Employed Model Dominates Physician Opportunities

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LESS THAN 10% FEATURE PRIVATE PRACTICE SETTING

EDITOR’S NOTE: We’re delighted to again welcome Kelley Dunn, Senior Director of Marketing for Merritt Hawkins the nation’s leading physician search and consulting firm and a company of AMN Healthcare, as a guest columnist for SpaceCoastDaily.com and Space Coast Medicine and Active Living magazine.

She reports on Merritt Hawkins’ 2014 Review of Physician and Advanced Practitioner Recruiting Incentives, which has been published annually over the past 21 years, and this year highlights the rapidly changing physician opportunity market.

I was fortunate to have practiced my specialty of general and vascular surgery in an era in which an individual physician had a very good chance of success in a private practice setting by providing top quality service to his/her patients and referring base of physician colleagues.  

However, the complexities and burdensome regulations of the business environment and structural landscape of medical practices today challenge physician-owned practices, and physicians are increasingly turning to hospitals and integrated healthcare systems for solutions to address the strains of the stalled economy, Medicare and Medicaid cuts and a rapidly evolving regulatory climate. 

With the promise of more economic stability, reduced hours and therefore better quality of life, more resources and the ability to devote more time to patient care, the number of new physicians joining hospital-owned practices across the country now far exceeds the number of first-year practitioners or physicians seeking a move, who go to work for medical groups owned and operated by physicians. 

This proclivity for ever-increasing hospital system-owned physicians is evident here at home with the Wuesthoff Health System, Parrish Medical Center and Health First physician groups steadily adding on to their employed physician groups and dominating the physician landscape on the Space Coast.

—Dr. Jim Palermo, Editor-in-Chief

MERRITT HAWKINS • ATLANTA, GEORGIA — Over 90 percent of new physician job openings feature employment by hospitals, medical groups, community health centers or other healthcare facilities.

That is one of the key findings from Merritt Hawkins’ 2014 Review of Physician and Advanced Practitioner Recruiting Incentives, a report Merritt Hawkins has produced annually for the last 21 years examining national trends in physician recruiting and compensation.

The 2014 report tracks the 3,158 physician and advanced practitioner recruiting assignments Merritt Hawkins conducted from April 1, 2013 to March 31, 2014. Of these assignments, the great majority (over 90 percent) featured practices in which newly recruited physicians will be employed, either by hospitals, medical groups, community health centers, academic medical centers or other facilities.

Less than 10% of the recruiting assignments featured independent practice settings, such as partnerships, concierge practices or solo practice settings, down from over 45% in 2004.

EMPLOYED MODEL NOW FIRST CHOICE FOR MOST DOCTORS

The report strongly suggests that the employed model is almost the only choice for physicians seeking practice opportunities today.   However, in our experience, employment also is the first choice for most physicians today. Very few are seeking small, independent practices.

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Both the Affordable Care Act (ACA) and market forces are driving the trend toward larger entities such as integrated hospital systems and consolidated medical groups, which typically employ physicians.

Both the Affordable Care Act (ACA) and market forces are driving the trend toward larger entities such as integrated hospital systems and consolidated medical groups, which typically employ physicians.

Other proliferating sites of service, such as urgent care centers, retail clinics, and Federally Qualified Health Centers (FQHCs) also typically employ doctors.

What this means for the quality of care patients receive is hard to determine. However, the move toward the employment of physicians may affect patient access to physician services.

According to a 2012 survey conducted by Merritt Hawkins for The Physicians Foundation, employed physicians see 17 percent fewer patients per day than do practice owners. As more physicians become employees who work set schedules (rather than small business owners) lines to see a physician could get longer.

PRIVATE PRACTICE INCREASINGLY COMPLEX AND REGULATED

Physicians themselves are seeking employed settings to mitigate financial risks and to avoid the increasingly complex and regulated environment typical of private practice.

One exception is concierge practice, the only private practice option which appears to be growing in popularity. Merritt Hawkins conducted 32 searches for concierge settings last year, up from only ten such searches two years ago.

In concierge practices, physicians contract directly with patients for payment, eliminating in whole or in part third party payers such as private insurance companies or government sponsored insurance plans such as Medicare.

PRIMARY CARE PHYSICIANS, ADVANCED PRACTITIONERS IN GREATEST DEMAND

The report further indicates that for the eighth year in a row, Merritt Hawkins conducted more search assignments for family physicians than for any other type of doctor.

Advanced practitioners such as physician assistants (PAs) and nurse practitioners (NPs) are in growing demand, with the number of search assignments Merritt Hawkins conducted for PAs and NPs increasing by 320% over the last three years.

Advanced practitioners such as physician assistants (PAs) and nurse practitioners (NPs) are in growing demand, with the number of search assignments Merritt Hawkins conducted for PAs and NPs increasing by 320% over the last three years.

Physicians specializing in general internal medicine were second on the list, also for the eighth consecutive year.

Family physicians and other primary care doctors are in increased demand due in part to their expanded role as care coordinators in team-based delivery models such as Accountable Care Organizations (ACOs) and medical homes.

Advanced practitioners such as physician assistants (PAs) and nurse practitioners (NPs) also are in growing demand, the report indicates.   The number of search assignments Merritt Hawkins conducted for PAs and NPs increased by 320% over the last three years.

VALUE-BASED INCENTIVES

The new report suggests that the use of value-based physician incentives stalled in the last year.   In 2013, 39 percent of Merritt Hawkins’ search assignments offering a production bonus featured at least one value-based metric such as high patient satisfaction scores or low hospital readmission rates.

In 2014, that number dropped to 24 percent, indicating that employers are still struggling to create physician compensation formulas that incorporate both volume and value based metrics, or are hesitating to do so until the terms of such formulas become clearer.

I would be happy to provide Space Coast readers with a copy of Merritt Hawkins’ 2014 Review of Physician and Advanced Practitioner Recruiting Incentives. Please call me at 770-481-1181 or email me at Kelley.dunn@merritthawkins.com.

ABOUT THE AUTHOR

Kelley Dunn

Kelley Dunn

Kelley Dunn is Senior Director with Merritt Hawkins, the leading physician search and consulting firm in the United States and a company of AMN Healthcare (NYSE: AHS).

She earned a double major in Biology and Chemistry from the University of Georgia, a Masters degree from Florida Atlantic University, and is currently a faculty instructor with the University of Florida.

With more than eight years of healthcare staffing experience, Kelley has consulted with over 2,000 clinics and hospitals in Florida. 

She can be reached at 770-481-1181 or Kelley.Dunn@merritthawkins.com.


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