January 15, 2014

The Physician Practice Is Changing

The Physician Practice Is Changing

The American physician is evolving from self-employed practitioner to somebody’s employee, and nobody knows that trend better than headhunting companies such as Merritt Hawkins.

The company’s latest annual review of recruiting trends, released last week, said its findings suggest that “the independent, private practice model is becoming an anachronism.” The review looks at search assignments handled by Merritt Hawkins as well as 2 sister staffing companies, Staff Care and Kendall and Davis.

Merritt Hawkins reported that 64% of physician search assignments from April 1, 2012, to March 31, 2013, came from hospitals looking to hire. In 2004, hospitals generated just 11% of physician searches. Back then, the majority of assignments came from group practices, physician partnerships, and solo practitioners, said Travis Singleton, senior vice president at Merritt Hawkins.

Other organizations than hospitals also want to hire MDs and DOs — Merritt Hawkins is conducting more and more searches on behalf of retail clinics, urgent care centers, free-standing emergency departments, and community health centers. In all, between 85% and 90% of all search assignments involve some form of physician employment compared with 30% in 2004, said Singleton. “It’s a complete flip-flop in our business,” Singleton told Medscape Medical News. “We’re seeing the demise of private practice.”

The switch to employee status has been “a tough transition for physicians, especially those who have been in the field for some time, to move to a worker bee mentality from an entrepreneurial mentality,” said Singleton. In contrast, recent medical school graduates not only accept their role as employees — “it’s the only world they know” — but also prefer it for the lifestyle it makes possible. “They want to come in at 9, they want to leave at 3,” said Singleton. “They want to have quality of life, no call, vacation. And employment offers them that.”

Changing Job Markets Reflect Sea Change in Healthcare For the seventh year in a row, primary care tops the list of the most recruited medical fields, with first place belonging to family physicians and second to general internists. A shortage of these clinicians contributes to high demand, as does the linchpin role they play in new models of care delivery and reimbursement, such as medical homes and accountable care organizations, according to the Merritt Hawkins report.

Top 20 Most Requested Physician Searches by Medical Specialty Specialty
2012 2013
2008 2009
Family medicine 624 595
Internal medicine 194 391
Hospitalist 178 169
Psychiatry 168 122
Emergency medicine 111 86
Pediatrics 87 93
Obstetrics/gynecology 77 137
General surgery 74 152
Neurology 71 87
Nurse practitioner 69 N/A
Orthopedic surgery 57 147
Physician assistant 50 N/A
Hematology/oncology 45 57
Otolaryngology 40 54
Cardiology 38 103
Gastroenterology 37 78
Urology 26 78
Pulmonology 24 83
Dermatology 22 45
Geriatrics 20 7
Source: Merritt Hawkins

With primary care physicians and many specialists in short supply, demand also is building for nurse practitioners (NPs) and physician assistants (PAs). These 2 professions broke into Merritt Hawkins’ list of the 20 most recruited specialties for the first time in 2012-2013 and did not merely land at the tail end: NPs ranked 10th, and PAs ranked 12th.

NPs and PAs are generally regarded as supplements to physicians, not replacements, according to Merritt Hawkins. However, in another sign of reduced professional clout for medicine, NPs and PAs increasingly answer to corporate employers such as Walgreens, which operates retail clinics, and less so to independent physicians, who traditionally have employed these clinicians.

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Become an industry leader Information from Industry The pecking order of Merritt Hawkins’ most recruited specialties also speaks to other major changes in healthcare, including the Affordable Care Act. Similar to NPs and PAs, geriatricians cracked the company’s top 20 list for the first time in 2012-2013, taking the last spot. The specialty is hot because healthcare organizations are struggling to care for a burgeoning senior population. Hospitalists rose to third place on the list for 2012-2013, the company stated, as hospitals sought to reduce inpatient stays, medical errors, and readmissions, all of which important goals in healthcare reform.

In contrast, radiology fell out of the top 20 list in 2012-2013 after having occupied first place a decade or so ago. Other specialties also have seen big drops in demand. Merritt Hawkins conducted 147 searches for orthopedic surgeons in 2008- 2009 but only 57 in 2012-2013. Cardiology slid from 103 to 38 searches during that same period.

The diminished job market for various specialties reflects continual erosion of reimbursement rates for physicians who perform surgeries and diagnostic procedures, which is part of a shift to a healthcare system oriented toward prevention and “generally directed by primary care physicians,” Merritt Hawkins explained in its report.

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