Retained search, exclusive search, and contingency search are the three engagement models that define how physician recruiting firms partner with hospitals, health systems, multi-specialty groups, and private equity-backed platforms. Each model carries a fundamentally different fee structure, a different level of recruiter commitment, a different incentive alignment, and a different downstream cost profile. The right choice depends on the seniority of the role, the size of the candidate pool, the geographic difficulty, the timeline, and the tolerance for upfront risk. This guide explains how each model works, what it costs, where it performs best, and how MedicalRecruiting.com structures its own engagements — almost entirely on contingency, occasionally exclusive, rarely retained — so employers can make an informed decision for every search.
Contingency physician recruiting is the most common engagement model in the United States, used for the overwhelming majority of permanent physician placements outside of executive and chair-level searches. Under a contingency model, the employer pays nothing until a placed physician accepts an offer and starts in the role. There are no upfront fees, no retainers, no monthly minimums, no per-search charges, and no cost for candidates who are presented but not hired. The recruiting firm assumes 100% of the upfront risk and earns its fee — typically 20% to 25% of the physician's first-year guaranteed compensation (base salary plus signing bonus) — only on a successful start. This is the model MedicalRecruiting.com uses for the substantial majority of physician searches.
The contingency model aligns recruiter incentives directly with employer outcomes: the firm earns nothing if the search does not produce a hire, so every hour invested by the recruiter is at risk. That alignment is why contingency works well for high-volume, mid-market, and metropolitan physician searches where the candidate pool is substantial and the recruiter can run several concurrent searches efficiently. It is also why contingency works well for primary care, hospital medicine, urgent care, emergency medicine, and most outpatient subspecialty searches — roles where the candidate market is well-developed and the time-to-fill is predictable. Contingency engagements typically allow the employer to work with multiple recruiting firms in parallel, which broadens candidate exposure but can create coordination overhead.
Most contingency engagements at MedicalRecruiting.com include a 90-day replacement guarantee at no additional cost: if a placed physician departs within 90 days for any reason, the search is re-run at no additional fee. Combined with the zero-upfront-cost structure, that means employers can engage a contingency physician recruiter with effectively zero financial risk and evaluate the pipeline head-to-head against any incumbent firm or internal in-house talent team. For most healthcare employers in most markets, contingency is the right starting model — and the model that produces the highest volume of placements per dollar invested.
Retained physician recruiting is the model used most often for senior leadership searches — Chief Medical Officer, Chief Clinical Officer, Department Chair, Service Line Director, Medical Director — and for highly specialized subspecialty searches with very thin candidate pools (interventional cardiology in tertiary markets, complex spine surgery, MFM, REI, transplant surgery, electrophysiology with structural heart capability, pediatric subspecialties at children's hospitals). Under a retained model, the employer pays a portion of the total fee upfront — typically one-third at engagement, one-third at slate delivery, and one-third at start — regardless of whether the search ultimately produces a hire. Retained fees often run 28% to 35% of first-year guaranteed compensation, materially higher than contingency.
Retained engagements are exclusive: the employer commits to the retained firm for that specific search and does not engage other firms in parallel. In exchange, the retained firm assumes a higher level of search rigor — typically including a written search committee charter, a documented competency model, a structured candidate scoring rubric, off-market sourcing of currently employed and non-actively-looking candidates, and a longer runway to deliver the slate (often 90 to 180 days versus the 14 to 21 days that contingency searches typically run). Retained searches also commonly include a market and competitive landscape analysis, a deliberate assessment-based interview architecture, and a multi-stage final-round process designed to surface long-term cultural and strategic fit.
Retained search is the right choice when the role is mission-critical, the candidate pool is genuinely scarce, the search must be discreet (current incumbent still in seat, brand-sensitive search, sensitive partnership transition), or when the employer needs a single firm to run a fully managed, multi-month search process. Retained search is the wrong choice for most physician searches, however — the upfront cost is high, the timeline is longer, and for the substantial majority of physician roles the candidate pool is deep enough that contingency produces equivalent or better outcomes at a fraction of the cost. MedicalRecruiting.com runs a small number of retained searches per year, almost exclusively for medical executive and senior medical leadership roles where the model genuinely fits.
Exclusive contingency — sometimes called engaged search, retained-light, or hybrid search — is the model most healthcare employers underuse. Under exclusive contingency, the employer commits to a single recruiting firm for a defined search window (typically 60 to 90 days), but does not pay any upfront fee. The firm runs the search with the rigor of a retained engagement — written search profile, off-market sourcing, structured weekly pipeline updates, dedicated principal recruiter — and earns a contingency fee at start, often at a slightly reduced percentage in exchange for the exclusivity (sometimes 18% to 22% versus the standard 20% to 25%).
Exclusive contingency is the right model for difficult-to-fill physician searches that are not severe enough to justify a full retained engagement: rural-market subspecialty searches, second- or third-tier metro searches in competitive specialties, partnership-track openings with complex compensation structures, and roles where the employer is willing to commit exclusivity in exchange for a fully prioritized pipeline. It is also the right model when the employer has previously run an open contingency search, received fragmentary candidate flow from multiple firms, and wants to consolidate the search behind a single accountable principal recruiter for a defined window.
MedicalRecruiting.com offers exclusive contingency engagements with a written exclusivity agreement, a defined search window, weekly pipeline updates, and a reduced contingency percentage compared to open contingency. For employers who have struggled to fill a specific role on open contingency, exclusive contingency typically converts in 60 to 90 days where open search has produced no acceptable candidates in 6 to 9 months — at a fraction of retained cost.
