A VMS or MSP works when the role is a commodity and one qualified body is interchangeable with another. A physician is the opposite. Volume, acuity, procedures, and schedule make every seat and every facility different, even inside one health system. The VMS rewards speed of presentation, not fit. First-to-submit fills the seat fast. It does not fill it right. This page explains the difference from the physician who runs the vetting.
A VMS sits between the hospital and its agencies and ranks them on speed and rate. A physician-led agency works the opposite way, starting from what the clinical role requires. One optimizes for the fastest, cheapest submission. The other optimizes for the physician who fits the seat. That difference decides who ends up on your floor.
The model is now mainstream. The US locum tenens market reached an estimated $9.6 billion in 2025, and Staffing Industry Analysts reports that 47 percent of advanced practice staffing revenue already flows through an MSP or VMS. Demand keeps climbing. CHG Healthcare found that 81 percent of facilities used locums in 2024, well above the 56 percent that had planned to.
Inside a VMS, the hospital picks from a pool of candidates who were first in. Being first in does not mean best quality or right fit, and often it is simply the lowest rate that gets accepted. The hospital is not vetting these candidates. It is the locum company racing to the door to get as many of its own names in as it can the moment an opening appears. Industry coverage of VMS programs says it plainly: cutting time to submit is a major focus for firms competing inside them. Many openings close within hours, because the bigger-tier firms submit 20 to 30 candidates at a time.
A physician-led agency starts before the submission. It takes the time to understand the need from the ground up, what the role requires clinically, and which physician fits that specific situation. The submission comes last, after the match, not first in a race.
The hospital case for a VMS is real, and it deserves a fair hearing. A VMS is software that distributes orders, consolidates billing, and reports spend across every vendor. An MSP goes further and manages sourcing through one partner under one master agreement. For a health system juggling dozens of agencies, that brings order.
Rate control. Aggregated volume gives the hospital leverage to standardize rates across vendors.
One invoice. Consolidated billing replaces a stack of agency invoices.
Compliance and visibility. Credential checks, spend data, and supplier scorecards in one place. One MSP case study published by HFMA reported more than $15 million in savings over three years for a California network, largely by curbing off-contract departmental spend.
Even vendors in the space draw the boundary. A VMS works best when candidates outnumber openings. Hard-to-fill roles are where it struggles, and few roles are harder to fill than a physician who fits.
A VMS is worth it when the role is a commodity, where one qualified body is interchangeable with another. A physician is never that. The specialized skillset, the interpersonal skills the work demands, and the fact that a physician is dealing with human lives put the role outside commodity logic. First-to-submit gives you the fastest and the cheapest. It does not give you the right fit.
Every facility is different, even within the same health system. A physician who fits one site does not automatically fit another. The volume, the acuity, and the culture change from one floor to the next, and the VMS model cannot see any of it. It ranks on the two things it can measure, speed and rate, and treats as interchangeable what is not.
That is why finding the right physician the first time is essential. A fast fill that does not fit is not a saving. It becomes a patient-safety risk, a care delay, a premium replacement, and a future vacancy. The full cost of a bad-fit hire is broken down on our cost-of-vacancy page.
Physicians feel the VMS from the other side of the screen, and their critiques are consistent.
The fee comes out of physician pay. Writing on The Health Care Blog, Val Jones, MD, argued that agencies often pass the VMS cost along by offering lower hourly rates, and that booking favors the lowest salary requirement over the best qualifications.
The race degrades the information. The same critique describes agencies racing for first submission that leave out details or misrepresent availability, which wastes credentialing time on both sides. Physicians are reduced to a set of numerical fields on a vendor list.
Submission without consent. Hospitalists writing in The Hospitalist advise physicians to require in writing that they cannot be presented to a hospital without permission. A single presentation can block a physician from working that hospital through another agency for about a year, even if they never work a shift.
Recruiters who cannot answer clinical questions. The same guidance tells physicians to speak with the medical director before accepting, because recruiters may not understand the day-to-day realities of the work. Another hospitalist warned against factory mill firms where larger margins and overloaded recruiters produce errors.
The friction is not one-sided. Hospital and industry voices raise their own concerns.
Slower, not faster. Extra contact points create bottlenecks. A nurse staffing association leader described no-direct-contact rules slowing interviews and leaving postings live after they were filled.
Weaker candidate flow. A competing executive argued that staffing firms send their strongest candidates to facilities where they hold direct relationships, not to the anonymous queue.
Blurred accountability. When the contract runs through an intermediary, the line between the hospital and the firm responsible for the physician gets harder to see.
Fees in the rate. MSP programs have historically charged vendors roughly 2 to 4 percent of the bill rate, a cost that tends to surface in the price or in clinician pay.
Match the model to what you are placing. An MSP or VMS manages vendors and paperwork well, and for commodity roles that is enough. For physicians, a physician-led partner is the model that gets the fit right, because it starts from the clinical variables the software never captures.
Those variables decide the placement. Patient volume per day. Whether procedures are required. The acuity and disease presentation of the patients the physician will see. The schedule and the exact days that need to be filled. A physician-led partner matches a physician to all of it, then confirms the fit for both sides before a name reaches your desk.
There is a second problem the VMS cannot solve. A job posted to a VMS carries a lot of information, but not the exact information a physician is looking for. Physicians of a given specialty have very particular questions they ask before they will even express interest. A physician-led partner knows those questions and answers them up front, so the physician who accepts is the physician who stays. Every candidate is vetted by physicians, not by a non-clinical recruiter, and often at a price more competitive than the national firms.
The two models can coexist. Many hospitals keep a VMS for nursing and allied roles and work direct with a physician-led partner for the seats where fit decides the outcome.
Admiral Healthcare is physician owned and physician led by an active clinician. Fahhad Farukhi, MD MBA MA, is a practicing hospitalist who has been on both sides of these placements and knows the questions a physician asks before taking a job and the ones a hospital should ask before signing. The vetting described here, physicians evaluating physicians, is how Admiral works every day, not a claim bolted onto a VMS.
Fahhad Farukhi, MD MBA MA. Practicing Hospitalist. Board-Certified Internal Medicine. Managing Partner, Admiral Healthcare.