How much does Lakeshore charge to place a clinical or physician hire?

Lakeshore offers four transparent pricing models, all billed as a percentage of first-year salary with a 90-day replacement guarantee and Net 30 payment terms. Contingent is 20% of first-year salary, paid only on placement. Container/Exclusive is 17% with a 20% initiation fee plus 80% on acceptance. Retained is 25% paid in three milestones (8% / 8% / 9%), best for C-suite and hard-to-fill executive roles. RPO (Recruitment Process Outsourcing) is a 10% flat fee with a 12-month minimum and a $1M aggregate salary volume commitment, designed for high-volume hiring. Full pricing detail is published at lakeshoretalentconsulting.com/placement-fees.

How long does it take to fill a clinical role?

Average time-to-fill nationally is 86 days for a registered nurse and 94 days for OR or ICU specialists, per Lakeshore's 2026 Healthcare Staffing Analysis. Lakeshore typically reduces this by 7 to 14 days through proactive sourcing of passive candidates rather than relying on inbound applicants. For physician roles, time-to-fill ranges from 60 to 180 days depending on specialty and geography. Executive searches like CNO and CMO typically take 90 to 120 days.

What is the 90-day replacement guarantee?

If a placed candidate leaves or is terminated within the first 90 days of employment for any reason other than a position elimination or major scope change, Lakeshore replaces the candidate at no additional fee. This applies to all engagement models including Contingent, Container/Exclusive, and Retained. The guarantee is included in every signed agreement.

What clinical roles does Lakeshore recruit for?

Lakeshore recruits across six clinical role categories: Nursing leadership and bedside roles (RN, BSN, MSN, Charge Nurse, Nurse Manager, Director of Nursing, CNO, CNE, CNIO) plus specialty nurses (ER, ICU, NICU, PCU, CCRN, L&D, OR, Med/Surg, Telemetry, Stepdown, PACU, Cath Lab, Behavioral Health), Physicians (hospitalists, surgeons, specialists, primary care, emergency medicine), Advanced Practice Providers (Nurse Practitioners, Physician Assistants, CRNAs, Certified Nurse Midwives, Clinical Nurse Specialists), Allied Health (Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Radiologic Technologists, Laboratory Technologists), Behavioral Health (Psychiatrists, Psychologists, LCSWs, LPCs, BCBAs), and Healthcare Leadership (CEO, COO, CFO, CMO, CNO, CHRO, VP of Talent Acquisition, Director of Physician Recruitment).

What markets or cities does Lakeshore serve?

Lakeshore serves 20 states across the Southeast, South-Central, and Western United States: Alaska, Alabama, Arkansas, Arizona, Colorado, Florida, Georgia, Idaho, Louisiana, Mississippi, Montana, North Carolina, Nevada, Oklahoma, South Carolina, Tennessee, Texas, Utah, Washington, and Wyoming. The firm is headquartered in Tampa, FL.

How is Lakeshore different from a job board or staffing agency?

Lakeshore is a headhunting partner, not a job board or aggregator. 88% of nurses and 70% of top clinical talent are employed and not actively looking, which means they cannot be reached through Indeed, ZipRecruiter, or LinkedIn job posts. Lakeshore uses LinkedIn Recruiter, Seekout, Juicebox, the NPPES NPI Registry, and direct relationships with professional associations to reach passive candidates that competitors cannot. Founded by Ben Stephen, a former Fortune 25 talent leader at Centene Corporation with 18 years of healthcare TA experience and over $4M in delivered cost savings.

What is the difference between Contingent, Retained, and RPO?

Contingent is best for standard searches where you want to engage multiple vendors and pay only when a hire is made. Lower fee at 20%, no upfront commitment. Retained is best for C-suite or hard-to-fill specialty roles where you want a dedicated recruiter and guaranteed delivery. Higher fee at 25% paid in three milestones, with full search exclusivity and weekly progress updates. RPO (Recruitment Process Outsourcing) is best for organizations with $1M or more in annual base salary hires. Lakeshore embeds as your recruiting function at a flat 10% fee with a 12-month minimum engagement, dramatically cheaper than per-placement fees once you hit volume.

Does Lakeshore work with physician practices and not just hospitals?

