3 Medical Specialties Most Pursued for Employment by Hospitals

Hospitals today are increasingly employing physicians for a variety of reasons, including the desire to gain more control over referrals and to be prepared for movement towards the accountable care model.  However, some specialties are markedly more sought after than others. Primary care, cardiology and surgical specialties such as neurosurgery and orthopedics are particularly attractive.

1. Primary care.
The impending move toward accountable care within the healthcare landscape is a strong reason for hospitals to enlist primary care providers. With ACOs, a core concept is that the ACO shares in savings with Medicare. To qualify to be an ACO, an organization must have 5,000 or more beneficiaries managed by primary care physicians. The primary care physicians will oversee the management of care and direct services. As such, many hospitals looking to develop ACOs are working to build up their primary care provider base.

John Narcross, a senior engagement manager with The Chartis Group, a healthcare consulting firm, says primary care physicians are a target because they serve as an entry point into the delivery system that hospitals will begin trying to create. Primary care includes traditional outpatient, hospital internists and family medicine, says Frederick T. Horton, president and CEO of Horton, Smith & Associates, a physician recruitment firm.

Janet Schwalbe, vice president of physician services at Gwinnett Medical Center in Georgia, echoes the importance of primary care providers to hospitals.  "Looking at our community survey for Gwinnett, primary care is where the patient starts and that's where healthcare reform is moving." It's critical to reach out to primary care specialists and integrate them, she says.

Additionally, there is a growing general physician shortage, further increasing the demand to snap up physicians. Several national studies have indicated a shortage of 150,000 primary care physicians over the next 10-15 years. As a result, hospitals wishing to attract physicians will have to offer competitive salaries. The average total annual compensation is $232,553 for a family medicine physician and $265,545 for an internal medicine specialist, according to data from the Delta Companies, a healthcare staffing firm. Given the primary care physician's direct power of referral, hospitals are increasingly interested in acquiring primary care providers who can then direct patients to the hospital's facilities.

2. Cardiology. Cardiology can be a big money-maker for the hospital since it is a high revenue specialty. As such, cardiologists are one of the first specialists hospitals are going after, says Chris Regan, a managing director with The Chartis Group.
Fortunately for hospitals, cardiologists are increasingly leaving private practices to join hospitals due to decreasing reimbursements. According to the American College of Cardiology, 30 percent of cardiologists surveyed said they have begun or have already integrated into a hospital. A great deal more are engaged in discussions to do so. These decreases are more easily absorbed by the hospital institution because employed cardiologists and cardiovascular surgeons generate significant revenue for the hospital.
However, hospitals can expect to pay significantly more in salary to a cardiologist compared to other physicians. The average annual compensation for a cardiologist from June 2009 to June 2010 was $583,750, according to data from the Delta Companies.

Additionally, cardiology is a critical specialty for hospitals looking to improve their clinical excellence and/or develop bundled payments. Both of these efforts are best achieved with aggressive integration actions, says Robert A. Minkin, senior vice president with The Camden Group and former president and CEO of Exempla Saint Joseph Hospital in Denver.

3. Neurosurgery and orthopedics. Finally, there is a fair amount of demand for neurosurgery and orthopedics in the surgical category. "Neurosurgery is important for the medium- to- larger-sized hospitals as it is a significant revenue generator and is viewed as a premier service that can be an image booster," says Mr. Horton. 

Ms. Schwalbe supports this trend, saying Gwinnet is planning to employ neurosurgeons. "There is a shortage of neurosurgeons and you must anchor them in your facility," she says.

Orthopedic specialists are also attractive to hospitals because their procedures pay well and will be on the rise as the population continues to age.

Marshall K. Steele, MD, CEO of Marshall Steele, a healthcare consulting firm, says his former orthopedic practice was recently purchased by a hospital and he strongly encouraged the move. "American healthcare has been all about independence for a long time, but now we need a culture of interdependence," says Dr. Steele. "Specialists bring the surgical patients with them to the hospital and it just makes total sense for both sides."

Neurosurgeons and orthopedic surgeons won't be cheap for a hospital to employ. The average annual compensation for neurosurgeons is $571,000, according to 2010 data from Merritt Hawkins, a physician recruitment firm. Orthopedic surgeons employed by a hospital averaged $404,210 in annual compensation, according to the Locum Tenens 2010 Orthopedic Surgery Salary Report. However, a recent study from Merritt Hawkins suggests an employed physician can generate revenue for a hospital in excess of 5-10 times his or her annual salary.

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