Emergency Medicine retains position as hardest to recruit among the Most In-Demand Physician Specialties

The top 6 of the Most In-Demand Specialties on PracticeLink.com retain their rank of Most Challenging to Recruit; rest of Index shows little change in Q2.

Of the 15 Most In-Demand specialties on PracticeLink.com, Emergency Medicine has retained its position as the most challenging to recruit.

Emergency Medicine was also at the top of the PracticeLink Physician Recruitment Index in the First Quarter of 2012 as well.

The PracticeLink Physician Recruitment Index measures the relative ease or difficulty of recruitment based on supply and demand information gathered by the PracticeLink system.

The higher the “Jobs per candidate” number, the more difficult healthcare recruiters may find the search for those specialists.

The top six specialties on the Index didn’t change this quarter, and none have left or joined the Index’s list of the Most In-Demand specialties since October.

The Most In-Demand specialties are compiled from the number of jobs posted by in-house recruiters on PracticeLink.com.

PracticeLink.com is the most widely used online physician job bank, with 15,500 physician jobs from 5,000 health care facilities nationwide. More than 20,000 job-seeking physicians and advanced practitioners are registered with PracticeLink at any one time.

The 15 Most In-Demand Specialties Q2 2013 (ranked by difficulty to recruit)

Rank Specialty Jobs Per Candidate Change in Index Rank
1 Emergency Medicine 3.03 Same
2 Urology 2.09 Same
3 ENT 2.07 Same
4 Neurology 1.52 Same
5 Orthopaedic Surgery 1.51 Same
6 Gastroenterology 1.19 Same
7 Family Medicine 1.05 +1
8 Psychiatry 1.01 +1
9 Pulmonary/Critical Care 0.97 -2
10 Internal Medicine 0.84 Same
11 Hospitalist 0.67 Same
12 General Surgery 0.57 +1
13 OB/Gyn 0.54 -1
14 Pediatrics 0.46 Same
15 Cardiology 0.38 Same

 * The most in-demand specialties are determined by the number of job postings in the PracticeLink.com Job Bank.

PracticeLink.com is the most widely used online physician job bank, with more than 20,000 registered health care professionals and 5,000 health care facilities representing every specialty, nationwide. For more information about PracticeLink and the PracticeLink Physician Recruitment Index, or to arrange an interview about physician recruitment trends, please contact: Laura Hammond, Director of Communications; Laura.Hammond@PracticeLink.com, (502) 272-3836.

 

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Urgent Care practitioners are in high demand

Urgent Care is the hardest to recruit of the 15 most in-demand physician specialties for this year’s third quarter, according to the latest PracticeLink Physician Recruitment Index.

Six months ago, Urgent Care didn’t even make the list of the 15 Most In-Demand Specialties, which are ranked according to the total number of jobs per specialty in PracticeLink’s Job Bank and then sorted by physician supply.

Urgent Care practitioners, because they are in high demand, can expect more negotiating power when looking for a position.

Because of the high demand, health care facilities should also expect to spend more time and money to fill Urgent Care openings.

The PracticeLink Physician Recruitment Index measures the relative ease or difficulty of recruitment based on supply and demand information gathered from the PracticeLink Job Bank. The more jobs per candidate, the more difficult health care recruiters may find the search for those specialists.

PracticeLink.com is the most widely used online physician job bank, with 15,5000 physician jobs from 5,000 health care facilities nationwide. Search the PracticeLink Job Bank to find jobs in your specialty and ideal location.

 

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Pediatric Subspecialists in High Demand—And Challenging To Recruit

Twelve of the 15 Most Challenging Specialties To Recruit from the PracticeLink Physician Recruitment Index are Pediatric Subspecialties

Pediatric Subspecialties again make up most of the PracticeLink Physician Recruitment Index’s list of the 15 Most Challenging Specialties to Recruit.

That means physicians in the below specialties are in high demand—and health care recruiters may find these positions difficult to fill in the second quarter of 2013.

Pediatric Dermatology, Pediatric Hem/Onc Neuro, and Pediatric Adolescent Medicine are all new to this quarter’s Index.

The PracticeLink Physician Recruitment Index measures the relative ease or difficulty of recruitment based on supply and demand information gathered by the PracticeLink system.

The higher the “Jobs per candidate” number, the more difficult healthcare recruiters may find the search for those specialists.

PracticeLink.com is the most widely used online physician job bank, with 15,500 physician jobs from 5,000 health care facilities nationwide. More than 20,000 job-seeking physicians and advanced practitioners use PracticeLink at any one time.

