From hello to hired, with Trent Cotton of iCIMS

Health care hiring is in a strange place. Clinical job applications jumped 10% at the start of 2026, yet the gap between open positions and actual hires keeps widening, a sign that getting candidates in the door is only half the battle. In this episode, Medical Economics Managing Editor Todd Shryock speaks with Trent Cotton, head of talent insights at iCIMS, about what the data reveals and what physician practices can do with it.

Cotton explains why so many candidates drop out between the application and the offer, how smaller practices can out-recruit enterprise hospital systems by competing on candidate experience and why pay transparency in a job posting keeps the hiring funnel clean. He also digs into the friction that drives applicants away, the two factors that most influence whether staff stay and where AI genuinely belongs in hiring, from automated scheduling to the conversations that should always stay human.

Don’t miss our recent episodes on the No Surprises Act IDR rule 2026, selling your practice, urgent care and cash-only practice.

Music Credits:

Steady State of Mind by Yigit Atilla - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:26 | Sponsor message Copic medical liability insurance.

0:26 – 0:57 | Cold open Cotton frames the question driving the episode: how do practices fast-track top talent from hello to hire?

0:57 – 1:39 | Introduction Austin Littrell introduces the episode and guest, previewing what the latest data reveals about health care hiring and how physician practices can compete for talent.

1:39 – 3:14 | What's behind the surge in clinical applications Todd Shryock opens the conversation, and Cotton explains the January jump in clinical applications, tying it to post-pandemic turnover leveling off and clinicians looking for better compensation.

3:14 – 4:35 | Why hires lag behind openings Clinical openings are up far more than actual hires. Cotton points to a steep drop-off after the application, the gap between recruiter and hiring-manager interviews and the bureaucracy of offer approvals, with the fastest-moving practices winning.

4:35 – 5:57 | How a small practice out-recruits a hospital system Cotton's answer is candidate experience. He argues smaller practices win by making hiring feel personal and frictionless, citing survey data that 60% of candidates abandon applications that are too long, opaque on pay or unclear on qualifications.

5:57 – 8:17 | Compensation and the case for pay transparency Cotton says the data doesn't show practices have regained leverage on pay, and makes the case for listing compensation in the posting: it keeps the top of the funnel clean and avoids wasting everyone's time, even as he acknowledges why some employers hesitate to post pay.

8:17 – 10:55 | The non-clinical side Non-clinical applications are outpacing both openings and hires. Cotton attributes the slow pace to the same screening and scheduling bottlenecks, and urges understaffed practices to build a pipeline now, re-engaging strong past applicants before the candidate pool tightens.

10:55 – 11:47 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

11:47 – 13:44 | Removing friction from hiring Cotton defines friction as any point where candidates drop off, and explains how AI-driven skills matching and job simulations are reshaping the process, including a notable shift among Gen Z candidates who now prefer assessments to compete on skills rather than résumés.

13:44 – 14:46 | What drives retention Retention comes down to two things, Cotton says: hiring for genuine skill fit and giving employees a visible career path, especially in high-volume and entry-level roles where people often leave simply because they can't see a future internally.

14:46 – 16:33 | Where AI belongs in hiring Asked whether a hands-on practice has an edge over a hospital using AI, Cotton, a self-described AI advocate, says it depends entirely on where it's applied. He keeps the hiring-manager interview, the deeper recruiter conversation and the offer human, and automates much of the rest.

16:33 – 17:28 | The next 12 to 18 months Cotton points to growing concern about a shrinking candidate supply, and says recruiters are already getting creative, partnering with local universities to build talent pipelines and shape curriculum.

17:28 – 18:43 | Final advice and close Cotton's parting advice: map your candidate journey, decide what only a human can do and what can be automated, then share that roadmap with applicants for transparency. Todd Shryock thanks Cotton.

18:43 – End | Outro Austin Littrell thanks the guest and wraps the episode.