Specialists in Demand

"If you have a skill set that everybody wants, where are you going to go with it?"

This is the question Mark E. Smith poses when talking about today's hot physician specialties. Smith is executive vice president of physician search and consulting firm, Merritt, Hawkins & Associates, which publishes an annual Review of Physician Recruitment Incentives. The report, which is designed in part to help practices evaluate whether their recruitment incentives are competitive, also shows which medical specialties are in highest demand.

Last year, of 2,220 physician searches and consults the company performed, about one-quarter were in radiology and cardiology (252 and 226 searches, respectively). Orthopedic surgery posted third with 172 searches, up nearly 20 percent since the 2000-2001 survey. And the demand shows no signs of slowing.

"The data [for the 2002 survey] was completed in April," says Smith. "In radiology the average search [now] starts at 300 to 325. Orthopedic surgery has changed a lot. In orthopedics, our average search is more like 325 to 350 for a really average spot. Any [practice] who's looking for one of these specialties is faced with the challenge of being financially competitive."

Indeed, it's a seller's market for certain physicians. "I could have found a job just by sitting around doing nothing," says radiologist John Gustavson.

Clearly, in this environment, practices needing to fill positions for in-demand physicians have to be active in the recruiting process and think about how they can set themselves apart. But not all practices do, according to Smith.

"As you define recruiting, does that mean you're going to accept someone if they show up or does that mean you [truly] recruit them? The vast majority of practices recruit in the 'next guy' fashion," says Smith, meaning that if the first guy doesn't work out, they'll just look for the next guy.

"The majority of successful practices have to get involved," says Smith. It's all a matter of "who is selling what they have better? Who's putting [candidates] in a position where they feel their interests will be best cared for?"

Attention-getters

When they're weighing offers from wooing practices, salary is generally the number one consideration for physicians. But it's not the only one.

"Another that's not as visible but is [almost] as important is their time off," Smith reports. "It isn't quantified in our survey but it's important. What candidates are looking for has radically changed. In the 1998-99 survey, if they were starting at $200,000, the expectation would be three to four weeks of vacation. Today it ranges from a very low of six weeks up to 13. We had one [candidate] who was provided 26 weeks -- that's half the year! But now eight to nine weeks off is pretty common."

Other benefits are attractive, too, says Smith, "like juiced-up CME allowances and deferred compensation  -- it gives [physicians] vehicles at their income rate to defer some taxes."

Moving allowances and loan forgiveness are also attractive perks, says Gustavson. But he thinks practices need to be "up-front about the numbers. I think practices that are coy about their numbers [are] a turn-off, like people who wouldn't immediately tell how much vacation they give or the starting salaries. I find that unsettling. For better or worse, you are going to use that to stratify the different groups you're looking at."

Gustavson suggests that some practices reconsider how they position themselves and make their offers more physician-oriented. "A lot of practices sell themselves short  -- they start out saying, 'very busy practice' and then only offer four weeks of vacation. That's going to scare people off."
 
Times are changing

While a solid compensation and buy-in package can be a good start in the race to recruit, practices should watch for changes in their local markets that increase the level of competition  -- a trend that's cropping up even in remote locations like Alaska.

According to Beth Balen, practice administrator at Anchorage Fracture and Orthopedic Clinic, "We haven't had any problems keeping doctors. We have a two-year partnership track; they get what we thought was a decent salary and an incentive bonus, and after two years they go to the shareholders' salary scale, which is really good."

But times are changing. Recruiting new doctors to Balen's practice is becoming challenging, not because they aren't willing to come, but because they have more options than ever when they get there.

The practice has been working on recruiting another surgeon and, at the same time, "We've had a big influx of orthopedic surgeons into Anchorage. We need one [in our practice], we're really busy, but I don't know how much of our market share we're going to lose to the doctors coming in. Five of the six [orthopedists] coming into Anchorage are spine surgeons."

Balen says practicing in Alaska is attractive because of the lifestyle and because "there is virtually no managed care here. They can pretty much come here and practice medicine and not worry about that nonsense." And those who do make the move up north are increasingly well rewarded: "One of my doctors met a young spine surgeon right out of fellowship and we brought him up for an interview," says Balen. "He'd already been offered  $400,000 to $500,000 per year plus incentive bonuses. They've already come up attached to other practices."

