The cost of a hiring decision is something every healthcare organization eventually faces, yet few measure it from beginning to end. Every organization develops its own hiring philosophy, but understanding the true cost of a hiring decision often requires looking well beyond advertising expenses or the time spent interviewing candidates.
Weighing the cost of a hiring decision often plays out in conversations like this one, long before any job posting goes live.
Every healthcare organization develops its own hiring philosophy, and the cost of a hiring decision is rarely part of that philosophy in any measured way. Some practices recruit almost exclusively through internal efforts. Others occasionally engage outside recruiters for specialized or difficult-to-fill positions. Many use a combination of both over time.
None of those approaches is inherently right or wrong.
Many organizations never measure the total cost of a hiring decision. Most organizations can tell you what they spent to advertise a position. Fewer can estimate the financial impact of an unfilled chair, overtime for existing staff, onboarding time, reduced productivity, or restarting a search after an early resignation.
Few organizations combine those costs into one calculation, even though they often represent the largest part of the equation.
The Numbers Behind the Cost of a Hiring Decision
These figures do not suggest that every organization should hire differently. They simply illustrate that the financial impact of turnover extends well beyond recruiting expenses. Vacancy costs, onboarding, lost productivity, and repeated hiring cycles often exceed the costs most leaders initially consider.
Reviewing the cost of a hiring decision after each search can help organizations make more informed hiring decisions over time.
| Role | Typical annual turnover | Estimated cost per departure |
|---|---|---|
| Front desk / Administrative | 25%–35% | $15,000–$66,500+, depending on practice size and market |
| Dental / Medical Assistant | ~28% | $22,000–$34,000 |
| Hygienist / Clinical Support | ~18% | $15,000–$25,000 |
| Office Manager | ~22% | $28,000–$49,000 |
The fill window itself adds to this equation. The average time to fill a front desk role currently runs 45–60 days, up from 25–30 days before 2020. During that stretch, missed call and patient-contact rates tend to climb 15–25 percentage points — a real, if less visible, cost on its own. Government labor data tracks this same tightening across the wider labor market through the Bureau of Labor Statistics’ JOLTS report, which most HR teams use as a benchmark for hiring and separations trends.
Why the First 90 Days Carry Particular Weight
Across industries, roughly 22% of new hires leave within their first 90 days, and about 30 out of every 100 new employees resign within their first six months. This isn’t a reflection on any one organization or hiring process — it’s simply the nature of the earliest stretch of any new role, where both employers and new hires are still testing fit, expectations, and day-to-day reality.
A hiring timeline doesn’t always end where organizations expect it to. When a new hire doesn’t make it past the first few months, the organization is naturally back where it started — except now with the original time and cost already spent, and a second search beginning.
A simple way to look at it: If a first hire costs an estimated $22,000 in vacancy time, recruiting, and onboarding, and the role turns over again at day 75, that cost doesn’t disappear — it becomes the starting point for a second hiring cycle, with its own 45–60 day timeline layered on top.
The True Cost of a Hiring Decision in Healthcare Extends Beyond Recruiting
Many healthcare employers prefer to recruit on their own, and for good reason. They know their culture. Managers understand the role. Trusted leaders conduct thoughtful interviews. Over the years, those organizations have built successful teams through their own hiring process.
The question isn’t whether an organization can recruit successfully on its own. The better question is whether the organization has measured the complete cost of hiring, from vacancy through long-term retention.
The Comparison Most Supervisors Are Actually Making
In practice, the decision often comes down to two numbers that are easy to put side by side: what an outside recruiter would charge, and what it appears to cost to handle a search internally, which frequently looks close to free. Measured that way, doing it internally almost always wins — there’s no invoice to point to, so it reads as the cheaper path.
TThat comparison isn’t incorrect. It’s incomplete. Supervisors naturally compare the two costs they can see: the recruiter’s fee and the internal cost of conducting the search. Other operational costs emerge elsewhere in the organization, often outside a supervisor’s view but directly within a practice owner’s financial responsibility.
The View From the Front Desk
Front-desk employees feel the impact of short staffing first. Calls take longer to answer, check-in lines grow, and staff have less time to give each patient the attention they deserve. Their immediate priority becomes keeping the day on schedule.
The View From the Owner’s Office
From an owner’s vantage point, those same conditions look different, because they eventually show up in numbers an owner does track closely, even if no one connects them back to a staffing gap:
- Patient experience and satisfaction scores. Longer hold times, rushed check-ins, and a visibly stretched front desk shape how a patient describes the visit — and often shape the review they leave.
- Referral and retention patterns. Patients who feel rushed or poorly attended to are less likely to return or recommend the practice, even when the clinical care itself was excellent.
- The condition of the team absorbing the gap. Existing staff covering a short-staffed desk are often doing more work without any change to their pay or schedule. Over time, that’s less a staffing shortfall than a quiet driver of the next resignation.
- The clinical team’s experience of the front office. Providers depend on a functioning front desk to keep the schedule moving; a strained one creates friction that reaches back into the clinical side of the day.
None of these costs appear on the invoice next to a recruiter’s fee. Instead, they appear weeks or months later as operating costs that organizations rarely connect to the original hiring decision. That’s why a supervisor and a practice owner can look at the same vacancy and reach very different conclusions about its true cost.
What the Full Cost of a Hiring Decision Means in Practice
Most hiring managers make decisions with only part of the financial picture. They can see the cost of advertising, interviewing, and extending an offer. Vacancy costs, onboarding time, and the risk of early turnover usually become clear only after the hiring process ends.
That doesn’t make the decision wrong. Organizations often recognize the full cost only after completing one hiring cycle. Sometimes they don’t see the full picture until they complete a second search.
Organizations that build a habit of reviewing the true cost of a hiring decision in healthcare after each search tend to have a much clearer picture of what it actually costs to keep critical positions filled over time. For a deeper look at how staffing shortages compound this further, see our related piece on navigating healthcare staffing shortages.
When the Conversation Naturally Shifts
Every organization eventually reaches positions that are difficult to fill, highly specialized, or simply too important to leave vacant for long. At that point, some leaders continue recruiting internally. Others decide to supplement their efforts with outside expertise for that specific role or season.
Every organization reaches positions that are difficult to fill, highly specialized, or simply too important to leave vacant for long. Some leaders continue recruiting internally. Others bring in outside expertise for specific roles or hiring situations.
Neither approach is universally right or wrong. The better decision comes from understanding the true cost of a hiring decision and weighing the operational and financial realities surrounding the position.
Prepared by The AGA Group, as part of an ongoing series looking at the workforce data behind everyday staffing decisions in healthcare and dental organizations.
Sources: SHRM, Gallup, Work Institute, AIHR/InsightGlobal, Bureau of Labor Statistics (JOLTS), and 2025–2026 dental industry staffing research (Dental Economics, DentalPost). Figures reflect industry benchmarks and ranges; individual results vary by role, market, and practice size.