The 15 Most Challenging Specialties to recruit in Quarter 2 2013 are:

Rank

Specialty

Jobs Per Candidate

Change in Index Rank

1

Flight Surgery

*

+1

2

Peds-Child Abuse 

*

+2

3

Peds – Dermatology

*

New

4

Peds – Hem/Onc Neuro

*

New

5

Peds – Neuro Critical Care

*

Same

6

Peds – Neuro Surgery

*

Same

7

Peds – Rheumatology

*

-7

8

Peds – Perinatal

*

+1

9

Peds – Emergency Medicine

4.09

+1

10

Peds – ENT

4.00

-3

11

Peds – Surgery

3.67

+1

12

Peds – Adolescent Medicine

3.50

New

13

Emergency Medicine

3.03

+1

14

Peds – Allergy & Immunology

3.00

-1

15

Geriatrics

2.73

Same

An * denotes a specialty for which there are jobs posted but no candidates at the time of the list creation.

For more information about PracticeLink and the PracticeLink Physician Recruitment Index, or to arrange an interview about physician recruitment trends, please contact: Laura Hammond, Director of Communications; Laura.Hammond@PracticeLink.com, (502) 272-3836.

 

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How tight is the job market in your specialty? Spring 2019 Issue

What’s your competition like? For job-seekers of all kinds, it can be hard to know. A simple PracticeLink.com search for opportunities in your specialty will give you an indication of the demand for physicians like you, but without knowing who else is vying for those jobs, it’s hard to get an accurate picture of supply.

How many other candidates in your specialty are actively looking for jobs at the same time? And how does that number correspond to the number of opportunities available?

That’s where the PracticeLink Physician Recruitment Index comes in. The Index is a relative indication of the ease or difficulty of job searches in various specialties based on supply and demand information gathered by the PracticeLink system quarterly. The larger the “jobs per candidate” number for your specialty, the better your potential standing in the market.

The change in rank reflects the specialty’s movement since last quarter.

The Most-Challenging-to-Recruit Specialties are those specialties with the highest demand-to-supply ratio in the PracticeLink system. The specialties on this list likely won’t come as a surprise to candidates; they’re often narrow fields.

The Most-In-Demand Specialties represent the specialties that have the most jobs overall posted on PracticeLink—specialties for which the demand for physicians is highest. For the Index, we then rank those in-demand specialties according to the supply. Those at the top represent specialties with the most jobs available and the fewest candidates per job.

After reading these Indexes, ask yourself: Do these Indexes match my experience of searching for a job in my specialty? Do I need to widen or narrow my job-search parameters as a result?

This PracticeLink Physician Recruitment Index was pulled January 2019. Candidate ratios include physicians who have registered with PracticeLink.com within the past 24 months.

 

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Family-friendly cities

These family-friendly places have top schools, affordable housing, friendly neighborhoods—everything a physician with kids needs in a new place to practice. Plus, there are plenty of venues for play, from lakeshores to mountain bike trails to museums and film fests just for kids. With remarkable job opportunities for physicians in each location, these cities are worth exploring both for their renowned health care and their great livability.

Milwaukee, Wisconsin

Milwaukee, Wisconsin, sits on the shores of Lake Michigan and is one of the Midwest’s best-kept secrets. The people are friendly, the population is diverse, and the city is home to top medical institutions like Froedtert and the Medical College of Wisconsin. In a city made up of 191 neighborhoods, residents can choose to live in suburban, urban or rural communities, and can find family-friendly fun by exploring all this up-and-coming city has to offer.

Familiar with the German word gemütlichkeit? It means good cheer or friendliness, and it’s the spirit that embodies Milwaukee and the people who live there. The city has also been dubbed “Smallwaukee” by locals, because you can’t go long without seeing the face of someone you know on the street. For physicians seeking dynamic careers in a city with a small-town feel, Milwaukee is a perfect place to land.

Kristine Cooper, D.O., is an assistant professor of medicine at the Medical College of Wisconsin. "I love having access to all of the specialists on the cutting edge of medicine and research." -Photo by Joe Hang

Kristine Cooper, D.O., is an assistant professor of medicine at the Medical College of Wisconsin. “I love having access to all of the specialists on the cutting edge of medicine and research.” -Photo by Joe Hang

Kristine Cooper, D.O., is an assistant professor of medicine at the Medical College of Wisconsin. After attending medical school at Des Moines University College of Osteopathic Medicine in Iowa, Cooper began practicing in the greater Milwaukee area, where she stayed for 15 years until moving back to Iowa to be close to a family member who was ill. After her family member passed away, she knew she wanted to return to Milwaukee. When a recruiter reached out to her to see if she was interested in an opportunity at Medical College of Wisconsin, she took the job.

“I love being part of the academic medical team,” says Cooper of her current role. “I love having access to all of the specialists on the cutting edge of medicine and research.”

