Executive Summary:

Recruitment challenges in the healthcare sector aren’t limited to care delivery. Executive recruitment is also a pain point for healthcare organizations across the country. Here, we dig into the three leading approaches to executive searches in healthcare:

In-house executive searches
Contingent searches
Retained searches

We’ll take a close look at these three approaches, highlighting their strengths, weaknesses, and which best suits a healthcare organization seeking long-term leadership solutions.

The New Realities of Healthcare Executive Recruitment

We often say that in healthcare, the only constant is change. Yet the more things change, the more they stay the same. For example, in the aftermath of the 2008 financial crisis and the newly-implemented Affordable Care Act, healthcare organizations struggled to find the right candidate—though not for a lack of options. While it was overwhelmingly an employer’s market, the rapid changes to the sector and nascent regulations demanded a new type of leader. Fast forward nearly 20 years to today and healthcare organizations still struggle to find the right candidates, although for entirely different reasons.

While the financial crisis brought an abundance of candidates, the healthcare sector now faces a shortage, and not just in terms of clinicians. From CEOs to CIOs, the healthcare industry struggles to attract top executive talent. And when it finally does? Those leaders don’t always stick around. In the year between July 2024 and July 2025, hospital CEO departures have increased by 15%.

The bottom line for healthcare organizations now, as it was during the Great Recession, is that it’s not just about filling your executive leadership roles. It’s about filling your leadership roles with the right people. Let’s talk about how your organization can do that.

Contemporary Healthcare Executive Search Models Explained

Whether your organization’s leadership vacancy is planned or unplanned, you need to take swift action. What are your options? At Kirby Bates, we break them down into three main categories.

1. In-House Searches

In-house searches are typically led by your organization’s own HR team or a specially formed search committee. With this approach, you might turn to applications on hand, internal candidates, and traditional job boards to find your candidate.

2. Contingency Searches

Contingency searches are carried out by—you guessed it—contingency search firms. You can also probably guess that they’re paid on contingency. Therefore, they work quickly and you can expect contingent searches to be the fastest.

3: Retained Searches

Retained searches blend characteristics of an in-house search and a contingency search. Retained healthcare executive recruiters partner with your organization to understand your needs, giving you a great deal of control like you’d experience with an in-house search, while reducing the administrative burden of executing a search while also reaching a broader talent pool.

Which Type of Executive Search is Best?

Most healthcare organizations, regardless of their scale, will use one of the three to fill their vacancy. However, these three options aren’t created equally, and each one does its best work in different circumstances. Let’s take a closer look at some key considerations for each search model.

Key Considerations for an In-House Executive Search

The first thing to know about in-house executive searches is that they can be riskier than many organizations anticipate. More broadly, they tend to be high-risk, high-reward, yet that risk is often obscured by the rewards: reduced costs and a high degree of control. Still, risks do exist, and what’s particularly dangerous about them is that they may be unknown or unrealized quantities.

For example, many healthcare organizations struggle with the fact that recruiting an executive requires a vastly different approach than hiring clinicians, which is what many healthcare organizations’ HR teams are best equipped to do. Those gaps are most acute when HR teams are forced to grapple with an executive candidate’s qualifications and judge whether they would be a shrewd financial leader, for example.

Secondly, in-house searches don’t generate a deep pool of candidates from which to choose. Most in-house searches are limited to candidates who either are already known from previous searches, are local, or are internal. Facing such a limited talent pool can lead to an overcorrection that’s equally hard to deal with: a vast, but unfocused talent pool.

Sorting through a flood of applicants can quickly consume your internal teams’ bandwidth and resources without revealing any truly outstanding candidates.

When in-house searches go south, they can leave your organization facing risks beyond leadership vacancies. If an in-house executive search drags on, it can create, expose, or exacerbate the following risks:

Deteriorated Trust

When an in-house executive search goes well, it can boost morale and give your organization confidence. On the other hand, when it goes poorly, it can erode the trust that’s so difficult to build in the healthcare market.

Everyone from the executive team down might question the decision to handle the search internally. This deterioration in trust can make it harder for a new leader or existing teams to get the buy-in needed for process changes.

Stalled Projects

Healthcare executive leaders often spearhead broad, organization-wide initiatives. Today, we’re watching them lead a new wave of digital transformations. As patient and payer expectations shift rapidly, the impact of these initiatives is often core for an organization’s ability to remain financially sound and retain or grow their market position.

However, as a vacancy remains unfilled, these critical projects often remain stagnant. While it’s always possible to keep those projects moving without a leader, it’s significantly harder to make sure they’re moving in the right direction. For a sector that’s always in flux, both stagnation and directionless movement represent a risk that can make your organization less stable and less competitive.

Insulated Thinking and Decision Making

A final risk of in-house searches we need to call attention to is that they occur in a bubble. Executive leadership changes aren’t easy, yet they always offer a vital opportunity for change. By opening your organization up to a new executive, you expose your organization to fresh ways of doing things and new possibilities. Ideally, it creates room for your organization to receive candid feedback about where its shortcomings are, and hear from potential candidates about how those issues can be addressed.

