Competition for physicians remains intense as the younger generation, seeking a lighter workload, exacerbates the doc shortage
According to a story circulated at the Society of Hospital Medicine's sold-out annual conference this past May in Chicago, one healthcare executive attending was said to have voiced concern about all the recruiters and staffing agents working the booths. Apparently, he was afraid that if the staff physicians he brought with him visited the exhibition floor, he could lose them to another organization.
“It's a concern for hospitals; they are concerned about loss of talent because it is very competitive,” says Rusty Holman, chief operating officer for Brentwood, Tenn.-based Cogent Healthcare, whose roster of about 350 physicians provides hospitalist services for facilities in 20 states. “They say for every hospitalist there are five or six job opportunities. I don't know if that's entirely accurate, but it is a fiercely competitive environment.”
Holman, who was the 2007-08 president of the SHM, says that he doesn't doubt the story of the skittish executive is true.
“The exhibit hall was sold out well in advance of the meeting, and 45% of the exhibitors were registered as recruiting or staffing,” Holman says. “And I have a feeling there were others there for multiple purposes—of which staffing may have been one.”
Recruitment of physicians is indeed getting more competitive and threatening to become a full-contact sport. Irving, Texas-based recruiters Merritt Hawkins & Associates reports a 15.8% jump in business, conducting 3,288 physician and certified registered nurse anesthetist searches between April 1, 2008, and March 31, 2009, compared with 2,840 searches for the same period between 2005 and 2006.
Along with staffing and recruiting firms like Merritt Hawkins, many healthcare organizations employ their own recruiters. More than 1,200 of these workers belong to the Association of Staff Physician Recruiters, or ASPR, a 19-year-old organization based in St. Paul, Minn., that just released its first snapshot of who recruiters are and what they do.
The new Recruiter Benchmarking Survey, which is based on 2007 data, includes information on more than 4,700 physician searches conducted by 350 in-house recruiters covering almost 200 departments. The data were then analyzed by the Medical Group Management Association and compiled in a 118-page report.
“We need more participation,” acknowledges Brett Walker, ASPR president and director of physician recruitment for the Indiana Clinic, a partnership between the Indiana University School of Medicine and Clarian Health, a six-hospital system based in Indianapolis. “But, in three years, this will be the gold standard on physician recruitment and retention.”
Walker says he believes members of his organization were a little “gun-shy” about reporting so much information about their searches, so only about 25% of members participated in the inaugural survey. He expects that to double next year and then steadily increase each year thereafter.
“The industry has been starving for this,” Walker says. “Up until this survey, there's nothing out there with good measurable data. We needed to develop a tool to measure best practices.” Another use for the survey, Walker says, is to educate hospital executives on the fact that “doctors are not just falling out of trees.”
“I got a call yesterday: ‘Brett we just lost two neurosurgeons, and need one immediately,' ” Walker recalls. “I say: ‘OK. I'll stop off at the grocery store and pick one up on my way home.' ”
Walker says two factors are contributing to the increased competition for doctors, with one having to do with sheer numbers and the other being generational as younger physicians are not seeking to work the same number of hours as their predecessors.
“We're going to be in a constant recruitment mode because of the physician shortage,” Walker says. “Also, we almost need to find two doctors to replace retiring physicians who worked 70 hours a week their whole career.”
Cogent's Holman says workload limits have become a key to organizations landing the right physician, but he adds that they also contribute to the problem. “If the marketplace responds to a physician shortage by having physicians work less, you've fundamentally exacerbated the shortage,” he says.
The key findings of the ASPR/MGMA survey were relatively predictable: Primary-care physicians are in high demand and, in general, physician searches take longer and cost more in the Midwest. For this study that region is composed of Illinois, Indiana, Iowa, Michigan, Minnesota, Nebraska, North Dakota, Ohio, South Dakota and Wisconsin.
Primary-care specialists dominated the top in-demand categories of the survey (See charts.)
A search to attract an anesthesiologist to the Midwest took a little less time than a search in the East—a median of six months compared with five—but cost a lot more: roughly $25,400 for travel, lodging, entertainment, meals, advertisements and fees, compared with about $4,400, the survey found.
The states with the most physician searches conducted by in-house recruiters were Minnesota, with 677; Pennsylvania, 547; North Carolina, 498; Illinois, 320; Wisconsin, 257; and Missouri, 248. And while it cost just under $13,000 to find a hospitalist/internist for a Midwestern position, the median cost was about $5,100 for the South and $1,200 for the West.
A large percentage—almost 40%—of the recruiters responding to the survey were from the Midwest.
“Why? Because it's the toughest sale,” Walker says. “We don't have oceans; we don't have mountains. We don't have anything exciting. You don't have to sell New York.”
“For whatever reason,” Walker also says, the survey found that in-house physician recruiters are overwhelmingly female: 83.2% vs. 16.8%. And almost 57% of all recruiters have a bachelor's degree while about 20% have a master's.
