Walk into any hospital at 6 a.m. and you feel it immediately — the strain, the gaps, the weight of too much work falling on too few people.

The numbers back it up. Projections of tens of thousands of missing physicians. Nursing programs hitting walls. Rural clinics one resignation away from shutting their doors.

Every executive, every policy maker, every headline points to the same culprit: we simply don't have enough clinicians.

But what if that diagnosis is wrong?

Because there's a critical flaw hiding inside every workforce shortage model — one that nobody in healthcare leadership wants to talk about. A distinction so fundamental that, once you see it, you can't unsee it.

And it changes everything about how we should be solving this crisis.

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The HR Blotter

 AI Hasn’t Taken Your Job—But It’s Taking Your Peace - Researchers have a name for the dread spreading through offices: AI replacement dysfunction, the slow-burn panic that your job—and identity—are next on the chopping block. Polls show most workers expect AI to wipe out careers, even as hard evidence of mass displacement remains thin. The layoffs may be limited, but the fear is constant, corrosive, and already reshaping how people sleep, work, and see their future.

Desperate Job Seekers Now Paying to Get Recruited - White-collar workers are paying “reverse recruiters” to land jobs as the market tightens and unemployed candidates outnumber open roles. These services pitch AI-driven introductions, mass applications, and hands-on outreach—often charging upfront fees or a cut of first-year salary. Critics question the ethics and effectiveness, but desperate job seekers are betting cash for a shot at getting seen.

AI Anxiety and Layoffs Freeze Career Moves - American workers are increasingly “job hugging,” staying put out of fear as hiring cools, layoffs mount, and AI anxiety spikes. A growing majority say they’re avoiding risks despite longer hours and stalled advancement, trading momentum for perceived stability. Low turnover may look healthy on paper, but beneath it sits disengagement and a workforce bracing for impact.

35 Million Prompts Later, ROI Still Elusive - New research from Paligo analyzing 74 million prompt uses shows article and blog writing dominates AI automation, with 35 million uses—five times more than any other task. Workers are systematizing writing, marketing, design, and even strategy through prompt libraries, yet companies still struggle to show measurable ROI and face mounting risks around accuracy and quality. The data signals massive demand for automation, but in high-stakes fields like technical documentation, speed without structure creates costly consequences.

No AI, No Promotion: Accenture Draws the Line - Accenture is tying leadership promotions to AI tool usage, tracking weekly log-ins to push reluctant senior staff into the generative AI era. While juniors adapt quickly, some partners bristle at what they call clunky, overhyped tools, forcing management into a blunt “carrot and stick” campaign. With its stock down 42% and a sweeping reorg underway, Accenture is betting internal compliance will prove it can sell AI reinvention to clients.

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The Jim Stroud Podcast

Not subscribed to The Jim Stroud Podcast? Then you’ve been flying blind. Here’s a sneak peek at the latest episode debuting tomorrow.

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The Clinicians Who Aren’t There

Walk into a hospital at 6 a.m.

You can feel it.

The strain isn’t theoretical. It’s operational.

Chronic RN vacancies.
Specialists booked out for months.
Rural clinics functioning one resignation away from collapse.

Executives are solving an equation that does not balance: rising costs, tightening reimbursement, and roles that stay open long enough to distort budgets.

Patients feel it too.
Longer waits.
Shorter visits.
More complexity.

The dominant narrative is simple: we do not have enough clinicians.

But that assumption deserves scrutiny.

Because there’s a difference between a supply shortage and a visibility failure.

The Numbers Are Real — But They’re Incomplete

Yes, projections are serious.

HRSA estimates a shortage of 158,990 FTE physicians by 2038.
The AAMC projects up to 86,000 physicians short by 2036.

Primary care alone could face a deficit of 20,200 to 40,400 physicians.
Psychiatry, geriatrics, oncology — all flagged as critical.

Allied health isn’t immune.
Respiratory therapists, technologists, pharmacists — BLS projects continued demand growth across categories.

The pipeline problem compounds it.
Medical school seats grow. Residency slots do not.
Nursing programs hit faculty bottlenecks.

Add demographics:
An aging population.
An aging physician workforce.

On paper, it looks like scarcity.

But here is the critical flaw in most shortage modeling:

We measure known supply.
We do not measure total capacity.

And those are not the same thing.

The Infrastructure Problem No One Talks About

Healthcare workforce data is fragmented.

Licensing boards track licensure, not active practice.
Professional associations track members, not availability.
Employment records track full-time roles, not part-time flexibility.

