Recruiting Physicians Takes Twice as Long as a Decade Ago

It takes twice as long to recruit a physician today than it did just a decade ago, due to a growing shortage that is expected to worsen as demand for physicians grows and supply remains flat, says Travis Singleton, vice president of marketing at Merritt Hawkins, a physician-recruiting firm in Irving, Texas.

In 2002, he reports, it took 2-3 months on average for Merritt Hawkins to find a physician for a hospital, group practice or other client. Now it takes 7-9 months and by the time the physician has moved and begun his new job, about a year has elapsed, he says.

Mr. Singleton says many hospitals have suspended recruiting, preferring to wait and see how healthcare reform and the financial recovery will play out, but he thinks that's a mistake. "The reality is that the need for more physicians is not going away," he says. "Hospitals that wait a year or two will find that it even harder to recruit the physicians they need."

Demand rises for generalists, falls for specialists

Demand for physicians is greatest in primary care, Mr. Singleton says. "For the last three years there has been a 20 percent increase in requests for primary care physicians each year," he says. And the demand is still rising. In the first quarter of 2011, Merritt Hawkins saw a 20 percent increase in primary care demand over the first quarter of 2010. The reason for all this growth? "Hospitals were taking their primary care physician network for granted," Mr. Singleton says. "Now they recruiting to rebuild those networks."

Specialist demand, in contrast, has been falling. A decade ago, hospitals were investing heavily in service lines like heart, oncology and orthopedics, Mr. Singleton says. Then specialty care started losing money. Requests for cardiologists, who took a big hit in reimbursements, have been falling by 20 percent a year, he says. Demand for gastroenterologists, anesthesiologists and radiologists is also down, while orthopedics demand is just a bit off, he says.

Origins of the impending shortage

Even though specialist demand has been falling, it will eventually recover because of the impending overall shortage of physicians, Mr. Singleton says. The current shortage got its start in the 1990s, when healthcare policymakers perceived a glut of physicians. Congress froze Medicare-funded residency training positions in 1997 and the number of slots has not risen since then.

Now U.S. medical schools are dramatically expanding their class size, but the number of residency positions still has not increased in 14 years. With the total number of residency slots static, U.S. medical students are likely to push foreign-trained physicians out of training programs, but the total of new physicians isn't increasing, Mr. Singleton says. Now, faced with huge budget deficits, the federal government may not have the will to expand slots. "It would take another $5 billion to $10 billion a year in federal spending to train the physicians we need," he says.

Compounding the shortage is young physicians' growing desire to work shorter hours. This means more physicians are needed to do the same work. Some young physicians are asking for flex schedules, under which they can work half the normal time, Mr. Singleton says. Moreover, almost half of U.S. medical school graduates are women, who, on average, work 0.67 of the time of their male counterparts, he says.

Growing demand for midlevels

As it becomes harder to find physicians, Merritt Hawkins has seen a growing demand for midlevel providers, especially nurse practitioners and physician assistants. The company has experienced a 15 percent yearly growth in requests for NPs and PAs, mostly from group practices. But Mr. Singleton sees midlevel providers as only "a band-aid solution" to a physician shortage. The shortage, he says, will worsen in the huge expansion of covered patients in 2014 that is planned under the healthcare reform law. "The Massachusetts reform law is a harbinger of what will come in federal reform," Mr. Singleton says. "Patient waits to get an appointment in Massachusetts have been going through the roof."

Learn more about Merritt Hawkins.

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