Physician Recruiting Interview Fatigue

 
By Trevor Strauss, MBA 

In recent years, the concept of “interview fatigue” has been become a somewhat familiar one to physicians.  Residency programs and recruiters have provided insights on how to deal with the physical and mental stress/fatigue that comes with the interview process. Given how many job options physicians have today (residents, in particular) interview fatigue is something physicians need to understand. 

A topic that has less seldom been discussed is the interviewers and the fatigue they face from working to hire a new physician or other clinician.  Today healthcare is changing more rapidly than ever and each year many healthcare organizations are faced with the seemingly impossible task of staffing providers at all levels, from RNs and MAs to Mid Levels and Physicians. 

Merritt Hawkins has been involved on both sides of this paradigm for 26 years. We have seen candidates struggle to make a decision, because they are mentally burned out from all of their options on where to practice.  More importantly, our clients have dealt with the stresses of interviewing.

Interview Fatigue can manifest itself in many ways. A few examples are:

1. Assumption that candidates will not accept your offer based upon prior candidate feedback
2. Your staff, both clinical and non clinical, are disinterested during the interview process because they have seen too many candidates
3. Lack of effort or attention to your staffing needs leads to additional clinical burnout of the providers on staff
4. Domino Effect: staff or clinicians see multiple candidate turn down your position, they may feel the grass is greener elsewhere and seek new positions

Here are a few suggestions I have found effective for avoiding interview fatigue when you are adding a new clinical provider to your practice:

1.  Prior to starting a recruitment project, ensure that the entire team that will be affected by the additional provider has been brought up to speed on why you are recruiting and the specifics of the search.
2. Keep your clinical provider team focused on seeing patients and not involved in the day to day aspects of recruiting. 
3. Ensure that all candidates who you have the clinical team interview have been fully vetted by yourself or your recruitment partner to ensure a good conversation when the clinical team speaks to them.
4. Only schedule onsite interviews for candidates that you have determined are ready and willing to make a decision within the next 1-2 weeks.

Interview Fatigue is a very real and common occurrence within the healthcare marketplace. Candidates certainly have more options than ever before and face the stresses of multiple offers. As the interviewer, it is important to understand and realize how “interview fatigue” can affect your facility.

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Trevor Strauss is a Regional Vice President of Marketing at Merritt Hawkins, an AMN Healthcare Company. For additional questions or information regarding our services, please contact Trevor Strauss at 469-524-1601 or trevor.strauss@merritthawkins.com.

Photo credit: ThinkStock Images

Annual Inpatient and Outpatient Revenue Generated by Physician Specialties

Physicians play a large role in their respective communities, providing care and generating economic development income. Not only do physicians generate income for their communities, but also for their affiliated hospitals. Just how much revenue do they generate? Which specialties generate the most? These questions and more are examined in Merritt Hawkins’ 2013 Physician Inpatient/Outpatient Revenue Survey, which reports the amount of revenue physicians in 18 different specialties generate annually on behalf of their affiliated hospitals. 

Now in its fifth year, this survey provides benchmark data hospitals can use to develop a “quantitative analysis” of their physician recruiting programs. In addition, this data is often useful in setting physician compensation levels or recruiting incentives through a cost/benefit analysis comparing the aggregate expense of recruiting physicians to the average revenue generated by physicians in various specialties. See this brief video conversation with Phil Miller, vice president of communications for Merritt Hawkins, as he discusses the background of this benchmark survey.

A Conversation with Phil Miller: Physician Revenue Generation

Physicians Top-of-Mind at Becker’s Fourth Annual Hospital Meeting

By Phil Miller 

When hundreds of hospital executives gather for Becker’s Hospital Review’s fourth annual meeting on May 9th in Chicago, the topic of physicians will be very much to the fore.

The meeting, which will include presentations by over 80 hospital and health system executives, will feature 93 different sessions.  Of these, many will focus squarely on the topic of physicians, with session titles such as: “How a Health System Should Evaluate Its Physician Alignment Strategy,”  “How Doctors Think,” “Case Studies in Physician Integration Success,” and “Physician Compensation in a Value Based World.”  Leading these sessions will be top executives with organizations such as Community Hospital Corporation, Memorial Hermann Health System, Vista Health System, Sinai Health System, Methodist Health Care and many others.

The emphasis on physicians underscores the fact that a successful transition from a volume-based to a value-based health system is largely tied to physician behaviors and practice patterns.    

