Hospital Physician Specialists: To Hire or Not to Hire

Hospital hiring of physician specialists ebbs and flows, driven by reimbursement climates.

According to the American Academy of Orthopaedic Surgeons, hospital employment of orthopedic surgeons nearly doubled from 2.2 percent of surgeons in 1990 to as high as 4.3 percent in 2003, but had dropped to 4 percent by 2005, the most recent year for which data was available.

Hospitals face great challenges in recruiting from within a shrinking pool of physician specialists, according to hospital executives, orthopedic consultants and physician recruiters.

The American Medical Association reports that there are only 22,375 practicing orthopedic specialists in the United States, but that figure has remained virtually static. In 2007, 558 specialists completed orthopedic residency programs, compared to 557 in 2008.

Cheryl DeVita, senior consultant with St. Louisbased recruiting firm Cejka Search, says there is a shortage of orthopedic surgeons that isn't being replenished through residency programs. "Of that 22,375, only 8,639 are under the age of 45. The candidate pool is growing smaller. They are in great demand. And unless your hospital is located in a place people want to be, recruiting orthopedic surgeons is going to be difficult,"says Ms. DeVita, who pointed out that nearly as many orthopedic surgeons retire annually as enter the field.

When existing arrangements won't help hospitals in recruiting orthopedic surgeons with income guarantees or other incentives, "sometimes hospitals just have to bite the bullet and hire them at the market rate,"Ms. DeVita says.

And that's neither cheap nor easy.

In a 2007 compensation survey conducted by Cejka, the American Medical Group Association found orthopedic surgeons, on average, commanded $436,481 annual salaries, with spine and joint replacement sub-specialists reaping an average of more than $500,000.

Ms. DeVita says sometimes existing orthopedic groups don't want added competition and won't recruit themselves or are reluctant to pay market rates. Many orthopedic groups won't guarantee that the recruited surgeon will be able to pursue their chosen sub-specialties and are only seeking on-call coverage.

Kellie Risser, a consultant specializing in orthopedics in Columbus, Ohio, says there's only one reason to employ a specialist: "If you can't get one into your market any other way."

Ms. Risser says she hasn't seen hospital hiring of orthopedic surgeons work successfully, noting, "The specialist who wants to be hired is probably not the one you want."

Harry Herkowitz, MD, chairman of orthopedic surgery at Royal Oaks, Mich.-based William Beaumont Hospitals, says it's appropriate to hire physician specialists in those sub-specialty positions not filled by community-based orthopedics specialists.

"If local, private groups aren't currently offering those services, you might look at hiring someone to take over a sub-specialty not currently covered in your hospital,"says Dr. Herkowitz, who cited orthopedic oncologists as an example of a sub-specialty in demand in urban markets.

"Most orthopedic surgeons won't remove tumors, he says. "Also, some smaller community hospitals have difficulty covering trauma services and would otherwise have to send patients to other hospitals offering those services. Under those circumstances it might be advisable to employ a sub-specialist."

But Dr. Herkowitz, who says Beaumont hospitals do not hire orthopedic specialists, acknowledged that there can be drawbacks.

"Sometimes employed physicians have the mindset that they don't have to push that extra bit because they are being paid regardless of how hard they work,"he says. "Productivity can be an issue. Doctors on salary aren't always as motivated as those who are paid for the procedures they do."

Victor Dipilla, vice president of operations at The Christ Hospital of Cincinnati, says hiring physician specialists can prove "to be a slippery slope. Once you do it, you have to be prepared for the consequences. This is an issue we're grappling with now."

Mr. Dipilla says it's appropriate for a hospital to hire a specialist when it requires those specialty services, but low reimbursements or high medical malpractice rates make survival difficult in that market.

"Some hospitals are beginning to hoard cardiologists,"he says. "Another circumstance might be when you can't otherwise attract those specialists to your hospital and need them. In our case, we're studying this issue."

Anna Silva, vice president of ancillary services for Our Lady of the Lake Hospital in Baton Rouge, La., says hiring specialists should be a last resort. "I personally prefer working with existing community specialists,"says Ms. Silva. "But if the quality is not there in the community, or if they exist, but are not engageable, you may have to look elsewhere. It's not my first step, but it is an idea."

Contact Mark Taylor at markic46321@yahoo.com.

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