With over 1,200 students enrolled in the Medical College of Wisconsin’s medical school and graduate programs, the organization is the largest research institution in the Milwaukee metro area, according to Gabrielle Pollard, Medical College of Wisconsin physician recruiter.

“In 2016, faculty received more than $184 million in external support for research, teaching, training and related purposes,” says Pollard. “Annually, MCW faculty direct or collaborate on more than 3,100 research studies, including clinical trials.”

At the Medical College of Wisconsin, over 1,500 physicians provide care for more than half a million patients annually.

For Cooper, the combination of academia and practice allows her to flourish as a physician. She says, “I am constantly striving to be a better physician and always learning, as I have the opportunity to teach the next generation of physicians.”

According to Pollard, Medical College of Wisconsin is experiencing an exciting growth spurt which has opened up new opportunities for physicians. Froedtert, the college’s clinical partner, “is building a new neighborhood hospital to deliver academic quality medicine to the community where people live and work,” says Pollard. The organization seeks talented physicians in all specialties, but is particularly recruiting for emergency medicine and anesthesiologists.

Kristin Settle, director of communications at VISIT Milwaukee, notes that the city has no shortage of job opportunities. Milwaukee is home to the Children’s Hospital of Wisconsin (one of the nation’s top pediatric hospitals), Aurora Health Care (the state’s largest employer) and Wheaton Franciscan Healthcare (a not-for-profit health care system). On top of that, the city boasts eight Fortune 500 companies, adding to its reputation as a modern city that invests in itself.

“Milwaukee has something for everyone, and was ranked one of the top three up-and-coming places to live by U.S. News & World Report,” says Pollard. “It’s also a very family-friendly area with schools in the area being ranked as some of the top in the nation.”

“As a mom of three, I can tell you Milwaukee is extremely family-friendly,” adds Settle. Top attractions include the Milwaukee County Zoo, Betty Brinn Children’s Museum, Discovery World, the historic Mitchell Park Domes, three indoor botanical gardens, the Milwaukee Public Museum, the Milwaukee Art Museum and the Harley-Davidson Museum.

“We’ve even made our brewery tours and beer gardens kid-friendly,” Settle says. It seems only fair kids should be invited to the party, since beer and brewing is such an integral part of Milwaukee’s history.

It’s not just craft breweries that have exploded in Milwaukee; the arts are prominent too. “Milwaukee is home to 25 theaters and has one of the strongest performing arts communities in America,” says Settle. “And we have dozens of smaller, more intimate venues, giving us one of the best local music scenes around—take that, Nashville!”

When you want to get outside, Milwaukee has abundant opportunities for kayaking, biking, sailing, snowshoeing, tobogganing, skating, skiing and more.

“You have all the big city amenities with all the feel of small, friendly neighborhoods,” adds Cooper. “I would tell physicians considering relocating to Milwaukee—welcome home!”

Homewood, Alabama

Situated at the foothills of the Appalachian Mountains, Birmingham, Alabama, is a southern hub for health care. Newcomers to the greater Birmingham area, which includes the suburb of Homewood, are often struck by the natural beauty of the area, which also boasts a strong sense of community and hospitality, not to mention a low cost of living despite its cosmopolitan charm. Health care is the largest employment sector in Birmingham, and incoming physicians are welcomed with open arms into area hospitals and practices.

Jay Meythaler, M.D., did not want to retire from medicine. After working for over 30 years in public academic medical hospitals, including serving as chair of his department at Wayne State University for more than 12 years, he moved back to Birmingham. He’d practiced at the University of Alabama at Birmingham earlier in his career, and the city was a good fit again.

Though no one could fault Meythaler if he did want to retire, he says he simply wasn’t done taking care of patients.

In his current role as the medical director for Encompass Health Shelby County, Meythaler enjoys the opportunity to work with rehab patients, which is the hospital’s primary focus. The facility only opened in April of 2018, and Meythaler was a key player.

Both he and his wife are happy in Birmingham. “My hospital is on the back side of Oak Mountain. It has backpacking trails; I’m looking at the mountain right now from my desk,” says Meythaler. “My wife loves it. You’re close to Nashville, the coast, Atlanta.”

In addition to Encompass Health, the area also has health care organizations like the University of Alabama at Birmingham Hospital (which is among the 20 largest hospitals in the country) and St. Vincent’s Birmingham (which is operated by health network Ascension).

According to Meythaler, physicians often have privileges at more than one hospital, which contributes to a nice sense of familiarity among the medical community.

“I know physicians who do part-time at two different hospitals. That was very different from Detroit. [There,] it was as though all other hospital systems are the enemy,” he says. Not in Birmingham.