Whether there will be enough physicians for hospitals to align with is another question, one that Merritt Hawkins will address at the Becker’s meeting.  Kurt Mosley, Merritt Hawkins’ Vice President of Strategic Alliances, will present a session entitled, “Evaluating the Supply and Demand of Physicians: Market Strategies and National Trends.”    

The meeting promises to be highly informative, and Kurt will post some highlights about it in his blog series The Raised Hand.  We also would be happy to hear from any readers who attend the meeting about their experiences and impressions.

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Phillip Miller is Vice President of Communications for Merritt Hawkins and Staff Care, companies of AMN Healthcare, the leader in innovative workforce solutions.  He can be reached at phil.miller@amnhealthcare.com.

7 Steps to Successful Physician Recruitment

By Tom Florence 

Healthcare has dramatically changed in recent years, and physician recruitment has evolved with it.  Even with these changes, success in physician staffing still depends on a strategic plan that incorporates seven key elements:   

1. A verified need for physicians 
2. An analysis of the physician market 
3. A competitive financial package 
4. Create the contract
5. An extensive sourcing and screening effort  
6. Buttoned up interview and close process  
7. An effective retention plan

Physician Needs Analysis 

Starting a search without a verified need can lead to a lot of unwanted expense and opportunity cost.  There are a variety of ways to determine physician need including the GMENAC physician to population ratios, and consulting groups who can assist in determining how many and what types of physicians are needed in a service area.  This data can prove very persuasive to physicians being recruited to the area.

The Physician Market

With over 750,000 practicing physicians in the United States it may seem like there is large pool of candidates to choose from.  However, it is important to note how many physicians are available in the specialty that you need.  Where are these physicians located, and what are they looking for in a practice?  These questions must be addressed at the front end of the search process to help determine realistic candidate parameters.  Statistics show that at about 25% of the physicians are foreign medical graduates, and half of physicians prefer communities that have a population of at least 100k.  If your organization is seeking a physician, you should objectively measure your opportunity in the context of the national physician market.

Competitive Financial Package  

Often clients will mention that their financial package is locally competitive.  In today’s market, candidates have access to data that provides average salaries, benefits, etc. across the nation.  Much like a house that is listed above market price, your search could be overlooked if you are not staying competitive with the rest of the industry.  Four day work weeks, no call, and other quality of life benefits are helpful to promote if the finances cannot be changed.

Create the contract  

Taking a cue from Stephen Covey’s effective habits, begin with the end in mind.  Successful recruiters have always had the advantage of developing the physician contract prior to beginning the search.  A sample contract is important in both selling the opportunity and avoiding miscommunication after the interview.  As more physicians become employed, the contracts between hospitals and physicians should be less complicated than in years past.

Sourcing and Screening  

There are thousands of professionals today that earn their living by recruiting physicians.  There is approximately one physician recruiter for every 4 graduating medical residents.  The supply and demand is certainly on the physician’s side.  A strategic sourcing campaign incorporating direct mail, email, advertising, job boards, residency outreach and social media is a must.  Social media and other recent advances in recruiting based software have made the task of reaching physicians much easier.  However, contacting them is only half the battle.  Once sourced, physicians must be thoroughly screened so that all the financial and professional considerations are discussed.  Determining if they are the right match for you, and ensuring there is interest on the candidate side is both an art and a science.  The dedication to time on this step can make or break the search process.

Interview and Close Process  

When properly executed, the interview itself is an opportunity to confirm what has already been discussed with the candidate.  The details of the position, call schedule, financial package, administrative duties and other matters should be agreed upon before the visit.  When both the candidate and the client are highly informed of both situations, the interview becomes much more of a social match.  A surprise to the candidate or client during the interview generally results in a negative outcome.  Candidates and clients should never be pressured to make a decision after the interview.  However, it should be clear from the beginning of the process that a timely decision is expected.  Most clients and candidates know whether the opportunity is right for one another within days of the interview.  As a client you would not want to put an entire search process on hold for someone who is unwilling to make a timely decision.

Physician Retention  

Most employees want to feel appreciated, and physicians are no different.  In the Merritt Hawkins’ white paper “Ten Keys to Physician Retention” it is observed that the most important aspect of a physician retention program is the practice environment.  Physicians generally will stay in a setting where they have quick access to the equipment they need, patient data, reasonable schedules and professional colleagues.  Even perks as seemingly small as a parking space, can become an important piece of the retention puzzle.  In addition, communication between physicians and administration is essential.  

