RSS FeedTop 8 Physician Recruitment Trends Of The Decade
28 December 2009If you’ve been in the physician recruiting business as long as we have, you’ve seen a lot of changes in physician recruitment and medical practice over the years. Throughout the decade, the first one of the new millennium, many trends have emerged amongst candidates, hospitals, and recruiters. For better or for worse, these trends have altered the way hospitals and practices attract, recruit, sign, employ, and retain physicians. A variety of factors have created these trends over the past ten years, including population shifts, changes in the economy, and generational differences in younger physicians entering the workforce.
Below is a list of the trends from the 2000s which, in our experience, have made the most significant impact on physician recruitment, from 2000 through the present.
1.) Hospitalist Boom – the division of inpatient and outpatient labor has been the most significant trend in physician recruiting, as it not only affected the way primary care physicians are recruited, it created an entirely new recruiting market, for physicians who practice inpatient care only.
What’s Next? The hospitalist boom is already beginning to catch on in some other specialties, especially OB, as many physicians seek “laborist” jobs where they can remain on call at a hospital to deliver one baby after another, allowing the office-based OB/Gyn physicians to focus on office visits, without having to worry about OB delivery call.
2.) Shift in Demand from Specialists to Primary Care: In the early 2000s, specialists such as radiologists, cardiologists, and surgeons were being courted like top NFL draft picks. However, the aforementioned hospitalist trend has exacerbated a shortage in the primary care physician market, which was already feeling a strain, as internal medicine residents increasingly chose more lucrative careers in specialty medicine over primary care.
Therefore, while specialists and surgeons are certainly still in high demand, and are being recruited heavily, the most critical physician recruiting need across the board is now for primary care physicians, including both internists and family medicine physicians.
What’s Next? With the passing of health reform, the primary care physician supply shortage will be further intensified. Some experts are predicting that mid-level providers, such as physician assistants and nurse practitioners, will fill in some of the primary care gaps, a solution many feel is not ideal.
3.) Hospitals Employing Physicians Outright: Hospitals have reluctantly and increasingly taken on physicians as employees, to keep from losing them or to attract new providers to the area. Many smaller practices have been forced to close, due to declining reimbursements and increasing overhead, so hospitals are buying the practices, and/or employing the physicians to keep them in the community. The hospital absorbs the additional overhead and practice costs. According to the AMA, nearly one third of all physicians are employees of a medical facility or corporation. Kevin Perpetua, managing partner, feels that the actual number of employed physicians is closer to 50% or more. “The AMA’s total does not include many physicians who do not update their status with the AMA, or those who work for hospitalist groups, for example. Therefore, most likely half of all physicians, or more, are now employed, as opposed to practicing as owners of their own practice. We estimate that this is at least triple the amount of physicians who were employed at the beginning of the decade.”
What’s Next? It’s difficult to predict how this trend will play out over the next ten years. Much depends on the economy and on health reform, but with hospitals absorbing more and more costs, it seems that this trend is very detrimental to hospitals’ financial stability and viability. Therefore, we may begin to see many hospitals, particularly smaller ones, closing down under the economic burden.
4.) Increase in Diversity of the Physician Workforce: In some segments of the population, physician diversity still lags behind the diversity in the general population. However, the diversity of the physician work force has steadily increased over the years. In 2000, according to an AMA study cited by the HRSA, about 74% of the physician workforce was Caucasian. That number had decreased to about 53% or less by 2004, and most likely has decreased even further since that time. At least a fourth of physicians are internationally trained.
The increase in female physicians has also impacted physician supply and recruitment, and will continue to do so. About half of all medical school graduates are women, who also are often responsible for the majority of childcare, family, and household needs. “It has been reported that women who practice medicine tend to practice about 10 fewer hours per week, and retire an average of 15 years earlier than their male counterparts,” states Jim Stone, managing partner of The Medicus Firm.
5.) Earlier Recruitment of Residents and Fellows: In 2000, it was highly unusual for a resident or fellow to begin his or her practice search more than a few months prior to graduation. Due to multiple factors such as increased competition for new doctors, as well as the uncertain economy, many physicians want to sign on with a practice well over a year before they finish training. According to Jim Stone, practices and hospitals are also offering monthly stipends to residents and fellows of about $1,000 – $2,000 per month throughout the last year of training, to help solidify the physician’s commitment to come on board. Additionally, The Medicus Firm is currently working with several 2011 graduates who are actively interviewing, and a number of them have recently signed a contract with our client(s) and completed their search.
6.) Increased Signing Bonuses: Over the past decade, we have seen signing bonuses increase in prevalence and dollar amount. This is yet another trend that has been caused by the growing competition and demand for physicians. As hospitals and practices try to set themselves apart from the competing facilities, signing bonuses have increased from the early days of $10,000 here or $25,000 there, to $50,000 and above, with some reaching into the six figures!
7.) Shorter Partnership Tracks: Partnership tracks have decreased in length so much, it seems that they may be about to go the way of the dinosaur. Jim Stone states “Partnership tracks are now just one year as a general rule, where we used to see a lot of two-, three-, and even five-year plans. When recruiting physicians, the competitiveness of the market just doesn’t allow for practices to skim additional revenue off of incoming doctors as they could before. Now, the buy-ins, when they are still required, are purely based on the net depreciated asset value of the practice with no goodwill built in, which is different than in years past.”
8.) Quality of Life Becomes Top Priority: Quality of life, including work load, call schedule, and hours, has become a top priority for physicians seeking new practice opportunities. According to Bob Collins, managing partner, while quality of life has always been among the deciding factors for physicians, it is now the most important factor for many as they evaluate practice opportunities. Physicians’ primary concern has gone from “how much money will I make” to “how much to I have to work to earn the income needed to provide for my family?” Adds Collins, “I think this trend speaks to the lifestyle focus of newer physicians, that we didn’t often see in years (or decades) past.”
Honorable Mention / Future Game-Changers:
In addition to the above trends, there are a few growing trends that have emerged this decade, but haven’t yet made a significant impact. However, we feel these may be game-changers in coming years:
- Concierge Medicine
- Retail Medicine
- Specialized Contracting Recruiting Firms for Shift-based specialists (ER, Hospitalist, Radiologist firms)
What are your thoughts on these trends, and the impact they’ve made on physician recruiting? How do you think the next decade of physician recruitment will unfold? Please feel free to share your perspective on the past and future of physician recruitment and physician careers in medical practice.
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February 2nd, 2011 at 3:07 pm
Good review, thank you!
February 2nd, 2011 at 3:27 pm
Thank God that partnership traccs are shortening. I have seen too much open abuse of incoming physicians in the name of “you got to pay your dues”. Good for physicians! Your description “skim from the top” is an understatement. Many physicians lost up to 80% of their collections to greedy managing partners in the past.
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