Majority of New Physician Jobs Feature Hospital Employment

June 13, 2011 — Primary care physicians remain in high demand, although the majority of job openings are for hospital employees, not in private practice, according to a new survey by Irving, Texas–based national physician search firm Merritt Hawkins.

For the sixth consecutive year, family practice and general internal medicine were the top 2 most-requested physician search assignments. They were followed by hospitalists, psychiatrists, orthopaedic surgeons, emergency medicine physicians, obstetrician/gynecologists, neurologists, general surgeons, and pediatricians.

Reimbursement cuts and declines in elective procedures have reduced the volume of search assignments for radiologists, cardiologists, and anesthesiologists. Those specialists, which were among the most requested searches 4 to 5 years ago, are now ranked 17th, 18th, and 19th.

The majority of physician search assignments (56%) were for hospitals, up from 51% a year ago and 23% five years ago. Only 2% of the firm's search assignments featured openings for independent, solo practitioners, down from 17% five years ago.

Healthcare reform, which enhances the role of primary care physicians by encouraging new delivery models such as accountable care organizations, is one factor driving the need for additional family physicians and internists, Travis Singleton, senior vice president of Merritt Hawkins, said in a news release.

"The era of the independent physician who owns and runs his or her practice is fading," said Singleton. "Doctors today are more likely to be employees working for increasingly large health systems or medical groups."

Hospital acquisitions of physician practices have "to some extent replaced traditional recruitment in the past year, as health care organizations have focused on preparing for new delivery models," the survey found. "As this trend plays out, there has been a nationwide lull in the traditional physician recruiting market, which is only now showing signs of returning to its customary vigor."

Although "pay for performance" rather than volume has become the new mantra under healthcare reform, the survey found that physicians are still compensated on volume-based formulas such as the number of patients they see, the amount of revenue they generate, or the number of work units they accrue. More than 90% of searches in the 2011 review that featured physician production bonuses reward physicians for fee-for-service style volume. Less than 7% reward physicians for meeting quality or cost objectives.

"Quality and cost rewards may be the physician compensation standards of tomorrow," Singleton notes, "but patient volume, revenue or work units remain the standards of today."

Average salaries continue to increase. Family physicians were offered an average salary of $178,000 for 2010 to 2011, up from $161,000 in 2006 to 2007. Internists averaged $205,000, up from $174,000 five years ago. Urologists saw their salaries increase to $453,000 in 2010 to 2011, up from $400,000 just a year ago. Orthopaedic surgeons, earning an average of $521,000, saw an increase of just $2000 from a year ago.

Salaries have almost entirely replaced income guarantees as a compensation model. Only 9% of physician search assignments over the past year featured income guarantees, down from 21% in 2006 to 2008, and down from 41% in 2003 to 2004.

Signing bonuses, relocation, and continuing medical education allowances remain standard in most incentive packages. Housing allowances are a new form of recruitment incentive. Because of the volatile real estate market, some physician candidates are unable to relocate without such help.

The 2011 review is based on the 2667 permanent physician and advanced allied professional search assignments that Merritt Hawkins/AMN Healthcare's physician staffing companies were engaged to conduct during the 12-month period from April 1, 2010, to March 31, 2011.