The steps above indicate the importance of the front end work that takes place before candidates are sourced.  Without this preparation most physician searches are bound to take much longer than necessary, or fail.  Organizations that start with a clear plan, including an understanding of the types of physicians they need, how much they need to offer, and how the candidates should be sourced and interviewed have a much better chance of success.

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Tom Florence is the Senior Vice President of Recruiting for Merritt Hawkins, an AMN Healthcare company and can be reached at tom.florence@merritthawkins.com. 

Photo credit: ThinkStock Images

Happy National Doctors' Day – Merritt Hawkins Thanks You 

By Phil Miller 

One of the privileges of working at Merritt Hawkins is that we are able to see physicians “from the inside.”

Over the last 25 years, we have placed thousands of physicians and have spoken to or met with tens of thousands more, getting to know intimately what they do and who they are.

After literally countless personal meetings and telephone calls, what do we think about the physicians practicing at the front lines of patient care today?

The answer is conveyed in a short video we have produced with our sister firm – Staff Care -- in honor of physicians on National Doctors Day.  I hope you will take a moment to view it at the link below. 

Celebrating National Doctors’ Day - Video

If you know of any physicians who might appreciate this video message, please feel free to forward it to them, or to share it with anyone else who might enjoy this tribute to America’s doctors. 

If you have any comments or tributes of your own, I would be happy to review them and to share them with others.   

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Phillip Miller is Vice President of Communications for Merritt Hawkins and Staff Care, companies of AMN Healthcare (NHSE: AHS) and can be reached at phil.miller@merritthawkins.com. 

Relaxed Physician Immigration Laws/Licensure Rules Keys to Solving the Physician Shortage?

By Kurt Mosley 

I recently had the pleasure of addressing members of the Association of Staff Physician Recruiters (ASPR) on current and future physician recruiting trends. During the Q & A, the subject of President Obama’s 3 year signing extension of the “Conrad 30” program was discussed, along with the topic of physician immigration. During the dialog the question was asked if a relaxation of current immigration laws and licensing requirements pertaining to physicians could help alleviate the nation’s long-term physician shortage. Today, about 26% of the physicians in active patient care in the United States are international medical graduates (IMGs). Some of these IMGs are U.S. citizens who graduated from a medical school abroad. However, the great majorities were born abroad and came to the United States to complete medical residencies and fellowships and must obtain work visas to practice here.

 
One key to solving the physician shortage in the short-term would be to treat current physicians from pre-qualified countries (U.K., Germany, and Australia for example); the same way we treat physicians emigrating from Canada to the United States. If you are a physician currently practicing in Canada and wish to practice in the United States and obtain H-1B visa status, you need to pass one of the following U.S. examinations; the USMLE, FLEX or the NBME. However, Canadian trained physicians do not need to complete a U.S. medical residency to become licensed in almost all U.S. states (Canadian doctors are not considered IMGs). Case in point: my neighbor’s brother, who was born in Ghana, immigrated to the United States via the U.K. where he was a General Surgeon for 10 years (he was certified by the Royal College of Surgeons of England).  However, when he immigrated to the United States he was still required to complete a medical residency to be able to practice medicine.

 
Relaxing the residency requirement would, I believe, gain the interest of many foreign physicians desiring to practice in the United States, who are unwilling to undergo another residency when they have a track record of proficiency in medicine and patient care. The second key would be relaxing the current requirements of Canadian physicians to work in H-1B status. The Canadian exam (LMCC) is reciprocated for licensure in over 40 states; however Canadian physicians must still pass the USMLE, FLEX or NBME to be sponsored for H-1B status.  This course of action would no doubt be controversial, but the alternative is delayed and inadequate care for many of our citizens.  The key is identifying countries like Canada where medical training is deemed to be equivalent to our own.  If anyone has insight into the medical training available in other countries and its potential equivalence to our own, please feel free to share your comments. 

A Raised Hand will address the questions and concerns of healthcare facilities on emerging trends and offer practical solutions to some of the most pressing staffing challenges today. Kurt Mosley, Vice President of Strategic Alliances for Merritt Hawkins, an AMN Healthcare company, is nationally recognized as a leading authority on a wide range of health care staffing issues and trends.

New Whiteboard Video Illustrates Physician Compensation Trends

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Scope of Practice, New Buzzword of 2013?

