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It’s no secret that the physician shortage has impacted physician recruitment in the rural areas of our country for more than a decade. Those struggles continue, but now even our largest metropolitan areas are feeling the effects of the shortage. The Association of American Medical Colleges (AAMC) in its 2017 updated report titled, The Complexities of Physician Supply and Demand predict a shortage of 34,000 to 88,000 physicians by 2025, increasing to 40,000 to 105,000 by 2030.
…2025 is a short six years away, and the impact of this very real shortage is already upon us.
When the report was released in 2008, many of us felt the issues and implications sited were problems for a distant future, but now, 2025 is a short six years away, and the impact of this very real shortage is already upon us. If you have recruited or had a failed attempt to recruit a Family Medicine physician to a rural area you know all too well.
What are the contributing factors? How will we remedy them? How severely will your facility and community be affected? What can you do now to weather the storm that is coming if not already upon you?
While it may seem bleak at the moment, there is a solution. Let’s rephrase, there are several solutions, and it’s going to take all of them, along with a few we have not thought of yet to remedy the shortage. Here’s an excellent place to start.
While we all play a part in these large national focused solutions, there are solutions you can employ right now in your facility. Preparation and strategy will help you weather the shortage that will be the demise of many who are ill-prepared for the increasing challenges on the horizon.
Finding the right physician recruiting partner or employing your own in-house recruiting team is likely already a large part of your physician recruiting strategy. If you have a trusted physician recruiting firm placing providers for you, stick with them. If you don’t, find one. Experience and the quality of character in your recruiter are of the utmost importance. Second to that, is the quality of the sourcing tools they have at their disposal and how they leverage those tools.
Communicating your position to the market in a robust way that cuts through the noise of the competition is a complex task. You can’t build a home using only a hammer, and you certainly can’t recruit a physician with just one sourcing method. Physicians communicate and receive information differently. Text or e-mail may be the preferred method for some, especially the younger physician market, while more seasoned providers may prefer an email followed with a phone call. Finding and utilizing the smartest technology to communicate your opportunity across multiple platforms to ensure you’re getting the message out to the right market with the best analytics is key to your physician recruiting success.
Even if there are significant changes to improve the current physician shortage, it will take years to take effect in any meaningful way. Understanding your unique challenges and developing a physician recruitment strategy will put your facility in a better situation than those who do nothing or continue with outdated methods. Preparation, innovation, and strategy are crucial to weathering the shortage.
Active marketing finds passive candidates while passive marketing finds active candidates.
Passive versus Active Candidate
The Passive Candidate – A passive candidate is someone who is interested in pursuing new opportunities but has not yet taken any action to put themselves into the open market; therefore, they are not getting solicited day and night from every physician recruiter in the country.
An interested passive candidate is the best candidate you could interview for one simple reason. These candidates have less competition on them than the candidate who is actively looking for opportunities.
Given how competitive physician recruiting has become now that we are in the throes of a real physician shortage having a captive audience with a candidate, or at least diminishing the number of other opportunities they are looking at increases the odds of actually signing them.
Sourcing the passive candidate requires a form of direct contact. It could be a candidate you found through word of mouth from your physician staff or network. It could also be a response to a web or print posting you have out, but I’m sure you would agree that sourcing a passive candidate with a passive source like a posting is akin to attracting a unicorn with pixie dust.
Typically getting a response from the passive candidate market is the result of direct marketing emails, text, physician-specific social media targeting or utilizing a retained physician recruiting firm who has access to an extensive database of providers along with access to the latest direct sourcing tools.
The Active Candidate – The good news about an active candidate is that one thing is sure, they are looking for a new position. The bad news about the active candidate is that because they are putting themselves out to the market by sharing their CV on multiple job boards, they are looking at numerous opportunities at once and engaged with who knows how many recruiters.
If your location is ideal, your facility is new and beautiful, and your compensation package is north of 75 percentile MGMA you are probably in luck. The problem is that stringing together this sort of trifecta only accounts for about 1% of facilities out there
If you don’t fall into that 1%, then you are going to be competing with other offers during your closing process. In other words, these candidates are fickle and likely to take another position after wasting a great deal of your time and resources.
Something else to keep in mind is that recruiting from the active pool of candidates will require more interviews overall. This will increase your recruiting cost and time investment (yours and your staff) significantly.
