from now?

Locum tenens, locums-to-perm, RPO, and direct hire are all valid options. They are also very different tools. The challenge is that many healthcare organizations are pushed toward one model without fully understanding the tradeoffs.

If you’re a leader balancing patient access, provider burnout, operational pressure, and budget reality at the same time, this is for you.

Start Here: What Problem Are You Actually Trying to Solve?

Before talking about models, it helps to name the real issue.

Most organizations say they need to “fill roles.”
What they often mean is:

• Coverage now: because patient care is at risk
• Stability: because churn is impacting morale and continuity
• Scale: because growth is outpacing hiring capacity
• Relief: because internal teams are stretched thin

Each of those points to a different solution.

Recruiting works best when the model matches the problem, not the org chart.

When Locum Tenens Is the Right Answer

Locum tenens exists for one primary reason: time.

You need coverage quickly. You may not know how long you will need it. You cannot afford gaps in care. Locums offer you speed, flexibility and immediate continuity of care.

It works well when:

• A provider leaves unexpectedly
• Demand increases faster than hiring timelines
• Permanent recruiting is underway but incomplete
• Burnout or PTO coverage is putting pressure on existing staff

But it is not a long-term workforce strategy or a fix for ongoing structural gaps.

When Locums-to-Perm Is the Smarter Bridge

Locums-to-perm sits between temporary coverage and permanent hiring.

It gives organizations immediate support while creating a low-risk path to long-term stability, reducing hiring risk, allowing both sides to “try before you buy,” and maintaining care continuity during the transition.

Locums-to-perm works well when:

• You need coverage now, but want a permanent solution
• Candidate fit matters as much as credentials
• You want to see how a provider integrates with your team
• Previous direct hire attempts have not stuck

Used intentionally, locums-to-perm can prevent costly mis-hires and repeated backfills.

When Direct Hire Makes Sense

Direct hire remains the right answer for many roles.

It works best when there is time to be selective and internal teams have the capacity to support the process. Direct hire builds institutional knowledge and reduces reliance on temporary coverage over time. Perhaps most crucially, direct hire strengthens culture and is the ultimate in care continuity: patients get to know and trust their personal provider.

Direct hire is usually a good fit when:

• The role is clearly defined
• You are hiring for long-term stability
• Urgency is manageable
• Onboarding and ramp can be properly supported

However, it can be difficult to direct hire in competitive markets or for hard-to-fill specialties. Sometimes you just don’t have luxury to hire direct.

When RPO Is the Better Option

Recruitment Process Outsourcing is often misunderstood.

It is not about handing recruiting off. It is about extending internal capability with structure and scale. RPO creates predictable pipelines, reduces recruiter burnout and can improve the candidate experience at scale.

RPO works well when:

• Hiring volume is high or sustained
• Growth is planned, not reactive
• Internal teams need support, not replacement
• Leadership wants consistency and visibility

RPO doesn’t work well when it’s poorly integrated with operations or isn’t treated like a partnership. When RPO feels embedded, it works. When it feels transactional, it does not.

Healthcare organizations are often pushed into choosing one model because of contracts, vendors, or legacy decisions.

Real life does not work that way.

Many organizations need a combination.

• Locums for immediate coverage
• Locums-to-perm to de-risk permanent hiring
• Direct hire for core, stable roles
• RPO support to sustain growth

When recruiting is forced into a single lane, organizations either overpay for urgency or sacrifice stability for short-term savings.

The strongest outcomes come from intentional combinations, aligned to today’s reality and tomorrow’s goals.

What to Ask Before You Decide

Before committing to a recruiting approach, ask yourself:

• What happens to patient care if this role stays open another 90 days?
• Is this role temporary, transitional, or foundational?
• Do we have the internal capacity to support this volume of hiring?
• What does success look like one year from now?

Those answers matter more than the model label. 

A Better Way to Think About Recruiting Models

Instead of asking, “Which model should we use?” ask, “What mix gives us coverage, stability, and flexibility without locking us into the wrong structure?”

That shift alone changes outcomes.

At Optigy, we see recruiting work best when it adapts to the organization, not the other way around. Healthcare is too complex, and the stakes are too high, for rigid approaches.

If this article sounds like conversations you are already having internally, you are asking the right questions.

And those questions are usually the first step toward a recruiting strategy that actually works.

Let’s talk.