Premier Physician Recruitment Services

Pillars

State of Physician Recruitment


THE COMPLEXITIES OF PHYSICIAN SUPPLY AND DEMAND – A PHYSICIAN RECRUITING PERSPECTIVE

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?

 

Contributing Factors

  • Population Growth – The United States is the 4th fastest growing country in the world, are a 12% increase in the population is expected over the next 12 years. A recent US News and World Report article showed that the United States grew by 2,307,285 from 2017 to 2018. In the same article they broke out the top 10 states by population growth which shows some areas are significantly out pacing the 12% expected overall growth. How does your state stack up?Top Ten States by Population growth percentage from 2017-2018 (US News and World Report, 12-19-2018):
    1. Nevada – 2.1%
    2. Idaho – 2.1%
    3. Utah – 1.9%
    4. Arizona – 1.7%
    5. Florida – 1.5%
    6. Washington – 1.5%
    7. Colorado – 1.4%
    8. Texas – 1.3%
    9. South Carolina – 1.3%
    10. North Carolina – 1.1%
  • Aging population – Over the next 12 years, we will see a 55% increase in our population over the age of 65 as the “Baby Boomer” generation enter their golden years. 66% of Americans over the age of 65 have at least one chronic illness and 20% of them see 14 physicians on a regular basis. The subsequent increase in utilization/demand will undoubtedly exacerbate the staffing shortages many facilities already feel the full force of today.
  • Aging Physician Population – More than 25% of practicing physicians are over 60 and likely to retire in the next 10 years.
  • Residency Program Shortage – The Balanced Budget Act of 1997 imposed caps on the number of residents for which each teaching hospital is eligible to receive Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) reimbursement. These caps have remained in place and have generally only adjusted as a result of specific limited and one-time programs. It’s a myth that we don’t have enough students going into Medical School. We have quality students graduating Medical School that do not match to a residency, due to the lack of available residency slots and the limited number of available programs.
  • Immigration Bottleneck – 1 in 4 U.S. physicians, are foreign-born and these physicians are serving primarily in our most underserved areas of the country. Each state is allotted 30 J1 Visa slots for physicians through the Conrad 30 J-1 Visa program regardless of its total population or underserved population. Many of these limited spots go unused because of the archaic distribution factors. There is one additional program that helps to expand the available J-1 visas in several of our Southeastern states called the Appalachian Regional Commission; it’s just not enough.

NATIONAL SCALE SOLUTIONS

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.

  • Expanded Residency Programs – The AAMC strongly supports bipartisan GME legislation introduced in both the House of Representatives and the Senate, the Resident Physician Shortage Reduction Act of 2017 (H.R. 2267; S. 1301), which takes an important step towards alleviating the physician shortage by gradually providing 15,000 Medicare-supported GME residency positions over a five-year period. However, this legislation alone will not relieve the physician shortage.
  • Increase Visa Access to Foreign Physicians – The Conrad 30 J1 Visa program needs to be re-worked so that unused slots get redistributed where the need of underserved patient population is the greatest. Increase the total number of Visas available to foreign physicians. More programs like the Appalachian Regional Commission need to be created.. Create programs to vet the quality of international training programs, reducing the need for duplicating residency training or at least allowing a pathway where qualified foreign physicians are not required to repeat a full residency training program before establishing their full-time practice.
  • Innovations in Delivery – Significant expansions in Telemedicine are needed to bring virtual specialists into underserved areas. Technology needs to be better utilized to deliver prescriptions directly to the patient where risk is low and appropriate, reducing unnecessary physician visits whenever possible.
  • Continued Expansions in Physician Extender Support – A trend that has been ongoing for many years now and is sure to continue for many more. Specialization of these providers has been a natural progression as demand increases in areas like mental health and others.

YOUR FACILITY SOLUTIONS

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.

  • Retain Your Current Staff – The best and easiest physician you will ever recruit is the one you already have. Physicians need the same things all of us need in a work environment. A fair and equitable workplace, positive core leadership, open and transparent communication and having a voice all add up to a great environment. You don’t have to look too far to find an article or blog post on Physician Burnout. Remember, no one will feel the physician shortage more severely than the practicing physician.

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  • Defined Recruiting Strategy – There are many variables that you will need to consider. Finding the right strategies will take time and money. Physician recruiting is a moving target that may require a different approach for different specialties or practice settings. Every community or facility is different with their unique challenges, and potential offerings or upside to the physicians you are working to attract.The best place to start recruiting your next physician is with your current physician staff. Nurturing your physician staff’s relationships allows you to turn every member of your physician staff into a physician recruiter every time they attend a conference or speak to a colleague. There was a time in the not so distant past when this was the only way physicians were recruited at many facilities, of course, there are several other methods these days, primarily born out of supply and demand. There isn’t one method that works every time for every situation or specialty. You will need to have layers in your physician recruitment strategy that are weighted by urgency, specialty, and budget.

    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.

  • Home Grown Physicians – Promote opportunities for students in your community to explore careers with your facility. Proctorship programs along with tuition incentives will encourage these young students who are from your community with deep family ties who could serve your facility in an uncertain future. Imagine the pride of seeing someone come home after residency to serve their community. Imagine how much easier it will be to retain them.

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.

