Countering the Physician Shortage

Jim Stone, for HealthLeaders Media , February 21, 2008

These are challenging times for hospitals and groups trying to increase their ranks, but a strategic, responsive approach to the recruiting effort can make a big difference between hiring success and failure.

Last August, hospital executives and physician leaders at a hospital in rural Arkansas who had been trying to bring on a new general surgeon for nearly a year were elated when an ideal candidate delivered a glowing report on his interview experience. He liked the facility, and he couldn't imagine working with a more talented group of surgeons. Everyone he and his wife met had gone out of their way to make the couple feel welcome--as did all of the people they encountered in the small community, which was pretty much exactly the kind of place he and his wife hoped to raise their family.

But when the CEO tried to translate that positive experience into a statement that might elicit the young surgeon's likelihood of accepting the position, the balloon burst. He was interested, yes, but he had two more interviews that week, and was still working his way through the more than four dozen positions he was being asked to consider.

His final words were along the lines of "I'll keep you posted--and will let you know in a month or two." Two months later the surgeon took a position, one of the dozen he had interviewed for, elsewhere.

That kind of story is, unfortunately, not all that unusual these days--and it's happening not just in typically hard to recruit to rural communities but even in the urban centers that once had the relative luxury of simply tapping their top candidate. These days, more and more practice opportunities are open even in desirable urban markets such as Dallas, Chicago and Cleveland

As the physician shortage in our country becomes more acute, hospitals and physician groups desperately seeking more hands on deck are increasingly finding themselves in the "rejected" pile. In some cases that's because the offer isn't competitive or attractive (or both). But for the most part, it's because of the basic economic principles of supply and demand. There simply aren't enough physicians to fill the seemingly unending list of vacancies.

Physician job boards boast thousands of postings, and there are thousands more opportunities not being advertised on the Internet. The medical schools aren't expanding rapidly enough to address the void. In fact, the medical school graduation rate has been effectively flat since the 1980s, despite the population increase and growing demand for physician services.

For those who want to know just how severe the shortage situation is, there's no dearth of "bad news" numbers. In addition to the now widely accepted prediction that the United States will be short as many as 200,000 physicians by 2020 because of the aging population and a host of other factors, consider the following:

  • One in three of the nearly 800,000 physicians practicing today is over the age of 55, and a growing number of physicians are electing early retirement (before age 65), largely for personal reasons, according to American Medical Association data.

  • More than half of U.S. hospitals faced substantial, consistent gaps in specialist coverage in their emergency departments between 2005 and 2007, especially in orthopedics and neurology, according to American Hospital Association survey data.

  • The primary care shortage is worsening by the year, as evidenced by the fact that only 20% of internal medicine third-year residents chose primary care in 2005, down from nearly 55 percent in 1998, according to a recent report from the Center for Studying Health System Change.

  • The Bureau of Labor Statistics put the unemployment rate among U.S. physicians and surgeons at a miniscule 0.7 percent in 2006--which essentially means that there is no unemployment among doctors.

  • Shortages exist across the board, for all types of physicians, but the situation is especially dire--an estimated 20 percent or higher--in the following specialties and sectors: cardiology, family practice, general surgery, internal medicine, hospital medicine (hospitalists), oncology, orthopedic surgery, psychiatry and urology.

    Strategic approach can yield success

    That's the bad news, but there is a potential flip side: Hospitals and other hiring entities, in general, don't use all of the tools at their disposal to attract candidates and to differentiate their opportunities. And to those that make a concerted effort to recruit, a strategic and candidate-friendly approach to recruiting can increase the likelihood that, all other things--compensation and benefits, practice conditions and workload--being roughly equal, candidates might favor their opportunity.

    In reality, however, most hospitals and groups in the hiring mode overlook their own opportunities to seal the deal. That's either because they're not truly cognizant of the current market conditions and challenges they face, or because they are not responsive enough to candidates who do exhibit an interest in the practice opportunity. Following are a few key areas in which a combination of reality check and recruiting-strategy readjustment might make a difference in the outcome:

    Understand current market dynamics and the changing profile of the new generation of physicians, and adjust expectations accordingly. Competition for all candidates is stiff, and hiring entities should have a handle on both the local and national marketplace trends--especially in the areas of candidate supply, compensation, expected productivity and current trends within that specialty. Operating on old data, or designing and describing a new position based largely on a previous recruiting experience, are surefire ways to set up a search for failure. In short, an approach that worked five years ago likely won't work today, and as it's often said in the financial arena, past performance is no assurance of future success.