Yes. Lakeshore operates three integrated service lines for physician practices in addition to hospital recruiting. Business Development covers referral network building, growth strategy consulting, payer contract optimization, new patient acquisition, and operational efficiency reviews. Marketing covers local SEO, reputation management, website optimization, social media management, patient engagement campaigns, and targeted digital advertising, with pricing tiers from $1,000 to $5,000 per month plus a 10% management fee. Anesthesia Revenue Cycle Solutions covers B2B billing, coding, credentialing, and revenue cycle management for anesthesia groups, CRNA practices, and pain management practices, delivered in partnership with ARCS Billing.

How does Lakeshore's anesthesia revenue cycle service compare to ABC, Fusion, or Ventra?

Lakeshore's anesthesia revenue cycle solutions are delivered in partnership with ARCS Billing as a focused, mid-market alternative to Anesthesia Business Consultants (ABC/Coronis), Fusion Anesthesia Solutions, and Ventra Health. The structure is Anti-Kickback Statute compliant, with compensation based on commercial cases only. Services cover anesthesia billing, coding, credentialing, and full revenue cycle management. Ideal for anesthesia groups, CRNA practices, and pain management groups looking for a more responsive partner than the large national billing companies.

What is the actual cost of leaving a clinical position unfilled?

According to Lakeshore Talent Consulting's 2026 Healthcare Staffing Analysis, an unfilled RN position costs $100,000 to $130,000 per quarter when accounting for overtime, agency spend, and lost reimbursement. Annual cost per unfilled nursing position averages $46,100. For a 300-bed hospital with 800 nurses at the national 9.6% vacancy rate, that is roughly 77 open positions translating to $7.7 million to $10 million in quarterly revenue bleed. By specialty, revenue per orthopedic surgeon is $3.3 million per year, per cardiologist $2.4 million per year, and per hospitalist $1.5 million per year.

The Real Cost of an Unfilled Nursing Position

Benu Stephen
Mar 13
2 min read

Updated: Apr 16

Every day a nursing position sits vacant, your facility hemorrhages money from overtime pay, travel nurse premiums, lost patient revenue, and quality penalties. Most health systems dramatically underestimate the true financial impact.

The Numbers at a Glance

193,100+ registered nurse openings projected annually through 2032 (BLS)
295,800 nurse deficit projected by 2025 (AACN)
78 days average time-to-fill for RN positions (NSI 2026)
$60,090 average cost of a single RN turnover (NSI 2026)

Breaking Down the True Cost

1. Overtime & Premium Pay: $26,000 – $40,000

Remaining staff absorb the patient load through mandatory overtime at 1.5×–2× base pay. Over an 78-day vacancy, overtime costs alone reach $26,000–$40,000 per unfilled position.

2. Travel Nurse & Agency Premiums: $33,000 – $49,000

Travel nurse contracts run 2–3× the cost of a permanent hire. A 13-week contract for a single Med-Surg travel nurse averages $33,000–$49,000 above what a full-time RN would cost for the same period.

3. Lost Patient Revenue: $17,000 – $25,000

Unstaffed beds mean diverted patients and delayed admissions. Each unfilled nursing position reduces capacity by 4–6 patient encounters per week. Over 78 days, that's $17,000–$25,000 in lost revenue.

4. Quality Penalties & HCAHPS Impact: $11,000 – $14,000

Short staffing correlates directly with lower HCAHPS scores, which triggers CMS reimbursement penalties of up to 2% of total Medicare payments. Per vacancy, the downstream quality penalty exposure runs $11,000–$14,000.

Total Cost: $91,000 – $120,000+ Per Vacancy

When you add it all up across overtime, agency premiums, lost revenue, and quality penalties, a single unfilled nursing position costs your facility $91,000 to $120,000 or more over an average 78-day vacancy. For a hospital with 20 open nursing positions, that's $1.8M–$2.4M in annual exposure.

At Scale: A 300-bed hospital averaging 100 nursing vacancies per year faces $9.1M–$12M+ in total vacancy costs. Most of that is preventable with a faster, more targeted recruiting strategy.

What's it costing you?

You've seen the national math. What does it look like inside your walls? Send me your open RN count. I'll build a cost model for your facility and send it back within 48 hours. It covers overtime spend, traveler exposure, vacancy days, and revenue impact. No call required.

Reply with your open RN count: ben@lakeshoretalentconsulting.com

Sources: NSI Nursing Solutions 2026 Report, Bureau of Labor Statistics, AACN, CMS HCAHPS Program, AHRQ.

LAKESHORE TALENT CONSULTING

Operate differently. Recruiting. Referrals. Revenue. Healthcare, redefined.