Jamie Boutin, Encompass Health Corporation associate director of physician recruitment, says southern hospitality has a lot to do with the collegial atmosphere among doctors. “Physicians connect with physicians coming in,” he says. “We’re built to be welcoming. All hospitals are kind and nice, but when there’s a community where [new hires] happen all the time for all varieties of specialties, that’s a big plus.”

At Encompass Health, an acute inpatient rehabilitation hospital, Boutin says they are recruiting doctors specializing in physical medicine and rehabilitation. Encompass Health operates 130 hospitals around the country, including Birmingham’s Lakeshore Rehabilitation Hospital.

According to Boutin, most candidates at Encompass Health locations in Birmingham are younger physicians who have families, in part because of the affordable cost of living and the availability of family-friendly activities. “It’s an hour to the mountains, less than an hour to a bunch of lakes and four hours to the beach,” he says. “Candidates tend to be struck—they’re surprised by how beautiful it is and how close they are to all sorts of activities.”

“Family-friendly events and activities are plentiful in Birmingham,” echoes Dilcy Windham Hilley, vice president of marketing communications at Greater Birmingham Convention and Visitors Bureau. “It is widely considered one of the most family-oriented cities in the Southeast.”

Annual events include the Sloss Music and Arts Festival, the Sidewalk Film Festival (one of the top independent film festivals in the U.S.), the Day of the Dead Festival and the Pride Parade, to name a few.

You can find beautiful white sand beaches, along with plenty of opportunities for fishing, hiking, golfing and camping, all in the state of Alabama. If you want a change of pace, you are close enough to Nashville, Atlanta and the Florida panhandle to get away for a weekend.

In a region characterized by southern hospitality, moderate year-round temperatures and a thriving health care system, it is no surprise physicians and their families are finding themselves in greater Birmingham. As Meythaler says, “this is a really nice circumstance to be in.”

Warwick, Rhode Island

In the greater Providence area, including picturesque cities like Warwick, locals can get outside to enjoy the natural beauty of the state and soak up city culture in the same day (and kids will delight in an afternoon spent at the zoo or watching minor league baseball).

When Therese Zink, M.D., explains why she chose family medicine as her specialty, she recognizes her reasoning is not uncommon for physicians in her field.

“My reason for choosing family medicine is one that you will hear from other family docs,” she says. “As a medical student, I fell in love with every specialty I rotated on. Family medicine allows us to do it all.”

Zink’s career has included teaching, research and administration in the academic setting.

Now a physician at Care New England, a health system that includes several hospitals in Rhode Island, Zink chose her current role because it allows her to work in academics while also seeing patients part-time.

According to Jean Butler, Medical Group COO at Care New England, the focus the health system places on teaching partnerships with Brown University and University of New England College of Osteopathic Medicine is a big draw for physicians who are considering a job with the network.

Butler says that Care New England’s physician-dominated board of directors has a positive impact on the organization. “It’s 80 percent physician participation, and they really do lead the group and where the group is going,” she says.

In addition to Care New England’s hospitals, other medical facilities in the region include Rhode Island Hospital (the state’s largest hospital), Hasbro Children’s Hospital, and Miriam Hospital (noted for cardiac care), among others. Plus, Brown University’s Warren Alpert Medical School is a leader in medical education and biomedical research.

As for why physicians might want to relocate to the greater Providence area, other than the jobs themselves, Butler says Providence’s status as a “mini Boston” is one good reason.

“It has all the elements of a major city,” says Butler. Despite being convenient to Boston and New York, locals don’t have to leave town for culture, great cuisine or exciting events.

Providence’s signature event is WaterFire, an award-winning fire sculpture installation situated in the heart of downtown on three of Providence’s rivers. Other cultural opportunities include exhibits at the Rhode Island School of Design Museum, gallery nights at venues across the city, and a restaurant week that features nearly 100 restaurants.

For kids, there is Roger Williams Park Zoo, which is the third oldest zoo in the country. There is also the Providence Children’s Museum, the Providence Children’s Film Festival, and the Pawtucket Red Sox. And of course, you can get outside. “Rhode Island sits on the coast, so people who live here like boating and swimming,” says Butler.

For Zink’s partner, in particular, being in Rhode Island was a perfect fit. “My partner is from the West Coast, so he was ready to see the ocean again,” says Zink. “We have loved walking the rocky beach with our dog, Conner, who is enjoying the seafood and learning not to drink the saltwater,” she adds. And, says Zink, her role at Care New England and the ability to work part-time in family medicine gives her time to pursue another passion—writing. She is writing a trilogy of international aid novels that feature a family physician.

