Recruiters say why it’s getting tougher to hire primary care doctors

A greater number of older patients has increased demand for primary care doctors while an aging physician population has dampened the supply. The situation, amplified by a growing emphasis on primary care services, is making primary care physician jobs more difficult to fill, according to physician recruiters.

“We’re seeing a shift back to the importance of primary care, but there are not enough of them,” said Shelley Tudor, a board member of the Assn. of Staff Physician Recruiters. “Health systems have to take a different approach to recruiting.”

Primary care physician positions took 151 days to fill in 2011, up from 125 in 2010 and 115 in 2009, according to the annual benchmarking report the Assn. of Staff Physician Recruiters released Oct. 10. About 150 in-house recruiters with hospitals, health systems and large medical groups participate each year. These staffers usually work to attract physicians for employed positions, although they sometimes have independent postings available as well. Seventy percent of searches in 2011 were for practices owned by hospitals or integrated delivery systems.

“Everyone is looking for primary care physicians,” said Tudor, who also co-chairs ASPR’s benchmarking committee. “Primary care specialties tend to be in everyone’s top 10 list.”

Family physicians, internists and hospitalists were in the top five of requested medical professionals in the ASPR survey. Filling out the top five were nurse practitioners and physician assistants.

Another sign of struggle for recruiters comes from the number of available positions filled by year’s end. Recruiters filled only 51% of available positions for any physician specialty by the end of 2011, a decrease from the 60% filled in 2010.

Recruiters say difficulties are primarily a result of an aging population — both patients and physicians. The number of people 60 to 64 years old rose 55.6% from 10.8 million in 2000 to 16.8 million in 2010, according to the U.S. Census Bureau. The population of people 65 to 69 grew 30.4% from 9.5 million in 2000 to 12.4 million in 2010. The number of physicians older than 65 grew from 50,993 in 1975 to 216,302 in 2011, according to the American Medical Association’s Physician Characteristics and Distribution in the U.S., 2013 Edition. Physicians in this age group made up 13% of doctors in 1975 and grew to 21.5% in 2011.

According to the AMA, 85,044 out of 216,302 physicians older than 65 in 2011 provided patient care. An additional 13,780 worked in an administrative, teaching or research capacity.

Fewer retirements, fewer moves

Several surveys have indicated that, because of the economic downturn, many physicians who planned to retire did not. Doctors keep practicing because they want to — long past the age when people in other professions have hung it up. But recruiters say older physicians tend to work fewer hours than younger doctors and are less amenable to moving.

“Physicians move an average of four times in their career, but physicians who are 55 and older don’t move as much,” said Tim Sheley, a partner at Jackson & Coker, a physician recruitment firm based in Atlanta.

Primary care physicians tend to move less than those in other specialities. Nearly 12% of primary care physicians changed facilities, retired or died in 2012, but hematologists had a move rate of 20.4%, according to an analysis issued Oct. 23 by SK&A, based in Irvine, Calif. The move rate of head and neck surgeons was 17%.

Further complicating recruitment is the fact that many institutions have a greater call to provide primary care services. In part, that’s because inpatient volumes have been declining for years in response to advances in technology. Health system reform, with accountable care organizations and patient-centered medical homes, also is increasing the importance of primary care. The Affordable Care Act may lead to more than 30 million newly insured by 2022.

“Everybody wants a seat at the table, even if we’re still arguing about what the table is going to look like,” said Travis Singleton, senior vice president of Merritt Hawkins & Associates, a physician search firm based in Irving, Texas.

To attract physicians, recruiters say a variety of inducements may be offered: a four-day workweek, flexible scheduling, signing bonuses, educational loan forgiveness and jobs for spouses. Some positions may be designed to emphasize a physician’s professional interests, such as caring for certain medical conditions or performing specific procedures.

“You can get some very high-quality physicians by accommodating work-life balance and accommodating professional interests,” Tudor said.

This does not, however, mean that every physician can write his or her own ticket in every situation. Positions in urban areas, for example, attract more competition from doctors. The ASPR survey found that an average of only 47.9% of offers extended by institutions in towns of fewer than 10,000 were accepted. Facilities in cities of more than a half-million had an acceptance rate of 80%.

“Almost everyone is doing something to make themselves more attractive,” said Matt Neuwirth, regional vice president of business development with Cejka Search, a physician placement firm based in St. Louis. “But the more desirable the location, the fewer perks they’re going to offer. The more rural areas really have to be creative.”