Another factor you may not have considered is the psychological impact of your current physicians when they see candidate after candidate interview for a position that remains open. It may have them begin to question whether or not they are in the right place themselves. After all, they are getting solicited every day to look at other opportunities too. Physician burn out is exacerbated when your physician staff is spread too thin and seeing candidates pass on the position they are working in can have a negative impact on their attitude.
Passive Recruiting Approach – Often referred to as “Post and Pray” recruiting. It’s like setting a trotline and hoping the fish bite. Postings of any sort fall into this category. If you aren’t actively pursuing the candidate with some direct contact, you are recruiting with a passive method.
“POST AND PRAY” is not an effective recruiting strategy.
Active Recruiting Approach – Just what it sounds like. Actively sourcing candidates. Cold calling, emailing, texting, messaging through physician-specific social media sites and so on. To keep with the fishing analogy, this is more like fly fishing. Using a specific fly to cast into an area where you see the trout swimming and sticking with it until you land a basket full.
Actively recruiting the Passive candidate is the preferred method of any experienced physician recruiter. Reducing competition any chance you get is key to increasing your odds of success in a market this competitive.
In a recent dialogue with Dan Jones, Associate Director of Recruiting here at AMP, we discussed several scenarios in the interview process that occur on a regular basis that doesn’t serve the candidate or employer well. Below are some things that may prevent success during your hiring process.
As much as you are interviewing them, candidates are evaluating you to determine if your opportunity and community are a good fit for them and their family.
Spend time curating a detailed interview process, and you will see it pay dividends. While not an exhaustive list, based on candidate observations, these are the most common mistakes which lead to negative interview feedback.
When evaluating practice opportunities, it is essential to understand your compensation model for the long hours and specialized care you will provide. Below is a brief break down of several of the most common physician compensation models to help you know what will, or won’t, be a good fit for you.
1. Straight Salary – As the name implies this type of compensation model offers a guaranteed annual salary. Typically, the salary is guaranteed for the life of the contract and is up for negotiation when the employment agreement comes up for renewal.
Pros – Your compensation is guaranteed up front and not impacted by patient volumes, collections, etc.
Cons – There is no incentive for seeing higher volumes of patients and the salary can sometimes be lower to off-set the annual guarantee.
2. Salary Plus Productivity – This model offers base compensation along with a productivity incentive that can be measured in several ways (see a few examples below). When evaluating a position that provides salary plus productivity make sure you clearly understand if the salary remains intact, will reduce or go away completely over time. Most salary plus productivity models set a threshold and then pay you a portion of what is produced over that threshold. For example, your compensation could be a salary of $200,000 annually along with 50% of collections exceeding $500,000 annually.
3. Straight Productivity – As the name implies this employment model bases your compensation strictly on your productivity. There are a variety of productivity models, several listed above, in which your income could be based upon. Many employers will offer one or two-year salary guarantees but eventually, the guaranteed salary will go away, and you will be compensated strictly on a production-based formula.
Pros – You have complete control over your level of income. Typically, this type of compensation model offers the most autonomy for an employed setting when it comes to scheduling, work volume or time off. This model can be the most lucrative for that reason.
Cons – There is no guaranteed compensation to fall back on. If you take time off or are forced to miss work due to illness, this can impact your income.
4. Net Income Guarantee – This model is rare but worth mentioning. Generally, a hospital or health system would offer an income guarantee, essentially a loan, for one to two years for a physician to open a private practice in a given location. Typically, at the end of the guarantee period, the guaranteed money would be forgiven in two to three years. You would be accepting a loan from a hospital or health system to set up your private practice.
Pros – You will have complete autonomy. You will decide where and how big your clinic is, how you will staff your practice, how many patients you see, etc. You will be entirely in charge and in most case eventually own your practice.
Cons – In addition to practicing clinical medicine, you will be responsible for running a practice. Running a practice can entail staffing, billing, collections, and much more.
5. Partnership – Partnerships can take on many forms depending on specialty, size of the group, ownership of ancillary services, etc. Partnership offers the opportunity to be an equal ‘partner’ in a practice. Generally, this entitles you to ownership over physical assets and gives you a voice in how the practice operates.
Pros – Depending on the practice, this can be a very lucrative model, especially if the practice owns physical assets (surgical center, etc.). It also provides you with input into how the practice operates on a daily basis.
Cons – Most partnerships require a cash buy-in, although some will offer a full or limited partnership after a period of ‘sweat equity.’