For the field as a whole, median in-house physician recruiter's compensation is generally in the low $60,000 range except in the West where it's $50,000. Otherwise, compensation depends on title. Physician recruitment directors had median compensation of about $90,300; managers made $67,400; recruiters, $60,000; and coordinators, $38,200.
Walker says the field is adapting to its changing world, which now finds 80% of physicians launching their searches online and 75% of physicians staying in their positions only two to three years at a time.
Adapting to these factors, Walker says he never makes an initial contact with a doctor by telephone anymore and that reference calls and background checks aren't made until near the end of the process.
“With a resident or fellow coming out of training, they're interviewing at six different places, and I wouldn't want my program director to be hit up six different times,” Walker says. So he holds off until the call is vital to the process. “We don't initiate background checks unless we're about to give an offer—and often offers are given pending background checks and references.”
Other game-changers include having to help a physician's spouse or significant other find a job in the community and dealing with relocation difficulties stemming from physicians not being able to sell their homes in a timely fashion.
Travis Singleton, vice president of marketing for Merritt Hawkins & Associates, says some organizations are going to great lengths to accommodate the physicians they want to bring into the fold.
“Hospitals will say, ‘I'm going to buy your house,' if they have a neurosurgeon and that's what's standing in their way” of them joining the organization, Singleton says.
Signing bonuses are becoming customary, and another tactic more hospitals are using, Singleton says, is to increase signing bonuses by the amounts physicians lose selling their homes.
Walker says he likes to limit the hiring process to one or two interviews, with the second being mostly for final negotiations and to allow the physician to do some house hunting. He also recognizes that he may be footing the bill for other recruiters.
“If I fly someone out here for an interview, I can almost guarantee they're also interviewing with the competition,” he says.
Search firms can work with in-house recruiters by taking some of the more intensive searchers off the in-house recruiters' plates, Singleton explains.
“There are over 1,000 of us and this is all we do,” Singleton says. “We may have 10 to 15 people touching a search.”
Search firms can also help by filtering out unqualified candidates or those who may be qualified but appear unlikely to be a good match for a particular environment, Singleton says. But he adds that this can backfire when clients are so impressed by a handful of candidates that they begin to believe all of the job seekers are as qualified as the ones they just interviewed. That's when recruiters are instructed to organize what Singleton calls “a beauty pageant.”
“After a great search process, they say, ‘They were great, let's see who else is out there,' ” Singleton says. “They didn't see the frogs that had to be kissed to get them that prince.”
That said, Singleton adds that recruiters are being given more authority to be flexible in adjusting offers. “The days of going back to the board to get an OK are through—the candidate is gone by that time,” he says. “They're being approached earlier and more often and in more creative ways.”
Holman says young physicians are looking for mentorship, and one way his company provides it is through professional development programs offered at its Cogent Academy. “If McDonald's can have its Hamburger University, we can have Cogent Academy,” he says. “It's all designed to round out training you previously received but on things that were not well-covered such as quality improvement methods, coding and billing, or leadership and management skills. You don't get any of those things in medical school.”
Holman says Cogent's goal is to match candidates with the environment that suits them best—such as opportunities for independence or teamwork depending on which they prefer.
“I think it is important to compensate fairly, but compensation is more of a ‘dissatisfier' than it is a satisfier as no amount of compensation can make up for a position that has many other shortcomings,” he says. “I talk to a lot of physicians who are compensated very highly but are still rather unhappy.”
Holman says technical support is also important, as is having critical-care nurses, case managers and others who are just as dedicated to quality improvement as the physicians.
“We also offload administrative functions that physicians are neither trained to do nor enjoy doing,” Holman says.
And then there are situations where things just don't work out. Holman tells of one physician Cogent hired who had a wife and young child. The doctor went to work at a hospital in a small Texas town while his wife looked after their child. Although the arrangement worked for a while, when the child was old enough to attend school, the wife wanted to re-enter the workforce but there were no opportunities, and soon after the doctor and his family left.
For job candidates, however, Singleton says spousal discontent with a community is often used as a tactful way to turn down an offer—especially an offer made by an in-house recruiter because candidates will always view them as a potential employer down the road, and the candidate doesn't want to burn any bridges.
“That's the easiest answer to for them to tell you,” Singleton says. “Maybe they didn't like your money, didn't like your space or didn't like the rotation. But what's the easiest thing to tell you? My wife or husband didn't like their fit with the community.”
Of course some physicians just suffer from the grass-is-always-greener-someplace-else syndrome, recruiters say.
“There is no utopia. I tell that to people all the time,” Singleton says. “I say, ‘Doctor, you don't need a recruiter; you need a travel agent.' ”
Editor's note: This is an expanded version of an article that appears in the Oct. 12, 2009, issue of the Modern Healthcare print edition.
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