Executives at two top national physician-search firms, Merritt Hawkins and Jackson & Coker, identify three medical specialties that have experienced declining demand and explain the reasons why.
1. Cardiologists. "Cardiologists took a big hit in terms of demand in the past few years," says Travis Singleton, vice president of marketing at Merritt Hawkins. The company's requests for cardiologists have been falling almost 20 percent per year. Jackson & Coker has also seen significant declines in demand for the specialty. Cardiologists have been experiencing lower reimbursements and have had to contend with introduction of new pharmaceuticals to treat heart conditions that internists can prescribe, says Tim Sheley, vice president of Jackson & Coker Permanent Placement. "The same work the cardiologist did is now being done by the general internist," he says. "The internists can blend it into their practice." However, demand is still strong for interventional cardiologists, Mr. Sheley says.
3. Radiologists. The growth of telemedicine has reduced demand for radiologists, Mr. Sheley says. Companies like Foundation Radiology Group and Radisphere use a combination of locally placed radiologists and specialized radiologists at their headquarters. Mr. Singleton at Merritt Hawkins adds that another factor in the demand is a reduction in reimbursements under the deficit reduction act.
3. Anesthesiologists. Merritt Hawkins has seen a decline in requests for anesthesiologists due to increasing use of certified registered nurse anesthetists, Mr. Singleton says. He says CRNAs' pay is significantly less than that of anesthesiologists. In 2001, CMS began allowing states to opt out of a federal requirement that a surgeon or anesthesiologist must oversee the provision of anesthesia by CRNAs. By 2005, fourteen states had exercised this option.
In contrast, family medicine and internal medicine have been the most requested specialties since 2004, Mr. Singleton says. He says these categories have seen a 20 percent increase in requests each year for the past three years and demand is still rising. He says there are more geriatric patients who are turning to internists, and family physicians are being recruited to rebuild neglected referral networks. Also, many of the new physicians are female, and they work on average, 0.67 of the time of their male counterparts.
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