Hospital administrators across the nation are losing sleep over how they are going to care for 32 million newly insured patients, particularly as there are no plans to increase the supply of physicians. I recently had the opportunity to speak to the State Hospital Association Executives Forum (SHAEF). This group is composed of the presidents of the nation's 50 state hospital associations.  Richard Umbdenstock, president of the American Hospital Association, was also in attendance.  SHAEF members are striving everyday to solve the conundrum of how our health care community is going to do more with less. 

When I spoke, there was a consensus among the group that the physician shortage is here to stay. However, the question that many of the executives posed during the Q & A was, “with no short-term solution to the problem, how do we prepare to handle the influx of newly insured patients?”  Much of the discussion that followed centered on “scope of practice.”     

As we enter 2013, the effects of healthcare reform are finally going to surface, and access to healthcare will become more challenging.  Physicians of all kinds will have to modify their “scope of practice” to more closely involve the over 200,000 non-physician clinicians, such as Physician Assistants, Nurse Practitioners and other types of care-givers.  I outlined some thoughts on how this might be accomplished in a recent article in Temporary Physician Assistants and Nurse Practitioners: the Next Big Thing.  

“Scope of practice” restructuring is bound to remain a hot topic and I would appreciate any real-world examples readers could provide of how they see this taking place.  Have you noticed physicians embracing practice restructuring to increase access and reduce costs?

A Raised Hand will address the questions and concerns of healthcare facilities on emerging trends and offer practical solutions to some of the most pressing staffing challenges today. Kurt Mosley, Vice President of Strategic Alliances for Merritt Hawkins, an AMN Healthcare company, is nationally recognized as a leading authority on a wide range of health care staffing issues and trends.

The Practice of Medicine, the Business of Medicine?

By Kurt Mosley 

A common comment we hear from the many physician residents we work with and advise every year is, “We are ready for the practice of medicine, but we don’t want to anything to do with the business of medicine”. I agree with the first part of the quote -- that our physicians are among among the best trained in the world and are ready for the practice of medicine, and that many new physicians today are less eager to be entrepreneurs than were doctors in years past.

The question of physicians’ business knowledge of medicine also came up when at the Wisconsin Healthcare Financial Management Association (WHFMA) where I presented last week. The consensus among the attendees was not that physicians need better business knowledge(a given), but when and where should physicians receive this training and knowledge?

Business skills are becoming increasingly important for physicians because as the effective start date of the Affordable Health Care approaches in 2012, the health care industry will become increasingly complex. Some additional comments I have heard on why physicians will need more business acumen include:

• The Psychology of business-financial statements 
• Negotiating skills-insurance negotiations
• Economic analysis-strategies for minimizing risk through economic loss (ACO’s, Medical Homes etc)

Physicians who want to be proactive have the option of enrolling in an MD/MBA program, enabling medical students to obtain both their business and medical degrees simultaneously.  There are currently over 54 MD/MBA programs across the United States with an estimated 500 dual degree graduates per year. Another option available to medical students is the “virtual physician office “ offered to medical students pioneered by the Texas Tech School of Medicine, in which medical students and residents can learn to run a virtual medical practice in a controlled environment. 

I believe that physicians with business knowledge and training  can achieve positive changes in the health care industry, rather than accepting what the markets dictates. I would appreciate any comments or examples readers could provide on ways in which medical students, residents and in-practice physicians are on improving their knowledge of the “Business Of Medicine.”

A Raised Hand will address the questions and concerns of healthcare facilities on emerging trends and offer practical solutions to some of the most pressing staffing challenges today. Kurt Mosley, Vice President of Strategic Alliances for Merritt Hawkins, an AMN Healthcare company, is nationally recognized as a leading authority on a wide range of health care staffing issues and trends.

By Phil Miller 

According to the National Rural Health Association, about one thousand doctors retire or relocate from rural practice every year, and only 700 physicians take their place.  Partly as a result, the number of federally designated Health Professional Shortage Areas (HPSAs) has grown from under 3,000 some ten years ago to over 6,200 today.

For a variety of reasons, fewer physicians coming out of training are displaying an interest in rural medicine.  According to Merritt Hawkins’ most recent Survey of Final Year Medical Residents, less than 5% of newly trained doctors would prefer to work in a community of 25,000 or less.

“Country doctors” are important to their communities not just because of the medical services they provide but because of the central role they play in the viability of their communities.  When a small community loses its physicians, it may also lose its hospital – usually the first or second largest employer in town.  The domino effect from this event can be devastating to small towns.