"I don't know what you'd have to pay me to leave Bentonville," says Chad Jones, M.D. "It's wonderful here." -Photo by Stephen Ironside

“I don’t know what you’d have to pay me to leave Bentonville,” says Chad Jones, M.D. “It’s wonderful here.” -Photo by Stephen Ironside

Bentonville, Arkansas

The city of Bentonville, located in Northwest Arkansas, is one of the fastest growing regions in the nation. With a friendly and diverse population, great culinary experiences, affordable quality of life, good schools and expanding, state-of-the-art health care institutions, more and more people—physicians included—are deciding to call Bentonville and its neighboring communities home.

We have the whole world here,” says Chad Jones, M.D., an orthopedic spine surgeon at Mercy Hospital Northwest Arkansas. After graduating from Rhodes College in Memphis, Tennessee, Jones earned a master’s degree in biomedical engineering at Ohio State University. He also earned his medical degree at the Ohio State University before interning at Beaumont Hospital in Michigan.

Jones loves his specialty, specifically the fact that he can help make people better through surgery. “I don’t like taking care of sick people, but I love fixing broken people,” he says.

“We have a loud music selection that helps us when we’re operating. Here at Mercy Hospital, they have Bose sound systems for all the operating rooms, and the sound is fantastic.”

Physicians at the hospital treat patients from a huge variety of demographics, primarily due to the diverse population that is employed by Walmart’s Bentonville headquarters.

According to Raley O’Neill, Mercy Hospital Northwest Arkansas physician recruiter, the hospital—which is 10 years old this year—is expanding every single service it offers. Construction to the building, which is scheduled to be completed in the summer of 2019, will add 100 beds, significantly growing the current capacity of just over 200 beds. As part of the $227 million expansion, the hospital is also opening new clinics in the region.

With the significant population growth in the area, Mercy expects to add 1,000 jobs, including about 100 physicians. Currently, the greatest recruitment needs are in gastroenterology, urology and rheumatology, as well as for hospitalists and OB-GYN hospitalists. Pulmonologists specializing in electrophysiology are also in demand.

Other medical facilities in the community include Northwest Medical Center-Bentonville (a 128-bed acute care facility) and Washington Regional (a nonprofit, community-owned health care system with a hospital in Fayetteville and clinics across the region).

Kalene Griffith, president of Visit Bentonville, says that once people find employment and settle in the area, they tend to want to stick around. “We have people that change jobs rather than transfer out of the community,” she says.

In addition to the expanding health care options, the region offers affordable housing, top schools in the state, a budding music scene and cultural experiences for both children and adults. Cultural attractions include Crystal Bridges Museum of American Art, the Museum of Native American History, Bentonville Film Festival and Amazeum, a children’s museum with hands-on experiences.

“Most important, the people are friendly and welcoming,” says Griffith.

“A year or two ago, I was talking with a fairly well-known person in medicine about a potential position for me in Little Rock,” says Jones. “I told him I appreciated that, but with all due respect, I don’t know what you’d have to pay me to leave Bentonville. It’s wonderful here.”

 

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Burned out

Practicing medicine has never been an easy profession. But it’s also not getting any easier. Perhaps that’s what makes burnout not only a reality, but also on the rise—and rising fast. Tait Shanafelt, M.D., chief wellness officer of Stanford Medicine, has found that burnout rates among physicians are now twice as high as that of professionals in other fields.

In the most recent data from a national research study, Shanafelt found that nearly 49 percent of physicians reported burnout, as opposed to 28 percent for other professionals.

Although physicians of all ages and time in practice can and do suffer from burnout, it’s actually the younger physicians who seem to be particularly at risk.

“Residency is the peak time for burnout,” Shanafelt says. One factor is the long hours required of training.

Female physicians report burnout at higher rates than male physicians. In one survey from Medscape, 48 percent of female respondents reported burnout symptoms vs. 38 percent of male respondents.

Specialty can also play a role. One Medscape survey cites the following specialties have the highest reported rates of burnout: critical care, neurology, family medicine, Ob/Gyn, internal medicine, emergency medicine and radiology. Additional issues also contribute. For example, working emergency department shifts can contribute to “a distortion in circadian rhythm,” says David A. Farcy, M.D., who practices at Mount Sinai Medical Center in Miami Beach and is president of the American Academy of Emergency Medicine (AAEM).Likewise, “Emergency departments are the safety net of America, social issues are mounting and resources are getting less.”

The two factors most often cited in the Medscape survey as contributing to burnout are “too many bureaucratic tasks” (cited by 56 percent of survey respondents) and “spending too many hours at work” (cited by 39 percent of respondents).

Shanafelt notes another factor: complying with the demands of electronic health records. “About 37 percent of a physician’s time in an examination room is spent entering EHR data into a computer,” says Shanafelt—time that could be spent with the patient, and time that still often requires data entry on nights and weekends.