Unfortunately, when you run a search strictly in-house, it can create bias. Whether that comes from a search committee’s belief that your organization ‘knows best,’ or a desire to make a like-for-like leadership change, insulated thought processes can create problems down the line. A like-for-like leadership change can be comforting in a time of challenge, but it also means your organization is looking backwards rather than meeting the present moment.

Questions to Ask Before Pursuing an In-House Executive Search

If you believe an in-house approach could be the right fit for your organization, make sure that you and your internal teams align and agree on the following questions:

Does our HR team have the experience to manage the search efficiently?
Do we have the resources to get this role in front of the right leaders?
What risks will we face if we’re unable to fill this role promptly?

The Bottom Line on In-House Recruiting

In-house recruiting can be highly effective when your organization is focused on filling department-level roles. That said, its limited candidate reach, low advisory value, and the burden it places on internal teams make it unsuitable for executive searches.

Key Considerations for a Contingency-Based Executive Search

Contingency executive search firms are the first of two types of external searches we’ll cover. Contingency search firms’ defining characteristic is that they work at a rapid pace to fill your leadership roles. In some cases, this can be less than a month. With that in mind, it’s worth considering a few questions:

It takes about five months to fill family medicine roles, and slightly longer for surgical roles. Those are the core, commoditized roles that entire health systems depend on. Given that timeline, does as little as a month seem like too long or too short a period to find a fitting replacement for an entire healthcare organization’s executive leader?
If you were pursuing an in-house search, would your realistic timeline be shorter or longer than a month?

Contingency executive search firms do their job at breakneck speeds. If your organization’s need for leadership came about suddenly, unexpectedly, or while your organization was already dealing with an internal crisis, the promise of a rapid executive placement can be alluring. But be careful what you wish for.

Just as contingency searches can be framed as quick solutions, they can also cause your organization long-term problems. That’s due to the way contingency firms are incentivized by speed. To increase the speed of their search, most contingency firms will perform little work in terms of vetting and direct outreach to candidates, instead relying mostly on active candidates whose experiences are taken at face value.

Active vs. Passive Candidates

Contingency firms will share your organization’s executive leadership opportunity widely, attracting as many applicants as they can in hopes that one is the right fit. However wide a net they cast, though, they ultimately pull in one type of candidate: active job seekers. We have an entire article on active and passive candidates, which is well worth a read, but the bottom line is that passive candidates — those your organization seeks out — tend to be better fits than active candidates — those that seek an opportunity with your organization. Here’s why:

Turnover: Passive candidates are already succeeding somewhere. They may be sticking it out through uncertainty and difficulty in their own organizations. That’s the mentality you want to bring into your organization. Active candidates simply don’t have that same proven track record. The risk is that often an active candidate will join your organization only to jump ship again in the near future.
Cultural Fit: The interview process should always be a two-way street, with both candidates and organizations getting a feel for whether they’re a good fit. However, when an active candidate wants or needs a role, they may be willing to mold themselves to a role beyond what’s reasonable or sustainable. On the other hand, passive candidates typically have no pressure to feign their fit, meaning your organization can get a more authentic read on whether they’re the right person for your executive team.

The Bottom Line on Contingency Executive Searches

Contingency executive searches will do precisely what they say they will: fill your executive leadership roles quickly. Taking that into consideration, contingency searches can work well for mid-level leadership roles, or roles that are short-term in nature.

However, because contingency search firms deprioritize candidate screening and your organization’s input, they’re not suited to find leaders who require the cultural fit and leadership style necessary to take your organization forward long term. Pursuing a contingency search when a highly specialized type of leader is needed could leave you recruiting again soon.

I Don’t Want to Rush a Decision, But My Organization Needs Leadership Now. What Can I Do?

Let’s say your organization’s leader left unexpectedly. How can you root your leadership recruitment in long-term sustainability while also addressing the immediate needs of your organization? It seems like an impossible task. You can pursue a rapid placement with a contingency search, but doing so can create vulnerability in the long term. You could pursue a retained search firm (which we’ll discuss below), but doing so could leave you without leadership in the short term, meaning any initiatives you have underway could stall or start moving in the wrong direction. How do you balance the two?

Interim leadership is the best method. Interim leaders can come into your organization on short notice, pick up the pieces in the wake of your prior leader’s departure, and hold things steady until the right executive leader is selected for the long-term.

Interim leadership doesn’t come without challenges. For example, they naturally face more resistance from internal teams, who may see them as tourists. However, an interim executive leader who has dealt with similar scenarios will know how to keep teams focused on what matters at the moment, whether that’s keeping key initiatives moving or stabilizing an organization that’s hemorrhaging cash and talent.

Here at Kirby Bates Associates, we can provide best-in-class interim executives to right the ship. Crucially, our interim executive leaders can stick around post-placement to assist your new executive leader while they get up to speed, preventing the potential for internal whiplash as leadership changes rapidly.