Staff Care, the leader in locum tenens staffing which, like Merritt Hawkins, is a company of AMN Healthcare, has long recognized the vital contributions rural physicians make to their communities.  For 20 years Staff Care has sponsored The Country Doctor of the Year Award, in order to honor the spirit, skill and dedication of America’s rural physicians.  The award features two weeks of complimentary locum tenens coverage for the recipient.   More important, the award has brought national recognition to some extraordinary country doctors, such as Kenneth Jackson, M.D. of Kingman, Arizona, who flies a helicopter to the base of the Grand Canyon to care for an isolated Native American community, and Edward Lehman, M.D., of Mt. Eaton, Ohio, who maintained a practice of mostly Amish patients.  

Staff Care recently announced the recipient of the 2012 Country Doctor of the Year Award – Dr. Neil Nelson of Gibson City, Illinois.  Known for his precise diagnostic skills, Dr. Nelson’s practice includes 5,000 active patients in a town of only 3,500.  He has drawn patients from 50 different zip codes and from as far away as 1,000 miles.  Dr. Nelson is on call for his patients 24 hours a day, seven days a week and has not taken a vacation in over 12 years.  He continues to make house calls and in his “spare time” serves as an auxiliary deputy, and as a local liaison physician for the Shriner’s hospital in Chicago.  Until recently, Dr. Nelson was still very active as a farmer.  Learn more about Dr. Nelson from a recent article that appeared in USA Today.  

Merritt Hawkins is proud to be part of an organization that is shining a positive light on the key role country doctors play providing healthcare to rural communities.  We would be pleased to hear about any outstanding country doctors you may know of and welcome you to nominate a physician for the 2013 Country Doctor of the Year Award by downloading the nomination form at www.countrydoctoraward.com.

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Phil Miller is vice president of communications for Merritt Hawkins and Staff Care and can be reached at phil.miller@amnhealthcare.com 

Physicians and Immigration Law FAQ: A Guide to IMG-related Visa and Employment Issues

By Phillip Miller 

The demographics of the U.S. physician workforce are rapidly changing. Today, about one quarter of all active physicians (and one quarter of medical residents) are international medical graduates. 

Though many IMGs are U.S. citizens or green card holders, others require visas to work in the United States.  

A new white paper prepared for Merritt Hawkins by prominent immigration attorney Carl Shusterman provides answers to frequently asked questions about IMG-related visa and employment issues.  The white paper walks through the visa process step-by-step, providing hospital and medical group administrators and physician recruiting professionals with a clear guide to this sometimes confusing process. 

If you would like a copy of the white paper, please contact Shelby Ferrari, Merritt Hawkins’ Senior Resource Development Specialist, at shelby.ferrari@merritthawkins.com or call (800) 876-0500. For more immediate access to Merritt Hawkins' surveys, white papers and other data, join our LinkedIn Discussion Group. 

Over the last several years, we have found an increasing acceptance of IMGs as recruiting candidates.  If anyone is still experiencing resistance to internationally trained physicians, could you share the circumstances?

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Phillip Miller is vice president of communications for Merritt Hawkins, a national physician search and consulting firm and a company of AMN Healthcare.  

Should Physician Incomes Be Cut?

By Phillip Miller 

 Photo courtesy of ThinkStock Images  

Bloomberg.com author, Christopher Flavelle, argues that physicians should be paid less in order to reduce health care costs. While he concedes that physicians are valuable to society, he contends that their incomes, particularly those of specialists, are too high, driving up the nation’s $3 trillion annual health care spending bill.

This argument reminds me (as many things do) of an episode of “The Simpsons.”  Springfield has been threatened by a comet that astronomers at the local observatory have revealed is hurtling toward the town.  The comet eventually burns up before any damage is done, but an angry mob nevertheless sets off to burn down the observatory to ensure that no comet ever threatens the town again.

Like one of Springfield’s many mobs, Mr. Flavelle appears to be somewhat confused as to cause and effect.  As Timothy Norbeck of The Physicians Foundation points out in the white paper “Drivers of Health Care Costs” payments to physicians account for less than 20% of overall health care spending.  One of the real drivers of health care inflation is the chronically ill.  Mr. Norbeck indicates that the sickest ten percent of the population accounts for 63% of total health care dollars in the U.S.  Other cost drivers include technological advances, administrative costs, waste, defensive medicine, fraud, and insurance benefits that do not encourage consumers to shop for value.  Trimming payments to doctors would do little to prevent the comet of runaway health care spending from colliding with us.