Bringing burnout to light

The first step to getting help with burnout? Acknowledging there's a problem, says Antonia Francis, M.D. -Photo by Lauren Listor

The first step to getting help with burnout? Acknowledging there’s a problem, says Antonia Francis, M.D. -Photo by Lauren Listor

As recently as the late 1990s and early 2000s, the idea of physician wellness was rarely addressed as part of med school curriculum. Instead, the focus was on strength and resiliency. The message was this: physicians should do whatever was necessary to deal with the challenges of a career in medicine. That mindset created even more stress.

It took an increase in physician suicides to bring the matter to the forefront.

In 2012, the suicides of two residents in New York City shone a light on the issue of physician suicide. “As a result, the emergency community as a whole came together in 2016 to form a coalition of all emergency medicine groups to address wellness,” says Farcy. Goals of the coalition included defining the problem of burnout and determining ways to identify and prevent it.

Benefitting from the focus

For Farcy, the topic was deeply personal.

“During my medical school, emergency medicine and critical care fellowship training, physician burnout and wellness was never addressed,” he says. “We were taught to just press on.”

But while in residency at Maimonides Medical Center in Brooklyn, Farcy was a first responder on 9/11—an experience with memories that he put “in a box” and didn’t speak about to others.

Then, during a moment of silence paying tribute on the one-year anniversary, Farcy’s experiences hit him hard.

Farcy’s program director took notice and invited him to her office to talk. She suggested he get help and referred him to a representative from the ACGME. From there, he visited a psychologist trained in PTSD and survivor guilt—and got the help he credits with changing his life.

“I am grateful that my institution had a program in place and a plan to address the issue without fear of repercussion,” Farcy says.

Antonia P. Francis, a maternal fetal medicine fellow at NYU Langone Health Center, reports that while she hasn’t personally known any physicians who have committed suicide, “I trained at an institution that experienced two suicides of house staff within a three-week period, yet I can honestly say that during my medical training, the topic of suicide was not heavily stressed.”

Francis, who works a fairly typical 80-hour a week, says, “I experienced depression and burnout during my residency training and first year of fellowship,” she says. The first step was recognizing she had a problem. Then, she took action.

“I visited counselors and a therapist who specifically works with physicians who had mental exhaustion,” she says. “I also learned to practice mindfulness, started journaling for stress relief, and exercised more.”

When help doesn’t come

Untreated burnout can lead to medical errors, substance abuse, depression and even death.

“About 300 to 400 physician suicides are reported each year,” Farcy says, “but suicide in doctors is under-reported and often hidden, because a physician can make a suicide look like an accident.”

The AMA and STEPS Forward module (stepsforward.org) on physician depression and suicide reports that female physicians commit suicide at a 130 percent higher rate, and males at 40 percent higher rate, than that of the general population for each gender. Those statistics alone make burnout a problem in dire need of fixing.

Fixing the problem

Alleviating physician burnout is a complex challenge. Survey respondents cited more pay, fewer hours and patients, and fewer government regulations as key.

Early detection can also help. Farcy, who has been supervising residents in emergency medicine for 12 years, has seen and addressed depression and burnout in others. The early signs, he says, are “less involvement, less caring, and negative comments in a person who used to be very positive.”

Addressing burnout, however, comes with its own land mines. Sometimes when a physician who is depressed or approaching burnout speaks to their supervisor about the issue, the physician is forced to stop working or see a psychiatrist in order to be cleared to go back to work.

“Too often, this adds to the stress by causing a new burden on the physician,” Farcy says.

And when a colleague has moved beyond burnout to something deeper, expressing concern may not be enough. “By the time a doctor is in the early stages of depression, it is harder to get them involved in resilience,” says Farcy. “Telling them you need to go work out, do yoga, drink less, spend more time with your loved ones, etc., too often falls on deaf ears. The physician may hear it but won’t change or do these things because of their underlying depressive state.”

David Farcy, M.D., has seen and addressed depression and burnout in others. The early signs, he says, are "less involvement, less caring, and negative comments in a person who used to be very positive." -Photo by Rodrigo Varela

David Farcy, M.D., has seen and addressed depression and burnout in others. The early signs, he says, are “less involvement, less caring, and negative comments in a person who used to be very positive.” -Photo by Rodrigo Varela

The best answer may be in fostering a community that’s open to discussing burnout. Farcy says physicians need to feel free to talk openly, in a safe place, without being labeled as weak. “We have a wellness program where I work, and I have an open-door policy for anyone to be able to talk and share, without risk or fear of repercussion,” Farcy says.

“Once the person begins speaking, most important is listening and creating a plan,” he says.