We built measurement systems for a linear workforce.

Today’s clinician workforce is nonlinear.

Portfolio careers.
Telehealth across state lines.
Second careers.
Consulting.
Gig work.

The system tracks stability.
The workforce moved to fluidity.

During COVID, this became obvious.
Hospitals scrambled to locate licensed clinicians who weren’t in traditional roles.
Some returned temporarily.
Then disappeared again.

They weren’t gone.

They were invisible.

The Licensure Paradox

Millions hold active licenses.

Many are not in traditional full-time practice.

Some stepped away due to burnout.
Some moved into pharma, consulting, tech.
Some “retired” but remain open to part-time engagement.

The system categorizes them as inactive.

But inactive does not mean incapable.

It means unengaged.

That distinction matters.

Retirement Is Not Binary Anymore

The retirement model in workforce projections assumes exit.

Reality shows continuation.

Senior clinicians often prefer:
• Part-time
• Telehealth
• Mentorship
• Consulting

But credentialing friction discourages re-entry.

Months of paperwork for a short-term role is not an incentive.

It’s a deterrent.

So capacity remains dormant.

The Gig and Adjacent Care Shift

The gig economy grew 1400%.
Adjacent care settings grew 164%.

Clinicians are working — just not in traditional hospital systems.

Corporate wellness.
Home health.
School systems.
Virtual platforms.

Traditional sourcing tools were not designed for distributed talent.

So when we say “shortage,” we often mean:

Rural Healthcare Makes the Problem Obvious

Only 11% of physicians practice in rural areas serving 20% of the population.

That looks like disinterest.

But research shows clinicians with rural ties are far more likely to practice rurally.

The problem?

Discovery.

Loan repayment programs can offer $100,000 incentives.

But incentives only work if candidates are found.

Critical Access Hospitals struggle not just because clinicians refuse rural work, but because rural recruiting operates with limited digital reach.

The broadband divide limits both care delivery and digital discoverability.

When rural systems deliberately target clinicians with rural roots, recruitment improves.

The talent exists.

The discovery mechanism is weak.

The Hidden Cost: Overloading the Visible Few

When talent is hard to find, we squeeze those who remain.

That leads to:

Moral injury — being unable to deliver the care clinicians believe is right.

Not exhaustion.

Violation of professional ethics.

Then comes the productivity treadmill:

More patients.
Less time.
Higher throughput expectations.

Add supervision burdens for senior staff.
Add administrative creep.

One resignation increases pressure on those left.
Pressure accelerates departures.

That is the cascade effect.

And it is visibility-driven.

Technology Is Part of the Problem

Traditional recruiting tools assume active candidates.

Healthcare has a disproportionately large passive workforce.

Boolean search logic captures keywords.

It misses nonlinear careers.

AI recruiting tools often optimize database search.

They do not expand the universe.

LinkedIn works for many industries.

Healthcare is different.

Privacy concerns.
Platform fatigue.
Limited public digital footprints.

Database decay compounds the problem.

Contact data ages quickly.

Visibility shrinks.

The Category Shift: From Database Sourcing to Discovery-First Hiring

Posting and filtering is insufficient.

The future is discovery.

Not waiting for applicants.

Identifying licensed professionals wherever they are.

This aligns with the broader skills-first movement.

But discovery carries responsibility.

Seeing the full universe of licensed clinicians must be ethical, compliant, and consent-driven.

Visibility without ethics becomes surveillance.

Discovery done right becomes market efficiency.

Leadership Implications

If the issue is visibility, then:

• Time to fill is the wrong KPI
• Time to discover may be more meaningful
• Retention bonuses alone do not expand capacity

Organizations must ask:

Are we measuring the visible workforce…
or the possible workforce?

Reallocating budget from reactive retention to proactive discovery may expand supply without increasing headcount.

But this requires cultural change.

Data literacy.
Advanced sourcing capability.
New metrics.
Executive alignment.

Final Question

Are we short on clinicians?

Or are we short on effective ways to see them?

Generational expectations are shifting.
Technology is evolving.
Policy lags behind reality.

The healthcare system may not be suffering purely from scarcity.

It may be suffering from opacity.

And opacity is solvable.

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One more thing before I go…

If you are recruiting in the healthcare industry and think you have found all the candidates you can possibly find for a hard to fill role, I dare you to send me that req, along with what you’ve already done to find candidates. My response may surprise you.

In fact, I double-dog dare you. ;-)

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And as always, hit reply and let me know how I’m doing. Or slide into my DMs as the kids say. All good.

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