Mr. Flavelle’s column raises the bigger question of whether or not physicians deserve large incomes.  As has been noted elsewhere in this blog, when it is your health or the health of a loved one that is at stake, physicians are worth every penny they make.  Better access to preventive services, and better lifestyle choices by patients, will do more to reduce spending than pointing the finger at physicians.   

However, if you think I am missing something, or if you have additional points to add to the discussion, please post a comment.  I’m willing to concede that a man who gets all his analogies from “The Simpsons” may not have all the answers.

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Phillip Miller is vice president of communications for Merritt Hawkins and Staff Care, companies of AMN Healthcare.  He can be reached at Phil.Miller@amnhealthcare.com.

By Travis Singleton  

Change can be seen everywhere in the healthcare system today -- even in academic medicine where tradition often enjoys particular consideration and respect. 

An example of evolving practices and perspectives in academic medicine is apparent in the area of physician recruiting.  For years, the general approach to physician recruiting in academic settings has remained relatively static. The traditional approach features a search committee that oversees an often lengthy and ponderous recruitment process with a great deal of medical school/university involvement.   In addition, the prevalent practice among academic institutions has been to offer standard incentive packages that treat all physicians equally.  Salaries have been reasonably similar across entire departments.  

Even candidate parameters have been fairly uniform. In the past, standard parameters have included a requirement that the candidate come with grant funding already established and have a minimum number of publication credits.  Candidates also have typically been required to possess a baseline of experience in academics, with a minimum of professorial rank from another institution and a pedigree in training.   

For a variety of reasons, many academic settings now are taking a different approach to physician recruiting.   This trend is examined in more detail in a new Merritt Hawkins’ white paper entitled, “The Changing Landscape in Academic Physician Recruiting.”

Those who would like a copy of the white paper are welcome to contact me at travis.singleton@merritthawkins.com.

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Merritt Hawkins to Testify Before Congress

By Mark Smith 

During the last 25 years, Merritt Hawkins has spoken before literally thousands of hospital executives, board members, health professional associations and other groups.

We have never, however, addressed members of Congress.

That will change on Thursday, July 19, at 10 a.m. ET when I will have the honor of serving as an expert witness before the House Committee on Small Business/Subcommittee on Investigations, Oversight, and Regulations. The Subcommittee is holding a hearing on “The Decline of Solo and Small Medical Practices” to examine why the solo/independent practice model is becoming a thing of the past.

Merritt Hawkins will submit written testimony for this hearing. I will provide oral testimony and answer any questions members of the Subcommittee may have. The hearing can be viewed live on streaming video and I hope followers of this blog will have an opportunity to watch it here.

Merritt Hawkins was selected for this distinction based on the years of research and analysis we have conducted on physician practice trends, including our physician surveys and white papers. Some of this research has been in partnership with The Physicians Foundation, a non-profit group of physician and medical society leaders dedicated to empowering physicians and improving healthcare.

I would welcome any comments readers may have on the hearing and would be happy to forward Merritt Hawkins’ written testimony when it becomes available to the public later this month.

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Mark Smith is president of Merritt Hawkins and can be reached at mark.smith@merritthawkins.com

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By Travis Singleton  

It runs to 127 pages and includes over one million data points. It combines responses from some 14,000 physicians to 48 questions, many of them featuring multiple response categories. It generated written responses, some of them paragraphs long, from 8,000 physicians.    

And it is accurate. According to statistical response experts at the University of Tennessee it has a less than one percent margin of error.

I am referring toA Survey of America’s Physicians: Practice Patterns and Perspectives, a new report completed by Merritt Hawkins on behalf of The Physicians Foundation, a non-profit group of physician and medical association leaders committed to enhancing the medical practice environment.

The scope of the survey report is ambitious: to provide a “state of the union” of the medical profession revealing the current morale levels of physicians, their practice metrics and their practice plans.  The survey was sent by email to over 80% of all practicing physicians in the United States, giving the majority of the nation’s physicians an opportunity to have their voices heard. 

