Thursday, February 15, 2007

physician business ideas - An Innovative Take on Doctor Recruiting

I was looking at a February issue of the New England Journal of Medicine. More specifically, I was scanning the Classified Advertising Section devoted to recruiting young doctors.

There’s a story here.. Here’s a countdown of number of ads run for each specialty

Number of Ads for Various Specialties

Internal Medicine 99
Cardiology 46
Internal Medicine- Hospitalist 44
Gastroenterology 24
Nephrology 17
Hematology-Oncology 17
Pulmonology 16
Infectious Disease 16
Family Medicine 14
Neurology 7
Pediatrics 7
Rheumatology 7
Primary Care 6
Psychatry 5
Geriatrics 4
Ob-Gyn 3
Emergency Room Physicians 3
Endocrinology 3
Radiology 2
Orthopedic Surgery 2
Anesthesiology 1
Critical Care Medicine 1
Dermatology 1
Occupational Medicine 1
Opthalmology 1
Pathology 1
Radiology Oncology 1
Transplant Surgeon 1
General Surgery 1
Urgent Care 1
Total 352

This list indicates,

• A high demand for primary care physicians – 177 of 352, or 50 %.

• Nearly as high a demand for medical sub-specialists -- 143 of 352, or 41%.

• A low demand for proceduralists and hospital-based specialists – ophthalmologists,
general surgeons, orthopedists, pathologists, radiologists, transplant surgeons, 7 of 352, 2%. This is surprising since hospitals, particularly these specialists, are purported to be in demand by hospitals.

• Only one ad for dermatologists, which I am told, is one of the specialties most in demand among medical students, because of its relatively high income, limited hours, no weekend calls, and low practice exposure -- might indicate positions for dermatologists are filled from within dermatology residency programs through personal networking.

What’s going on here? Is high demand for primary care because of lack of medical students entering primary care specialists? Are primary care doctors becoming hospitalists because hospitals have found hospitalists to be such a valuable commodity? Is there a shortage of medical specialists – or is the aging populations simply increasing the need for them? Do the proceduralists and hospital-based specialists already have job promises before completing their residencies? Perhaps it’s a little of all of the above.

In any event, to give this blog a more human quality, I’ve created a fictitious story of a young internist just finishing residency. I base this story on information from a “2006 Survey of Final Year Medical Residents “from Merritt, Hawkins, and Associates, the nation’s largest physician recruiting firm (merritthawkins.com.)

You’re 30 years old and in the final year of your internal medicine residency. It’s been long haul – college, medical school, residency, and fellowship – and you’ve grown weary of delayed gratification.

As a general internist, you’re in demand. You’ve received over 60 inquiries about job opportunities. But you’ve yet to accept any offers. You’ve investigated many opportunities on your own -- mostly through the Internet and personal networking – and to a much lesser extent in the advertising sections of medical journals.

You’ve spent most of this year weighing the job opportunities. Your top four considerations are geographic location, a good financial package, adequate call coverage, and loan forgiveness. As far as practice settings, you prefer a single specialty group, partnership, multispecialty group, or hospital employment – in that order. You would prefer to be in a community of at least 100,000 population. For you and overwhelming number of your other colleagues, rural or small town practice is not attractive.

You’d like to be paid on a salary with production, though a straight salary or an income guarantee aren’t out of the question. You expect compensation in the neighborhood of $125,000 to $175,000. but you’re told some or your internal medicine colleagues are pulling down $200,000. In any event, you need a decent income to help pay off your personal educational debt which is nearly $100,000.

You feel you are “very” prepared to handle the “business side” of your medical career – employment contracts, compensation arrangements, and other facets of employment. You’ve prepared through personal research and talking to your buddies. Your medical school offered a few courses in practice management and even an MD-MBA program, but you were disinclined to take them. You still consider yourself a physician, not a businessman.

Despite the demand for general internists, you worry constantly about finding a good job, earning a decent income, having free time available, and to a much lesser extent, about picking a locale where malpractice rates are low. Still, if you had it to do over again, you’d pick medicine as a career.

You know demand is growing for primary care in general, even two-thirds of your medical school classmates chose residences in surgical, diagnostic, or hospital-based specialties. As a well-trained general internist and primary care physicians, you know you have multiple options, such as becoming a sought-after hospitalists, you’re in a buyer’s market, and you’re optimistic about your future. All you really seek is a decent well-balanced life in an attractive city, with time off to enjoy your life, your wife, and your family. Is that asking too much?

9 comments:

The Independent Urologist said...

Lots of jobs. It certainly is a buyers market, on the surface. But most of the jobs, just below the surface, probably are not that good.

Aggravated DocSurg said...

I think there may be a particular bias involved here -- speaking as a general surgeon, I do not know of a single general surgeon, urologist, anesthesiologist, or radiologist (to name a few specialists) that actually subscribes to the NEJM. There are plenty of ads for surgeons in surgical journals.

That said, I do agree with your premise that it is a "buyers' market" in primary care. Most of my colleagues across the country bemoan the lack of adequate primary care coverage in their communities and hospitals.

Rita Schwab - MSSPNexus said...

Another factor that I suspect influences these ads is hospital-based contract groups. For example, while there may have only been 3 ads for emergency department physicians, those ads could easily represent dozens of jobs in EDs around the country.

ObGynThoughts said...

Hi, I very much agree with "aggravated docsurg". Nobody who is serious about finding a job outside of internal medicine would look at the NEJM. Most specialties have their own publications and websites. In ObGyn that would be OBGmanagement, ObGyn News, Contemporary ObGyn, the Green Journal and the websites NTNjobs and healthecareers.com. That is where ObGyns look for adverstised jobs. Really smart OBGyns know that advertised jobs make up 30% and recruiter offered jobs make up 10-15% of all available jobs. Personal networking, and, even better, direct mail to all doctors in your target range gives you 100% access to available jobs. A review a supply and demand for "procedure specialties" based on ads in the NEJM fails right from the start.
Your Matthias Muenzer, MD

ObGynThoughts said...

Hi, I have one more comment: if you are interested in supply and demand, just look at the incomes of physicians. In the mid eighties an ObGyn in Boston earned about 300K. that bought a normal, decent house in Brookline, one of the best areas in town. Today, 20 years later, an ObGyn earns 250K and the same house costs 1.4 million. Our incomes have dropped dramatically. And, believe it or not, economy is supply and demand. Since our income has dropped dramatically - what do you think we have, a physician surplus or a physician shortage?
Why do people ignore such fundamental economic principles?
Your Matthias Muenzer, MD

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