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Passive Versus Active. We hear this all the time but what does it even mean?


It depends on whether you are talking about the candidate or the recruiting approach. A passive physician candidate is a good thing while a passive approach to physician recruiting is not.

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.

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5 common interview scenarios to avoid


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.

  1. Not engaging the staff and key personnel in the interview process – Candidates like to meet with potential colleagues and gain insight into what it’s like to work for an employer. Similarly, if someone is involved in the decision process, then they need to meet with the candidate.
  2. Poorly organized itinerary or a complete lack of an agenda altogether – A “fly by the seat of your pants” approach for interviewing signals dysfunction, muffles your company vision and seeds doubt in the candidate’s mind about your seriousness in hiring them.
  3. Not engaging the spouse – If relocation is involved, you are recruiting the spouse as well as the provider. Find out what the spouse needs are and do your best to accommodate those needs while they visit onsite.
  4. Not addressing concerns about a candidate – If you have questions about a candidate, the interview is the time to address those concerns. By the end of the interview, you should have enough information to know if you are going to move forward with an offer of move on to other candidates.
  5. Not providing a professional, insightful community tour – When providing a tour of the community for the candidate and spouse, it needs to be conducted by someone who can provide accurate and pertinent information, i.e., demographics, school ratings, state of the real estate market, etc. Just pawning a candidate off on someone to drive them around town for a while will not impress candidates.

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.

Engage
Organize
Plan
Insight
Community
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Job Search Checklist


Job Search ChecklistBesides my CV, what should I have prepared for my interview? What types of references might potential employers ask to see?

  1. Cover letter. A cover letter should share details about your professional interests and goals as well as who you are outside of work. A well thought out cover letter can help you stand out in the crowd, especially if you are a resident.
  2. Depending on your specialty and the position you are interviewing for, you may want to include case logs, descriptions of expertise in various procedural areas, experience with specific surgical or diagnostic equipment, description of leadership experience, etc. Make sure these items match the position you are interviewing for. If you are applying for a leadership role, tailor this information to showcase your experience as a leader.
  3. Professional references. References should be recent and pertinent to the position you are interviewing for. Depending on the confidentiality of your search, this can sometimes be difficult, but try to avoid providing references that you haven’t worked with for an extended period. Also, if you are applying for a clinical role, provide references who can speak to your ability as a clinician.
  4. Make sure you have an itinerary and know where you are going and who you are meeting. Showing up late and unprepared never makes a good first impression.
  5. Prepare questions. Part of the interview process is to gather information so you can make an informed decision. That said, don’t fly by the seat of your pants, prepare professional questions so you can get the most out of your interview. Never leave an interview without all your questions answered.
  6. Research the practice and area where you are interviewing. Many employers like to see that you have done your homework on their hospital/practice. They might ask questions to see how serious you are about their position.
  7. Get contact information of those you meet with during your interview. A personal letter or email to express your appreciation post interview has become a lost art. A quick follow up will help you stick out in the minds of those you met.
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Top 5 mistakes Doctors coming out of residency make.


  1. They fail to identify what is truly important to them in their first position. It will save a lot of time and headache to sit down and decide what your priorities are before starting your search. Sometimes an enumerated list can be a helpful way of identifying what is truly important to you.
  2. They fail to ask others for guidance. Insight is gained by speaking to experts in licensing, credentialing, physicians’ contracts, etc. It can also be helpful to speak to those with knowledge of the market to gain perspective of what is available.
  3. They rely too heavily on the opinions of others. While insight from others is great and can provide additional viewpoints, at the end of the day, everyone needs to make their own decision. Sometimes relying on your feelings and experiences are best, after all, you will be the one living and working in this position day in and day out.
  4. They have unrealistic expectations. Don’t expect to find the ‘perfect’ position. Odds are it simply doesn’t exist. Try to find a position that is aligned with the priorities you have established and if you find something that matches 7 or 8 out of your top 10, be happy.
  5. They go on too many interviews. There will be many chances to interview, but the more you interview, the more difficult it can become to separate one position from another. It also takes time to interview, which can be stressful and costly. Additionally, attending too many interviews can create a long decision process which can be perceived negatively by potential employers.
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Physician Compensation Models


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.

  1. RVU based production – Relative Value Units (RVUs) are a measure of value used in the United States Medicare reimbursement formula for physician services. The math to come up with the RVU is quite complicated so we won’t dive into that here, but at the end of the day, RVUs have been used since the 1990s as a straightforward way to evaluate patient complexity, geographic factors, payor mix, and physician efficiency.
  2. Collections based – Collections speak directly to the amount of billed revenue collected by a practice. When considering this type of production model, it is essential to determine the efficiency of the billing and collections department of a prospective employer.
  3. Encounter-based – This production model is based solely on the number of patients that a provider treats over a given period.
    Pros – You have guaranteed compensation, with the ability to increase your take-home pay by treating more patients, more complex patients, or picking up extra work (depending on the productivity model).
    Cons – Your income could be impacted by factors outside of your control. For instance, the efficiency of office or clinic staff, no-show rate of scheduled patients, how reliant the clinic is on walk-in patients. Typically, the collections rate of the clinic, the socio-economic status of patients, etc. impact the amount paid per encounter.

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.’

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