What the survey reveals is both startling and sobering: 

• Physicians are working 6% fewer hours than they were four years ago, resulting in a loss of over 44,000 FTEs nationwide.
• Physicians are seeing close to 17% fewer patients per day than they were four years ago, a reduction of over 100 million patient encounters.
• Physicians spend more than 22% of their time on non-clinical paperwork, resulting in a loss of some 165,000 FTEs.
• Physicians are disillusioned with the practice of medicine – 84 percent believe their profession is in decline.
• The majority of physicians – 57.9%  – would not recommend medicine as a career to their children and over 60 percent would retire today if they could.

Why do physicians feel this way and how are they changing their practice patterns?  These questions also are addressed in the survey report, which includes survey responses broken out in multiple ways, including by physician age, gender, and employed status.  Other points of interest revealed by the survey:

• Employed physicians see 17% fewer patients per day than practice owners.
• Female physicians see 13.7% fewer patients per day than male physicians.
• Even many young physicians (47%) would retire today if they could. 

This new survey report is one of the most comprehensive and detailed examinations of physicians ever undertaken in the United States. I believe it is a critical source of information for healthcare executives, policy makers, academics and others interested in the current state of the medical profession.

Those who would like a summary of the report may contact me at travis.singleton@merritthawkins.com or may call Shelby Ferrari of Merritt Hawkins at 800-876-0500.  I look forward to hearing your response to this groundbreaking new study.

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Travis Singleton is Senior Vice President of Merritt Hawkins, the nation’s leading physician search and consulting firm and a company of AMN Healthcare (NYSE: AHS). 

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A New, Hospital-Specific Model for Assessing Physician Staff Requirements

By Richard “Buz” Cooper, M.D. 

How many physicians in various specialties are appropriate for a given population?   

This question has challenged healthcare planners for decades.  The answer has generally been expressed as a national ratio of physicians-to-population, based either on estimates of the burden of disease (a “needs-based” methodology) or on estimates of the economic capacity to purchase services (a “demands-based” methodology).  These estimates have proven to be useful for national planning and international comparisons.

However, ratios often have been applied across the board, on the assumption that the number of physicians required per population in all areas of the United States is the same.   This simply does not reflect the operational reality of hospitals and other facilities serving various diverse populations.   Resources vary among population groups, depending on economic and demographic factors.  Clearly, physician requirements in a predominantly young, economically disadvantaged area of South Texas will not be the same as requirements in a predominantly older, economically robust area of South Florida.

I was therefore intrigued when Merritt Hawkins invited me to develop a methodology for assessing physician requirements on a case-by-case, hospital service area-specific basis.   After a period of data-gathering and refinement, the result of our efforts is the Hospital-Specific Physician Requirements Model, a new way of assessing the number and type of physicians hospital service populations can sustain.

The Model is built on a layered approach that begins with national projections, extends to historic regional differences, and considers local economic and demographic circumstances.   The Model allows hospitals to develop an objective picture of the projected physician services that will be demanded by the patients they serve and to adapt such estimates to evolving practice structures and personnel changes.        

Using demographic and payer mix information regarding a specific service area, the Model estimates the demand for patient care physicians, excluding residents, based on the levels of healthcare services that are likely to be purchased, which are partially driven by market forces and partially by a community’s response to unmet services.   

The Model therefore does not assess “need” (i.e., what might be most desirable in terms of the burden of illness in the area).  Rather, it assesses demand (i.e., the services the community can actually support).  Specific numbers generated per specialty by the Model can be textured through consultation regarding local trends in physician gender, age, practice patterns and the potential use of non-physician clinicians.

I believe this new Model offers a more practical, real-world approach to assessing physician requirements than models based on generic, national ratios and may be useful to medical staff planners, physician recruiters and others.  It may be particularly useful as part of a Community Health Needs Assessment (CHNA), which not-for-profit hospitals will be required to conduct once every three years starting in 2013.  I welcome your insights into this topic and would be happy to learn of any methodologies you are using to assess community physician requirements.

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Richard “Buz” Cooper, M.D. is a Senior Fellow in the Leonard Davis Institute of Health Economics at the University of Pennsylvania (a jointly sponsored by Penn’s Medical and Wharton Schools) and Director of the Center for the Future of the Health Care Workforce at New York Institute of technology.  He is a national authority on the physician workforce and author of the “Trend Model” for projecting the future requirements for physicians and other healthcare providers.  Dr. Cooper assists Merritt Hawkins in assessing Hospital-Specific Physician Requirements for its clients. 