    In short, facilities and groups absolutely must use every tool in their proverbial kits today when trying to recruit physicians. That means "sourcing" prospective candidates using every method possible including: Internet postings, journal advertisements, direct mail campaigns, cold calling, e-mail campaigns, physician career fairs and consistent communications with training programs. In the old days, using only one or two modes of getting the word out might have worked; now, savvy hiring entities understand that sourcing candidates is a process, not an event.

    Similarly, hiring entities must understand that the physicians coming out of training today are a different breed than their predecessors. It used to be that doctors looking for a new practice opportunity asked two questions: Where is it, and how much does it pay? Now there is a third question: How hard do I have to work to make that sum? Most physicians today have no interest in working 70 or 80 hours a week, even for above-market compensation. The upshot is that the hospital or group may have to significantly adjust its expectations in terms of workload for the prospective physician; as some industry observers have put it, it takes about 1½ physicians today to fill the shoes of one who is retiring.

    Likewise, hiring entities should avoid setting their sights on the stratosphere when envisioning their ideal candidate. We commonly encounter clients whose candidate parameters are not just broad, they're actually unrealistic and, often, unachievable in this market. The suburban community hospital that has its sights set on hiring an "American born and trained, board-certified surgeon who is under 40 and has strong personal ties to our area" is setting itself up for a very long search, at the least, and possibly an impossible task.

    It's important to look not just at what the hospital or group wants, but at what it truly needs, which may mean letting go of certain expectations and not getting hung up on credentials or "pedigree." (Keep in mind that medicine's "superstars" may not always be top notch when it comes to colleague and patient relations, or may not be willing to toe the line when it comes to institutional policies and procedures.) It's not unlike what we recently saw in pro football, when formerly unremarkable--and now star--quarterbacks Tony Romo and Tom Brady persisted through six plus rounds of the draft. At the very least, the laundry list of parameters may have to be pared down and candidates should be evaluated based on their individual merits, not based on broad classifications that may apply.

    Plan for, design--and deliver--a truly spectacular interview experience. It is surprising, frankly, how many hospitals and hiring organizations don't put the requisite effort into identifying and publicizing the positive differentiators for the position they're offering. That's an activity that should be thorough and thoughtful, and the ensuing script should be well communicated to everyone who will "touch" a prospective candidate--from the recruiter to the potential colleague and the practice administrator.

    In some cases, that effort may ultimately entail being prepared to gently correct a misinformed candidate--the surgeon who has been told that she can earn $400,000 at a competing opportunity one town down the road, for example, may not be aware that the competing entity doesn't offer much in the way of a "soft landing" when the income guarantee expires, or that its physicians have a call schedule from purgatory compared to the one your group can ensure.

    On a similar front, the hiring organization should ensure that a prospective candidate who inquires about the opportunity is met with a friendly, timely response. We have often heard that physicians' CVs sit on a desk unread for a week, or that a call goes unreturned for days simply because the recruiting physician in charge of the search is "too busy" to call the doctor back. That's not only rude; it's a recipe for disaster, given that in today's market that interested physician is likely to have six interview offers while he's awaiting that return phone call.

    When the interested candidate does make the trip, prospective employers should plan not only a positive interview experience but also a thorough one--one that will give the candidate a real sense of the collegial atmosphere, the physical working environment and the community. Oddly, in our experience, about one third of hospitals pay scant attention to designing an actual interview itinerary, when ideally, that itinerary should be both well planned and robust. It should include not just the facility tour, meetings with key physicians, a guided excursion through the town and dinner at the best local restaurant, but also informal (but planned) friendly welcomes from other hospital or practice staff the physician would work with.

    Sometimes, accomplishing that is a mere matter of sending a memo to other medical staff the day before the candidate's arrival, asking them to welcome the physician when they encounter her and express excitement about the visit. Little things go a long way in making individuals feel wanted, and pulling out all the stops can make an already positive experience more so. For example, ensuring that the visiting physician is picked up at the airport, and arranging for flowers or some sort of personalized welcome in the hotel room, should be considered musts in this competitive market.

    On a final note, it's important--if understandably difficult--to keep a positive outlook even in the face of repeated turndowns. Hospitals and groups that have wooed and lost a half-dozen candidates in as many months may feel defeated, but they should avoid exhibiting that to the next candidate--or they could be headed for more disappointments. Remember the famous quote by Malcolm S. Forbes, who once said that "failure is success if we learn from it."

    Jim Stone is a co-founder of the national recruiting firm Medicus Partners, based in Dallas.
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