Primary care doctors in demand; signing bonuses and higher pay for some

With fewer physicians choosing general medicine amid a growing and aging population, practices are having a harder time filling primary care slots, experts say.

By Myrle Croasdale — Posted June 19, 2006

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Family medicine resident Karl Kochendorfer, MD, had a better job-hunting experience than colleagues who graduated during the past decade: He had three job offers in the last year of his training and was able to negotiate a package tailored to the way he wanted to practice.

In August he will start in an academic clinical position at the University of Missouri in Columbia, a position that allows him to practice obstetrics and inpatient care while also pursuing his passion for IT research and development. The location met another of his criteria: staying in the Midwest.

"From what I hear, this is better than in previous years," Dr. Kochendorfer said of his opportunities.

Physician leaders and physician recruiters confirm that it is. They add that an increasing number of internists and family physicians are getting perks even beyond a job description tailored to their interests.

With demand for primary care physicians on the upswing and generalists now at the top of the most-recruited list, medical groups and hospitals are beginning to offer incentives such as signing bonuses and school loan repayment, according to physician leaders and physician recruiters. Some markets are even seeing an increase in starting salaries.

"The competition for general internal medicine graduates is quite intense," said William E. Golden, MD, chair of the American College of Physicians Board of Regents and an ACP delegate to the AMA House of Delegates. "The few being produced are in hot demand."

A 2006 review of physician recruiting incentives by recruiter Merritt Hawkins & Associates showed that general internists and family physicians were at the top of the recruitment list for the first time in six years, surpassing orthopedic surgeons, cardiologists and radiologists.

This is yet another sign of the difficulties hospitals and practices are having filling primary care positions.

"When people come to us, they can't get these physicians on their own," said Kurt Mosley, vice president of business development for Merritt, Hawkins & Associates. "We know they're getting desperate."

The perks

Salary increases are regional at this point. But signing bonuses, which had disappeared for internists and family physicians during the past decade, are re-emerging nationally.

Merritt, Hawkins & Associates did not break out signing bonuses by specialty, but in 2005-06 practices seeking physicians through the recruiter offered bonuses ranging from $5,000 to $75,000, with an average bonus of $20,480.

Also, some hospitals are offering to pay 33% of a new hire's loans each year over three years, in exchange for the physician treating Medicare and Medicaid patients, Mosley said.

In Boston, it appears that salaries are on the upswing, said Michael Barry, MD, past president of the Society of General Internal Medicine and chief of general medicine at Massachusetts General Hospital in Boston, via e-mail.

"We've had increasing difficulty finding good general internists for largely clinical roles at Massachusetts General Hospital, and salaries here are rising as a result," Dr. Barry said.

Nationally, Mosley said he expected starting salaries for internists and family physicians to climb 10% to 15% in the next few years.

He bases that theory on his firm's recent review of 2,840 of the company's search assignments for all specialties from April 1, 2005, to March 31, 2006. The majority of these searches were in cities of more than 100,000. The review showed:

  • 58% of client hospitals and medical groups of three or more physicians offered physicians signing bonuses in 2005-06, compared with 46% the previous year.
  • 34% of candidates were offered school loan repayment incentives in 2005-06, compared with 14% the prior year.
  • 23% of job openings recruited for in 2005-06 were in hospital settings, up from 19% in 2004-05.

Karen Zeller of Rocky Mountain Medical Search in Fort Collins, Colo., and president of the National Assn. of Physician Recruiters said NAPR members were seeing a similar increase in demand and incentives.

"I used to recruit mostly for specialists," Zeller said. "Now any number of my clients are recruiting for internal medicine."

Regina Levison of Levison Search Associates in El Dorado, Calif., said search firms are taking notice of the shift. "We've seen such a change over the last five years with candidates," she said. "They have so many opportunities, they're going for the biggest packages they can get."

Fewer practicing general medicine

The demand for primary care physicians, with the salary and incentive programs being used to recruit them, is being driven both by a decrease in the number of physicians choosing to practice general medicine and an increase in the need for these physicians as the population grows and ages, experts say.

Fewer U.S. medical graduates are going into internal and family medicine, and those who choose internal medicine often subspecialize later.

For example, a recent study found that only a third of those who were doing internal medicine residencies actually planned to practice general medicine.

Dr. Golden said he's seeing this supply downturn at his doorstep at the University of Arkansas in Little Rock, where he is on faculty.

The internal medicine program there once produced seven to eight generalists each year; now, only one or two graduates choose this path, Dr. Golden said. Those choosing to practice internal medicine "get offers from all over," he added.

Perry Pugno, MD, MPH, director of the medical education division of the American Academy of Family Physicians, said demand for primary care physicians to help patients negotiate the complex health care system is on the rise.

"I get e-mails from recruiters looking for family doctors every week," Dr. Pugno said. "Our job announcements in our journals are almost double what they were last year. It's really clear that the market for family physicians has jumped way up."

Dr. Kochendorfer said that although he wasn't offered a signing bonus, the salaries he was offered were competitive.

"I interviewed at four places, and I got job offers from three out of the four," Dr. Kochendorfer said. "It's been a great experience to negotiate salaries, terms and work on IT projects as well."

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Most wanted

For the first time in six years, general internists and family physicians are at the top of the "in demand" list for hospitals and medical groups, according to a review of 2,840 Merritt, Hawkins & Associates' listings. Here, by year, are the number of physician searches by specialty, starting in 2002-03 and continuing through 2005-06.

2002-03 2003-04 2004-05 2005-06
Internal medicine 113 124 188 274
Family medicine 122 165 166 257
Radiology 230 202 218 237
Orthopedic surgery 191 210 210 207
Cardiology 188 181 231 174

Source: Merritt, Hawkins & Associates

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Rising salaries ahead?

Some experts believe the increased demand for primary care physicians will drive up salaries for internists and family physicians by 10% to 15%. Here's a look at low, average and high annual salaries for those physicians, running from 2002-2003 through 2005-2006.

Low Average High
Internal medicine
2005-06 $130,000 $162,000 $250,000
2004-05 $130,000 $161,000 $210,000
2003-04 $125,000 $152,000 $200,000
2002-03 $125,000 $150,000 $200,000
Family medicine
2005-06 $115,000 $145,000 $220,000
2004-05 $125,000 $150,000 $200,000
2003-04 $120,000 $146,000 $195,000
2002-03 $120,000 $146,000 $190,000

Source: Merritt, Hawkins & Associates

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Internists turning to specialization

New physicians are still choosing internal medicine residencies, but studies show an increasing number are specializing rather than practicing general medicine.

57% of third-year internal medicine residents in 2003 planned to subspecialize, up from 42% who had those plans in 1998.

27% of graduating internal medicine residents picked primary care careers in 2003, down from 54% in 1998.

21% of general internists who did not renew their 10-year board certificates from 1990, 1991 and 1992 were no longer working in internal medicine. Within this group, 78% reported they were working in another medical field, 3% said they no longer worked in medicine and 2% were retired.

19% of first-year interns in 2003 planned to pursue a primary care career.

Sources: Academic Medicine, May 2005; Annals of Internal Medicine, Jan. 3

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