Learn more about our interim executive leadership services here.

Key Considerations for a Retained Executive Search

Third and finally, we have retained executive searches. Retained executive searches land firmly in the Goldilocks zone of precision fits and time-to-hire horizons. While retained searches don’t rival the speed of contingency searches, they tend to outpace in-house searches by about 40%. They offer the wide reach of contingency searches, although with profoundly more rigorous cultural and leadership assessment. Let’s take a closer look at what really makes retained search stand out.

1. Collaborative Approaches

The main drawback to contingency searches is how much your organization is forced to sacrifice in terms of having its needs heard and used to guide the search. For contingency search firms focused on speed, your highly-specified criteria become an afterthought.

Conversely, retained search firms work closely with your organization and its search committee to understand the environment a new leader will be entering and the key proficiencies they’ll need to adapt to your organization and help it thrive. When your organization doesn’t have a clear image of what their new executive leader needs to bring, retained search firms can change tack to an advisory role, guiding conversations with your organization’s key stakeholders, sharing insights into the current candidate market, and assessing your leadership structure’s needs. These conversations—not a particular timeline—are what ends up driving the search.

2. Confidentiality and Privacy

While there are many reasons your organization would want or need to conduct an executive search, not all of them are things you’d like to publicize. Maybe your organization is struggling, and you don’t want to highlight that in a public listing. Maybe your current leader isn’t qualified to meet the challenges facing your organization. Maybe you’re seeking a leader with a skill set that will give your organization a first-mover advantage in your local market. Regardless of the reason, you might not want to shout that you’re performing a search from the rooftops.

Retained searches are ideal for scenarios in which confidentiality is a core concern. Because retained searches lean heavily on direct outreach to passive candidates in the recruiter’s network, they remain tightly under wraps until your organization is ready to move.

This level of privacy isn’t possible with contingent firms, who often tend to use public platforms to share the role and collect potential candidates. Likewise, in-house searches can be confidential, but your search committee or HR department may struggle to identify a strong slate of candidates unless they’ve been identified well in advance.

3. Precision Candidate Fits

Given the collaborative nature of retained searches, recruiters know precisely what your organization needs. And with retained searches’ focus on passive candidates, they can reach out directly to the candidates in their network who are known to be great fits, allowing the slate of candidates to be ready in a surprisingly short period of time. Here at Kirby Bates Associates, we guarantee a slate of exceptional candidates within 30 days.

4. Minimal Administrative Burden

During an executive search, your organization faces the challenge of balancing its involvement with its bandwidth. That’s pushed to the limit in an in-house search, since your search committee or HR department will essentially take on an additional full-time role, and the balance is neglected in contingent searches in which your role is to stand back and wait for the candidates.

Retained searches help you reach the perfect equilibrium. Your organization gets to share the needs of its stakeholders and goals for the future, while the time-consuming task of finding leaders who can meet and deliver on those goals is completely managed by your retained search partner.

What to Look For in a Retained Search Partner

Specialization: There are retained search firms in every industry, as well as firms that dabble across industries. For a sector with life-and-death stakes and a demanding regulatory environment like healthcare, specialization is essential. Finding a firm that exclusively works in healthcare will give your organization the best experience.
Experience: As life goes through cycles, so too does healthcare. Working with a retained search partner that has been around long enough to see healthcare change and adapt with it means they can identify the candidates who have what it takes to steer your organization through the next cycle.
Proven track record: Any firm can talk the talk. Walking the walk is a different story. Look for a healthcare executive search firm that’s worked with leading hospitals, healthcare systems, and investment partners.

Approaches to Executive Search Summarized

The three primary methods for executing a retained search will all yield a candidate. The main differentiators are how candidates are identified, how quickly you can bring a leader in, and how well your new executive fits your organization.

In-House Executive Search Summarized

In-house executive searches may have the lowest direct costs and can be useful when your organization has strong candidates internally or locally. However, they struggle to reach candidates for highly specialized roles, and vacancies can remain open much longer than expected. As a result, they’re best suited for internal or department-level roles.

Contingent Executive Searches Summarized

Contingent searches have quick turnaround times and no upfront costs, but they achieve those results at the expense of tailored vetting and finding a spot-on cultural fit. Contingent searches are therefore most applicable when filling mid-level or short-term roles.

Retained Executive Searches Summarized

Retained executive searches offer the widest pool of candidates and the best fit for your organization’s needs, but they can take longer than other approaches. Their advisory-based, consultative approach, highly rigorous candidate vetting processes, and wide candidate reach make them ideal for identifying high-impact executives and strategic service line leaders.

Ready to Start Your Search?

Kirby Bates Associates is a retained executive search firm devoted solely to the healthcare industry. With decades of experience and deep clinical and business insight, and an unparalleled candidate database, we partner with hospitals and health systems nationwide to identify leaders who not only fit your immediate need but strengthen your organization for years to come.

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