Smith adds that "the other thing that's been affected greatly is the buy-in concept. I had a radiology group in the Northwest that had a six-figure buy-in. The candidate came back and said 'I'll accept your money, but I'm not going to pay a buy-in.' After a 15-minute conference call, the practice said 'OK, forget about it.' The buy-in is basically eliminated for those [in-demand] specialties."

Be proactive

Despite the prospect of an easy employment search ahead of him, Gustavson decided to roll up his sleeves and start sizing up what was available. "I'm different from most people in fellowships because I started looking for jobs even when I was studying for my boards  -- most people wait," he says. "I wanted to get it done early."

He suggests "doing some research before you start  -- a lot of the recruiters have Web sites with pages and pages of interviewing tips. I just printed those out and read voraciously before I started. Then talk to people who've been in private practice or academics  -- wherever you want to go. Find out what's important ... what does the buy-in mean? All these are things nobody tells us about" in medical school.

Gustavson says he paid particular attention to learning about contracts "because I've heard so many horror stories. I can think of four people I know who ended up leaving a job within six months to a year because their contracts were not in their favor. They didn't know what they were doing. Just do research before you start."

Finally, he says, if you're in a hot specialty, "don't be afraid to cold call people. I got tons of leads just going through the Yellow Pages or the Internet. You can't hurt yourself doing that. A lot of us don't have a real business or networking mindset, and I think people might be intimidated  -- but just go for it."

Practices, too, need to make more than a cursory effort to find the right candidate. Says Balen, "I posted an ad on the AAOS [American Academy of Orthopedic Surgeons] Web site, and I was very specific that I was looking for a fellowship-trained spine surgeon. I've gotten several nibbles from doctors, but not one of them is a fellowship-trained spine surgeon. Some of them aren't even orthopedists. The only way we're going to find the right doctor is for my doctors to go to meetings and talk to people. I don't think they're going to fall on our doorstep."

Future trends

So which specialties will be hot next week  -- or next year? It depends a lot on patient demand and population demographics, which both play a part in boosting certain medical specialties to the forefront.

"You've got the graying of America and the baby boom bubble, and they're still running biathlons, and everybody wants to be healthy," says Smith. "So you've got a substantially larger population, a more active population than the generation before  -- it's a population that's very preventative-oriented. How many 50-year-olds today have a cardiologist compared to their mothers and fathers when they were that age? A lot."

It's a trend that Jim Zacharias, practice administrator for Cardiology Group PC in Lawrenceville, Ga., calls "a dream come true for a cardiology practice. We are extremely fortunate to be in a high growth area with a young population where only 11 percent of the people are over 55."

Gustavson credits the demand for radiologists to "the way things are in the referring specialties, like primary care and the ER, there's such an increased volume of patients. Primary-care docs and ER docs are busier than they used to be, so they don't have as much time for the history, physical, and the full clinical workup," he says. "By increasing the use of imaging, that helps them fast-track the process. Also, because we can do a lot more than 10 years ago, with CT and MRI and PET, even the specialists rely on us a lot more."

Besides, he says, "there's a lot more direct marketing toward patients so they know about CTs and MRIs. People rely a lot on imaging - maybe a little bit more than they should - but patients definitely want it. You can't knock your head and go to the ER and not get a head CT. A lot of that is patient-driven."

Still, Gustavson wonders whether the demand will last, for example, with other specialties "doing their own ultrasounds, things like that." Smith senses a subtle shift, too.

"You'll continue to see a focus on the specialty and subspecialty side, but there will be a resurgence toward certain parts of primary care. I've already seen it happening," he says. "Many people have given up recruit[ing] a cardiologist, or an oncologist, or a GI, so they say, 'I'd like to bolster my IM base and give that subspecialist the support.' It's a matter of time before that trickles down to family practice. IM is the most obvious because of how it's tied into those subspecialists."

Perhaps not coincidentally, internal medicine has held steady for the last two years as the fourth most frequently searched specialty in Merritt, Hawkins' 2002 physician recruitment report.

Joanne Tetrault, director of editorial services for Physicians Practice, can be reached at jtetrault@physicianspractice.com.

This article originally appeared in the January/February 2003 issue of Physicians Practice.