Headlines of physician shortages with their resultant programmatic and corporate sequlae have chronicled leadership efforts to maintain clinical program integrity amid growing or lengthy physician vacancies. While some searches are successful, others fail to attract the right candidate or, in some cases, any candidate. Linked to reduced medical school capacity, maldistribution, compensation, aging cohort, attractive international markets, demanding workloads and healthcare restructuring, an ominous future is unfolding for physician recruitment. It will become more competitive for facilities.