While demand for primary-care physicians remains robust, hospitals, medical groups and other healthcare facilities are shifting their recruiting efforts to medical specialists, according to an annual report tracking physician starting salaries and recruiting trends.
Prepared by Merritt Hawkins, the nation’s leading physician search firm and a company of AMN Healthcare, the 2018 Review of Physician and Advanced Practitioner Recruiting Incentives tracks a sample of 3,045 physician and advanced practitioner recruiting assignments the firm conducted from April 1, 2017 to March 31, 2018. Now in its 25th year, the report indicates that Merritt Hawkins conducted a growing number of search assignments for medical specialists in the 12 months covered by the report, while conducting fewer searches for primary care physicians relative to recent years.
“It’s a matter of demographic destiny,” said Travis Singleton, senior vice president of Merritt Hawkins. “Americans are getting older, and it is medical specialists who will be taking care of our aging and ailing bodies and brains. We still need more primary care doctors, but a growing emphasis is being placed on recruiting specialists.”
The report indicates that 74% of Merritt Hawkins’ recruiting assignments in the last year were for medical specialists, up from 67% three years ago. By contrast, the number of searches the firm conducted for primary-care physicians (family doctors, internists and pediatricians) declined by 19% year-over-year and by 32% compared to three years ago. In its latest report on physician supply and demand, the Association of American Medical Colleges (AAMC) projects a shortage of up to 73,000 specialists by 2030.
“Family medicine was our number one search for the twelfth year in a row, so demand for primary care doctors is still strong,” Singleton said. “But it would be a mistake to believe that physician shortages are confined to primary care. Specialists also are in short supply.”
Part of the decline in primary care searches can be attributed to the growing use of nurse practitioners (NPs) and physician assistants (PAs), according to Singleton. The number of search assignments Merritt Hawkins conducted for NPs increased by 61% year-over-year, as NPs are being used to fill openings at the growing number of urgent care centers and retail clinics nationwide.
The Crisis in Mental Health
The 2018 report indicates that for the third year in a row, psychiatry was Merritt Hawkins’ second most requested type of search assignment, underscoring a pervasive shortage of mental health professionals nationwide. Seventy-seven percent of U.S. counties report a severe shortage of psychiatrists, and in 2016, it was reported that for the first time the largest share of healthcare spending in the U.S. is on mental health.
“Expanding mental health services is considered a key to addressing societal problems such as mass shootings, suicide and drug addiction,” Singleton said. “Unfortunately, the shortage of psychiatrists is a serious impediment to this goal.”
Highest Starting Salaries
Physicians practicing invasive cardiology have the highest average starting salaries tracked in Merritt Hawkins’ 2018 report at $590,000, followed by orthopedic surgeons at $533,000, gastroenterologists at $487,000, dermatologists at $425,000 and pulmonologists at $418,000 Starting salaries for family physicians reached an all-time high of $241,000, according to the report, while the average physician signing bonus also reached an all-time high of $33,707.
Merritt Hawkins 2018 report suggests that the use of value-based physician incentives is gaining momentum. Of those Merritt Hawkins clients offering physicians a production bonus last year, 43% based the bonus in whole or in part on value-based metrics such as patient satisfaction and outcome measures, compared to 39% the previous year and 32% the year before that. However, the 2018 report indicates that only 8% of total physician compensation is tied to quality or value-based metrics, suggesting that volume remains the primary method for measuring and rewarding physician productivity.