Compensation per Physician Work RVU

An Examination of How Work RVU Benchmarks are Derived and Utilized

By Peter Cebulka 

Some of the most frequent requests generated by Merritt Hawkins’ Candidate Corner Blog pertain to compensation per Physician Work RVU (sometimes referred to as wRVU).  Many inquiries come from physicians or employers requesting financial benchmarking data pertaining to typical Compensation to wRVU Ratios for their specialty or region.  Other inquiries are for recommendations associated with the proper structuring of an RVU compensation model.  

 
 Previously, Merritt Hawkins published a white paper titled RVU Based Physician Compensation and Productivity, Ten Recommendations for Determining Physician Compensation/Productivity through Relative Value Units.  Recently, we’ve expanded our coverage of the topic to include two new YouTube videos:  

 What is an RVU or Relative Value Unit

Top Ten Recommendations for RVU Physician Compensation

The video Top 10 Recommendations for RVU Physician Compensation  provides key principles for physician employment agreements.  Also, reference video What is an RVU or Relative Value Unit for a brief general overview of RVUs and their increased significance in healthcare staffing.   

 
Since 2007, the prevalence of RVUs as a metric in determining physician income has roughly doubled.  Presently, a majority of medical practices and physicians utilize RVUs in their compensation methodology.  Below is a table with recently released data from the 2012 report by the Medical Group Management Association (MGMA) showing total compensation and wRVU data from 2011 for selected Primary Care and Specialty Care physicians.   

It is important to note how these figures are derived.  Compensation per wRVU can only be calculated for those medical practices and physicians who track and report the number of wRVU they generate.  Physician compensation per wRVU is a metric that is often misunderstood.  It is a representation of how much a physician has been paid per wRVU over the course of the year, “when it’s all been said and done!”  The ratio is derived by taking the total compensation of a physician and dividing it by the number of wRVU they’ve generated over the course of the year.  

Do Doctors Really Drive Up Health Care Costs?

By Phillip Miller 

The “experts” are wrong. They are simply flat wrong.

That’s the only conclusion I believe a reasonable person can draw after reviewing the data and analysis compiled by Richard “Buz” Cooper, M.D., an oncologist and an internationally noted authority on physician supply and health care utilization studies.

No More Marcus Welby

By Carl Shusterman 

International medical graduates (IMGs) comprise a significant portion of the medical workforce, making up about one quarter of all physicians in active patient care in the United States and about one quarter of all medical residents. (Source: AAMC)

They are a key resource for physician recruiters, and many communities around the country would face severe access issues without them. However, two large states – Texas and New York -- , have passed legislation that will limit the locations where IMGs may practice.       

As physician recruiters know, physicians on J-1 visas are required to work in medically underserved areas in order to obtain a waiver of the rule requiring them to return home for two years after their training. However, the majority of IMGs today in residency training are on H-1B visas, which do not require physicians work in medically underserved communities.    

    
Hospitals, medical groups, academic medical centers and other health care facilities should be advised that the Texas State Medical Board will require all non-citizen and non-permanent resident physicians who apply for a Texas license on or after September 1st 2012 to agree to practice in a medically underserved area (MUA) or a Health Professional Shortage Area (HPSA) for three years as a condition of licensure.

This legislation would affect physicians completing their residency or fellowship training on temporary, H-1B visas outside of Texas who subsequently may seek practice opportunities in Texas. It also would affect physicians completing their residency /fellowship training on temporary, H-1B visas in Texas who do not have a permanent license and who may wish to accept a practice opportunity in the state. Physicians in both categories would be required to work in a MUA or HPSA as a requirement for Texas licensure.

              
The legislation does not apply to non-citizen/non-permanent residents who practice in graduate medical education programs in Texas. These applicants can still receive Texas licenses regardless of whether their medical program is located in an MUA or HPSA. However, once these residents complete their training and seek practice opportunities, they would need to practice in a MUA or HPSA. The law is not retroactive and IMGs who have been issued a license prior to September 1 will be able to renew their licenses regardless of where they practice.

New York is the only other state at this point that has a similar law in place.   

While the intention of these laws is to provide greater access to medical services to underserved area, they may have the effect of making U.S. residency programs less attractive to IMGs, which in the long run will only exacerbate physician shortages. 

I would welcome any comments from recruiters or others who these laws will affect.

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Carl Shusterman is a former Trial Attorney with the U.S. Immigration and Naturalization Service  and is principal of The Law Offices of Carl Shusterman, a Los Angeles firm specializing in employment-related immigration law. He can be reached at carl@shusterman.com