Recruiting Physicians: Easier Said Than Done?

Judging from recent news reports, surveys and studies, many hospital CEOs might imagine physicians running — not walking — to their local hospital and pleading for employment. As of 2010, roughly 75 percent of physicians were already in financial relationships with hospitals and 44 percent of those physicians were employed.

Physicians want closer ties with hospitals, that's clear, but are hospital CEOs underestimating the external challenges that might make a mess of recruitment efforts? There are a number of economic and social factors that can either aid or exacerbate a hospital's recruitment plan. Here are a few reasons why it may not be as easy as it seems to get physicians into a hospital.

1. Some hospital markets present more recruitment challenges than others. It might be a rural location or poor payor mix. Each year, more physicians stop accepting new Medicaid, uninsured and even Medicare patients — a trend that is not helping many markets when it comes to access to care. The portion of physicians accepting Medicare patients has steadily decreased from 95.5 percent in 2005 to 92.9 percent in 2008, the latest figures available.

A recent study found roughly 9 percent of medical groups would stop treating Medicare patients completely if the 27.4 percent SGR cut takes place. That cut is scheduled to go into effect March 1 unless lawmakers pass another resolution. "The payor mix problem is growing exponentially," says Craig Hunter, senior vice president with the consulting firm Coker Group. "We're seeing a lot of physicians base their decisions on their market and the plans they'll accept," he says.

2. Workforce attrition — in both age and morale. There's a small piece of good news along with the bad news on this front. First, the bad: by 2019, the number of physicians reaching retirement age is expected to be more than twice of what it was in 2009. The physician shortage isn't news to anyone, but medical students' decreased interest in primary care and increased demand for providers due to the individual mandate are really exacerbating an already pressing workforce crisis and making it harder for hospitals to find physicians to employ.

The good news? A recent survey found 70 percent of practicing physicians plan to work longer and postpone retirement due to the poor economy and personal savings. Though they're working longer, physicians still might not be happy and obviously aren't in it for the long-term. "They might start slowing down their practice," says Mr. Hunter. "Many physicians within the next five-year window could be gone if they grow frustrated enough. A lot of physicians are at a point where they could either retire or walk away, because many are so frustrated with the increased time they spend on paperwork that takes time away from seeing patients. Just this morning, I was on the phone with a physician who said she spends 30 percent of her time on non-patient related matters."

3. Challenges in building a primary care base. Primary care physicians might not be the most difficult provider to recruit — there just aren't enough of them. "The problem is, we need more general practitioners," says Mr. Hunter. "Those in internal medicine training, typically become some form of -ologist or hospitalists." Primary care physicians have been identified as the largest cost-cutters in medicine and new care models like patient-centered medical homes and ACOs are built around them. A solid primary care base is crucial for hospitals looking to progress with new care delivery models, but the shortage is making recruitment especially difficult.

4. A hangover from the 1990s. Reports of physicians fleeing to hospitals make it seem that the bad blood between the two has vanished, but it's not that simple. "Many physicians are working under the perception of, 'I don't want to work for a hospital, but in order to survive, I might have to,'" says Mr. Hunter.

On the other hand, Mr. Hunter also says he hasn't met many hospital CEOs who are highly enthusiastic about employing physicians. When asked whether they trust hospitals, 20 percent of physicians said "no" while another 57 percent said "sometimes," according to that 2010 PwC survey.  These bad feelings likely stem from the 1990s, when a large amount of physician-hospital affiliation was fueled by fear. "A lot of people were worried about managed care, and some hospitals felt they had to align with physicians to get downstream referrals. This reality really hasn’t changed," says Mr. Hunter. "Hopefully, by focusing on quality initiatives, improved access to care, and aligned incentives, we’ll be able to better meet the demands of the changing marketplace."

Related Articles on Hospitals and Physicians:

What Does 2012 Hold for Physician-Hospital Relationships?
Healthcare Reform and Opportunities for Performance Improvement: How to Use Data to Incent Physicians, Change Behavior
4 Best Practices for Supporting Employed Physicians' Independence

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