Consider a hospitalist search with $310,000 first-year guaranteed compensation. Under open contingency at 22%, the recruiting fee on a successful start is $68,200, paid only at start, with no upfront cost and no fee if the search does not produce a hire. Under exclusive contingency at 19%, the fee is $58,900, again paid only at start. Under retained at 32%, the total fee is $99,200 — paid in three installments regardless of search outcome, with the upfront portion ($33,067) at risk if the search ultimately does not produce a hire. For a high-volume specialty like hospital medicine where the candidate pool is deep, contingency or exclusive contingency is almost always the right model. Retained would only fit if the role is uniquely structured (academic appointment, partnership-track, executive component) or in an unusually difficult market.
For a child & adolescent psychiatry search with $295,000 first-year guaranteed compensation in a rural market, the calculus shifts. Open contingency at 25% would yield $73,750, but in a thin candidate market open contingency may not produce acceptable candidates at all. Exclusive contingency at 22% would yield $64,900 — and may convert in 90 days where open contingency has produced nothing in 6 months. Retained at 33% would yield $97,350 — appropriate if the role is mission-critical and the employer needs full search rigor over a 6-month engagement, but rarely the right choice if exclusive contingency has not yet been tried.
For a CMO or Chair-level search at $700,000 first-year guaranteed compensation, retained at 33% ($231,000) is almost always the appropriate model. Executive-level physician searches require the structured competency modeling, off-market sourcing, search-committee orchestration, and confidentiality that retained engagements deliver. Contingency at this level is generally unavailable at quality firms, and exclusive contingency is rare for true C-suite physician searches.
Start with open contingency for any standard physician search in a metro or mid-market geography where the candidate pool is well-developed. This includes most primary care, hospitalist, emergency medicine, urgent care, outpatient subspecialty, and first-time medical staff buildouts. Open contingency carries no upfront cost, allows multiple firms to compete, and produces strong outcomes for the substantial majority of physician searches in the United States.
Move to exclusive contingency when an open contingency search has run 60 to 90 days without producing acceptable candidates, when the role has unusual structural complexity (partnership-track, academic appointment, RVU and citizenship bonus structure, J-1 waiver, complex call coverage), or when the employer wants the rigor of a single accountable principal recruiter without the upfront cost of retained. Exclusive contingency consolidates accountability behind one firm and typically produces a slate within the agreed search window where open contingency has stalled.
Reserve retained search for mission-critical executive-level physician roles (CMO, CCO, Department Chair, Service Line Director), confidential incumbent-replacement searches, and severely thin subspecialty markets where structured off-market sourcing is the only path to a credible slate. Retained is also appropriate when the employer needs a fully managed multi-month engagement with formal search-committee orchestration and a documented competency-based assessment process. For everything else, retained is rarely the right starting model — and most healthcare employers overuse it.
MedicalRecruiting.com runs the substantial majority of physician searches on open contingency, with exclusive contingency offered for difficult roles and retained reserved for executive-level and severely thin subspecialty searches. Every engagement carries a 90-day replacement guarantee at no additional cost.
Contingency physician recruiting carries no upfront fee — the employer pays only when a placed physician accepts an offer and starts, typically 20-25% of first-year guaranteed compensation. Retained physician recruiting carries an upfront engagement fee paid in installments (often one-third at engagement, one-third at slate delivery, one-third at start) regardless of search outcome, typically 28-35% of first-year guaranteed compensation. Contingency is the right model for the majority of physician searches; retained is the right model for executive-level searches (CMO, Chair, Service Line Director) and severely thin subspecialty markets where structured off-market sourcing is required.
Hospitals should use retained physician recruiters for mission-critical executive-level roles (Chief Medical Officer, Chief Clinical Officer, Department Chair, Service Line Director, Medical Director), confidential incumbent-replacement searches where the search must be conducted discreetly while the current incumbent is still in seat, and severely thin subspecialty markets (interventional cardiology in tertiary markets, complex spine, MFM, REI, transplant surgery, electrophysiology with structural heart capability) where the candidate pool is small enough that structured off-market sourcing of currently employed candidates is the only path to a credible slate. For standard physician searches in metro and mid-market geographies, contingency is the right starting model.
Exclusive contingency — sometimes called engaged search or hybrid search — combines single-firm exclusivity with a contingency fee structure. The employer commits to a single recruiting firm for a defined window (typically 60-90 days) but does not pay any upfront fee. The firm runs the search with the rigor of a retained engagement (written search profile, off-market sourcing, dedicated principal recruiter, weekly pipeline updates) and earns a contingency fee at start, typically 18-22% of first-year guaranteed compensation. Exclusive contingency is materially less expensive than retained and works well for difficult-to-fill roles that are not severe enough to justify a full retained engagement.
A typical open contingency physician recruiting fee runs 20-25% of the placed physician's first-year guaranteed compensation (base salary plus signing bonus), billed only when the physician starts in the role. For a hospitalist with $310,000 first-year compensation, a 22% contingency fee equals $68,200, paid only on a successful start with no upfront cost and no fee if the search does not produce a hire. Subspecialty searches sit at the upper end of the range; high-volume primary care and hospital medicine searches sit at the lower end. Volume employers running multiple concurrent searches typically receive volume pricing and exclusive search rebates.
Yes, but selectively. MedicalRecruiting.com runs the substantial majority of physician searches on open contingency, with exclusive contingency offered for difficult roles and retained reserved for executive-level (Chief Medical Officer, Chief Clinical Officer, Department Chair, Service Line Director, Medical Director) and severely thin subspecialty searches where structured off-market sourcing is required. For the majority of physician searches, contingency or exclusive contingency produces equivalent or better outcomes at a fraction of retained cost.