Clif Knight, M.D., is senior vice president for education for the American Academy of Family Physicians (AAFP). He’s worked in private practice, as a hospital administrator, and as director of a family medicine residency program. As a residency program director, he witnessed resident burnout and tried to help his physicians recognize their symptoms and consider counseling and coaching.

Knight stresses that burnout is not due to a lack of physician resiliency, as was once commonly thought.

“It’s important to recognize that the majority of burnout is related to problems in the health care system and outside the physician’s control most of the time,” he says. “We need to fix the system’s problems instead of addressing only the resiliency and coping skills of individual doctors.”

Francis agrees. “Physician wellness isn’t only about individual and personal efforts, but about change on a broader level.” She suggests that institutional support and a change in our medical culture would go a long way to support physician wellness.

The path ahead

Now, medical education institutions are addressing burnout head-on. And there appears to be more help for physicians in the throes of burnout.

“Cultural and environmental changes are necessary to combat physician burnout,” says David A. Rothenberger, M.D., who advises on physician burnout at the University of Minnesota. “At our institution, we have a multi-year, major commitment from the top of the organization to devote time, talent and treasure to take on this problem.”

Rothenberger is also helping to build a coalition of those who want to address the issue of physician burnout. Currently, close to 80 individuals belong to the coalition, including academic and clinical leaders and staff.

Though progress is being made, Rothenberger says it will take a decade or two to fully address the issue.

“Achieving the needed transformation of the workplace culture to overcome the current physician burnout epidemic will take many years, and sustaining physician wellbeing is dependent on continuous effort to meet the future needs of physicians and other health care professionals,” he says.

 

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Leveling up

If you’re like most new physicians embarking on your career, you might not be thinking ahead to a management role. Your priorities are likely finding the right place to practice and, above all, helping patients.

But even if you don’t envision running a health system, hospital department or independent practice in the future, you should still be seeking out opportunities to develop leadership skills. These abilities will bolster your career as a physician—whether you see yourself in a corner office one day or feel certain you’ll always focus on patient care.

After all, some level of leadership is inherent in every physician role. Staff will look up to you and expect you to lead the way, and your employers will rely on you to guide new initiatives and solve problems. Learning to lead better can help you not only advance your career but also care for patients more effectively.

Filling a gap in your medical training

Mark Deshur, M.D., says it doesn't take a title to be a leader. "Even without a formal role, you can make a difference in how things are being done." -Photo by Colin Lyons

Mark Deshur, M.D., says it doesn’t take a title to be a leader. “Even without a formal role, you can make a difference in how things are being done.” -Photo by Colin Lyons

Despite their benefits, leadership skills rarely get attention in medical school and residency. With so many clinical priorities to cover, it’s hard to make room for non-clinical topics in the curriculum.

“Lots of physicians don’t want to accept that management skills are important,” says Maria Chandler, M.D., MBA, founder of the MD/MBA dual-degree program at University of California, Irvine and president of the Paul Merage School of Business Association of MD/MBA Programs. “But this is a disservice to medical students. We’re telling them [clinical education] is all you need, yet it’s not true.”

This focus on direct patient care is admirable, but it may be shortsighted. Chandler believes management training helps physicians care more effectively for patients. For example, physicians with business knowledge can be better advocates for clinical priorities. She explains, “If you’re interested in preventing chronic disease, you can learn to make the economic case for that.”

That’s one reason Chandler advises all physicians to learn some leadership basics. She says they should do so “as early in their careers as possible.” Once there’s an “M.D.” or “D.O.” after your name, people will expect you to guide them, regardless of your age. Many of these people—including the nurses, MAs and other staff you’ll work alongside—provide essential support for patient care. Working well with this team will require training you didn’t receive in medical school, and some of what you learned might even be counterproductive.

Unlearning the superhero myth

According to Dike Drummond, M.D., CEO of TheHappyMD.com, many physicians enter the workforce with misguided expectations. “In medical school and residency, there are no leadership courses. You learn by osmosis, and here’s how it works: you see patients, reach a diagnosis and write orders, and the rest of the care team waits on you,” explains Drummond. “You’re taught subconsciously that only you have the answers. But what kind of leadership style is that for team-based care?”

As a result, Drummond says that most doctors internalize a “Lone Ranger, workaholic, superhero, perfectionist ideal” in medical school. This mindset not only burdens physicians; it also makes it harder for staff to help. Nurses and others will follow your lead. If they’re always waiting for your orders, they’ll be underutilized and probably less motivated, too.

And when staff members don’t feel supported as part of the care team, patient safety can be affected. “It’s been proven in numerous studies that a lot of people feel too intimidated to say anything to a physician—even if it’s a life-threatening issue,” adds Chandler. “Leadership training can help physicians learn to create an atmosphere of teamwork.” In a culture where staff feel comfortable raising concerns, patient care improves.

