Physician Recruitment and Employment Trends (Part 2)

by Andrew Estialbo; edited by Michelle Penoyar

As healthcare reform continues to impact the United States, challenging times are certainly ahead for the physician recruitment marketplace. In the first edition of the Recruitment and Employment Trends, we discussed the latest workforce developments in primary care, cardiology, orthopedics, general surgery, oncology and gastroenterology. The following information is the second installment of the series.

Neurology. The Massachusetts Medical Society’s recent workforce study cited neurology as one of the specialties experiencing a severe shortage of physicians. In 2013, almost 50% of Massachusetts neurologists indicated they have altered and/or limited their scope of practice due to fear of being sued and lack of reforms in the professional liability system.

Another study conducted by the American Academy of Neurology (AAN) reported that the country needs 11% more neurologists to meet cognitive care needs. By 2025, it is projected there will be a 19% increase in need. The Association for Staff Physician Recruiters’ recruitment benchmarking survey reported that open neurology positions are the least likely to be filled, particularly for healthcare organizations located in communities with a population of 10,000 or less.

AAN also observed increased wait times for neurologist appointments, with times increasing from 28 business days in 2010 to 35 business days in 2012. AAN also cited that face-to-face time with neurologists is undervalued by today’s Medicare payment system. Medicare is offering inadequate reimbursement, causing many residents and physicians to sub-specialize or find more financially rewarding specialties.

Emergency Medicine. As the Affordable Care Act continues to reshape American healthcare, emergency medicine is expected to face critical shortages in physician supply. A 2011 Harvard Medical School report noted that ER visits in Massachusetts increased in 11 healthcare facilities after implementations of the state’s 2006 healthcare reform. The 2012 version of the same report observed that Medicaid patients were two times more likely to utilize ER services than those patients with private insurance. The ACA will increase the number of people with insurance coverage and these newly insured individuals are those who are more likely to utilize the ER.

A recent survey by the American Hospital Association reported that hospital closures decreased the number of ERs in the country by 650.  According to the Journal of the American Medical Association, one in four ER departments in non-rural communities has closed in the past 20 years. These closures leave many remaining ERs to operate at full or over capacity. In a study of one million ER visits, the Annals of Emergency Medicine noted that overcrowded ERs often meant longer stays, higher utilization costs and a five percent increase in mortality risk. One California hospital was so overcrowded that it closed its ambulance traffic for 100 hours in January 2013 and another 50 hours the following month due.

The increase in ER visits is creating a more competitive employment marketplace. A career report by the American College of Emergency Physicians (ACEP) shows that the states with the most emergency medicine positions are Texas, Ohio, California, Florida, New York, Georgia, Tennessee, Pennsylvania, North Carolina, and Virginia. Compensation for ER physicians is based on the geographic location of the facility as well as physician supply and demand in the community. More hospitals are offering increased reimbursement with employers in the Midwest, Southeast and some parts of the Western region offering $200 per hour or more. Some specific states that are offering a relatively higher compensation include Wisconsin, Iowa, Illinois, Texas, North Carolina, Ohio, North Dakota, South Dakota, Tennessee, Indiana, and Oklahoma.

Pathology. Pathology is a specialty that is experiencing a greater number of residents entering fellowships to further subspecialize. In a survey by the American Society for Clinical Pathology, 95% of residents pursued fellowship training and 35% of these residents noted interest in pursuing multiple fellowships to achieve specialty-specific skills and gain experience for future employment. The most popular fellowship programs include surgical pathology, cytopathology, hemapathology, GI/hepatic pathology, dermapathology and transfusion medicine.

Fellowship-trained pathologists have differing annual compensation. Those subspecialties that reported a salary of $200,000 or more include 50% of hemapathologists, 50% of pediatric pathologists, 25% of neuropathologists, 15% of forensic pathologists and 8% of transfusion medicine pathologists. In comparison, 56% of pathology residents who accepted job offers from their own residency programs had a salary range of $100,000 to $200,000.

Hospitalist. Hospital medicine is continuing to become necessary in the delivery of health care across the country. The demand for hospitalist services is increasing, which translates to increasing employment opportunities for many doctors. In fact, the Society for Hospital Medicine noted that there are currently 40,000 practicing hospitalists in the country, a significant amount compared to 1,000 hospitalists during the mid-1990s.

Beyond the growth and need for hospitalist medicine, there are emerging trends that are affecting the specialty today. One trend is that healthcare organizations are consolidating hospitalist services by acquiring additional hospitalist and post-acute groups. An increasing number of small hospitalist groups are driven to seek partnerships with larger organizations to address issues in infrastructure, recruitment, training, capital investment, and regulatory requirements.

Another emerging trend is that healthcare facilities are outsourcing their hospitalist services to hospitalist staffing companies instead of employing them. Hospital medicine is one of the top five most outsourced specialties in terms of patient care services.

Infectious Disease. Recent industry surveys show that infectious disease remains to be one of the lowest paid specialties with physicians earning an average annual salary of $174,000. Infectious disease physicians in western and southeastern areas earn the highest, while those in north central and northwestern regions earn salaries as low as $117,000. Infectious disease physicians employed by healthcare facilities are offered as much as $209,000 and those who are in private practice earn $204,000. Salaries for those in academic, research and government settings as well as outpatient clinics range between $158,000 and $164,000.

Many infectious disease physicians work for Accountable Care Organizations (ACO), with 25% currently employed and an additional 10% expected to join this year. ACOs provide doctors with various payment models aside from fee-for-service. Some of these payment models include shared savings programs, advanced payment for physicians in a rural settings and the Pioneer ACO Model.

Many private practice physicians use ancillary services to bring in additional revenue with 33% of self-employed infectious disease physicians offering ancillary services such as vaccinations, tuberculosis testing, and radiology services.

Urology. Urologists are experiencing many changes within their specialty. A Urology Times survey reported that urologists in solo practice declined from 37% in 2006 to 29% in 2012. During this same time period, those urologists who joined single and multi-specialty practices increased from 57% to 71%. Urologists see work-life balance and higher compensation as the main advantages of being employed by healthcare facilities and joining bigger practices. It also decreases their financial risk, administrative responsibilities, and practice management burdens.

There are approximately 9,500 urologists in the country. In terms of physician supply, urology has suffered from a 10% decline in physicians. In 2009, the physician-to-population ratio was three urologists for every 100,000 patients. According to the American College of Surgeons, 58% of all counties in the United States do not have access to a urologist. Geographic distribution is also an issue, as the ratio of urban to rural urologists is 7:1.

Urology is one of the specialties with the oldest physicians, second only to thoracic surgeons. Out of all urologists in the United States, 44% are over age 55, 18% are age 65 and older, and 8% are age 70 and older. Some of the strategies that healthcare groups use to deal with the shortage of urologists include utilization of primary care physicians, advanced practice providers, telemedicine and retail clinics. will continue sharing the latest physician recruitment and employment trends in various medical specialties. Our third installment is coming soon.

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