Physician Recruiting Woes Build for Rural, Primary Care Positions

Small-town or rural communities appeal to less than 10% of practicing physicians and 3% of trainees.

Competition for physician talent remains fierce.

So healthcare organizations hoping to draw doctors to new practice opportunities must do so with a clear, distinctive message that addresses candidates' concerns, says Jamie Thomas, an executive vice president at the Medicus Firm, a physician recruiting agency.

The top motivating factors among physicians considering a career change are compensation (29.33%) and schedule/hours (16.7%), according to the firm's 2017 Physician Practice Preference & Relocation Survey.

These results are consistent with last year's survey, but the proportion of physicians indicating that retirement is a factor in their career choices nearly doubled since last year (from 9% to 16.75%).

Altogether, 17.22% of the 2,351 physicians surveyed across various specialties stated they were definitely or likely planning to make a career change within the next 12 months.

More than a quarter, however, (28.64%) said they were definitely NOT planning a change in the coming year, up slightly from 27.5% in 2016 but still well under the 43% intent on staying put in 2014.

Rural Pains

Among practicing physicians, major metropolitan areas are the most desirable geographies in which to work (35.8%), while small-town or rural communities appeal to just 8.12% of practicing physicians and 2.7% of trainees. And according to this year's survey, rustic life is becoming an even tougher sell, says Thomas.

"It's always been the case that rural communities paid a little more because they had to. But now, urban communities are actually paying equal to what they're paying in rural communities," he says.

On an even playing field compensation-wise, practices and hospitals are wise to emphasize lifestyle benefits such as flexible hours—and follow through on facilitating work-life balance.

Picking Favorites

Nonetheless, only 16.44% of practicing physician and 25.17% in training cited "hospital employed" as the practice setting that appealed to them most.

The most-coveted opportunities are those in a single-specialty group or partnership (32.27% practicing/27.89% trainees).

These physicians are likely drawn to the camaraderie and collegial environment of a single-specialty group, says Thomas.

Meanwhile, the Southeast remains the overwhelmingly preferred region to work, with 23.49% of practicing physicians and 32.65% in training favoring opportunities in North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, Tennessee, or Kentucky.

ACA Approval Up—For Now

While still short of its 83% peak in 2015, overall physician approval of the ACA increased since last year, with 76% of respondents giving the law a passing grade, compared to 71% the previous year.

Interestingly, however, almost half (44%) of respondents said that none of their 2016 income was based on quality outcomes.

The runner-up response (14.34%) was that physicians were unsure about whether any of their compensation was connected to quality or value-based targets, while 13.52% said that between 1% and 5% of their income was based on outcomes.

But these numbers may be skewed by primary care, Thomas notes.

"While some specialties are being compensated for outcomes, what you're seeing in primary care is that it's still a very production-driven specialty. Internal medicine physicians are probably amongst the most unhappy and looking to make a change," he says.

When the idea of value-based care becomes more of a reality, physicians will be happy with the outcome, Thomas predicts, as long as it coincides with some slackening of productivity goals.

"So if they are getting compensated on seeing 20 patients a day and hitting specific outcomes, that could extend their day if they're still driven by production in addition to quality," he says.

"Or it could be that now the expectation is to see 16 patients a day and hit specific metrics, in which case it would be a favorable thing."