To build team leadership skills as a physician, Drummond says the critical first step is learning to listen and ask questions. “Your staff can always help,” he explains. “They want to help. But they’re not going to elbow you out of the way.”

Once you start asking staff how they can assist, Drummond says they’ll likely respond with many useful ideas. When you enable them to take on more meaningful roles, they’ll be happier and more engaged, too. That means more support and less stress for you as a physician, more attention for your patients and higher career satisfaction for the entire team.

New clinical and economic approaches are making the ability to lead diverse teams more critical than ever. Patient-centered medical homes require high-performing care teams, and alternative reimbursement models—with evolving definitions of value and quality—require physicians to lead change, sometimes in tandem with administrators.

Chandler says physicians don’t always see these opportunities as being directly tied to patient care. “Many doctors think of taking on leadership responsibilities and roles like serving on committees as a chore,” she says. “All some of us want to do is see patients—like a surgeon who’s tied up in an OR 80 hours a week and inadvertently gives up their input.”

But she says by getting involved in leadership, physicians can impact more patients while helping hospitals and health care systems make better decisions and reduce costs.

Don’t wait for an official title

In the business world, budding leaders learn the art of managing up, down and across—or in other words, finding ways to influence the workplace even when they aren’t in charge. Physicians can benefit from learning to do the same. This starts with recognizing opportunities to help not only their patients and their subordinates but also colleagues at all levels.

Mark Deshur, M.D., MBA, vice chair of operations in the department of anesthesiology, critical care and pain medicine at NorthShore University HealthSystem in Chicago, has found this to be true in his own career. He says he knew from the beginning that he would eventually seek some sort of leadership role, explaining, “I knew I wanted to be part of the decision-making process, not just subject to others’ decisions.”

Deshur learned early on that you don’t have to wait until you have formal authority to contribute ideas to improve your workplace. “We have so many people in my practice who are leaders without titles,” he says. “Even without a formal role, you can make a difference in how things are being done. You see an opportunity to do something a little differently and a little better, and that improves things for everyone else.”

And making suggestions isn’t just good for others. It’s also good for you. “It creates more career satisfaction and better engagement in the practice because everyone wants to feel that when you’re going to work, you’re making the place better,” Deshur explains. He adds that phrasing a suggestion as a question is a good way to persuade others without putting peers and senior colleagues on the defensive. “For example, you could say, ‘Do you think if we tried X, it might be an improvement?’”

At practices that welcome this type of input, younger physicians get to develop their leadership potential and prepare for formal management responsibilities down the road, Deshur says. He recommends assessing prospective employers by asking recently hired doctors if they’ve been allowed and encouraged to suggest changes.

Managing upward can be especially challenging in the medical world. Physician training favors on-the-spot decision-making, and this tends to develop reactive management skills rather than proactive ones. As a result, some supervisors only communicate with their subordinates when there’s a problem, which can be discouraging for young physicians who want to do well. Scheduling a regular check-in with your boss can help you confirm you’re on track.

Mentors provide invaluable guidance

If you nurture relationships with your boss and other experienced physicians, you may find they become long-term mentors. These mentors can be invaluable as you navigate key career decisions. “I’ve been very fortunate to have several mentors I’ve leaned heavily on,” Deshur says. “Even though my career trajectory was different than theirs, they helped me take a step back and think about what my strengths and weaknesses are and what am I interested in.”

Deshur didn’t have to look far for his mentors. He found them in his direct managers. “I was lucky that I had them right in front of me,” he says. “But if you don’t have mentors readily available, seeking out one or two people who can give you feedback and advice is so important. So many people have tremendous experience to share that you can learn from.”

Finding mentors may require effort and creativity, but one easy way to start is to keep in touch with older physicians you admired during your training. If your job takes you to a different part of the country, ask them to introduce you to respected colleagues in the area.

Joining your local medical society can also help you form relationships with physicians from a range of specialties, especially since society leaders are often interested in becoming mentors. The nurses at your new hospital are another great resource as they undoubtedly have insights about which doctors are most admired.

To MBA or not to MBA?

Deshur says finding mentors helped him prepare for another major step in his leadership plans: pursuing an MBA. “It was in the very back of my mind, since I’d taken business classes in college. But I kind of forgot about it during the early years in my practice,” he says. “Then my boss, who was also a mentor, told me how he’d gotten an MBA mid-career and asked me if I was interested in it.”

Deshur’s mentor urged him to enroll in the executive MBA program at Northwestern’s Kellogg School of Management. Because the program was located nearby and designed for working professionals, Deshur could enroll without leaving his practice. He credits his employer and fellow anesthesiologists for helping him through.

“You can’t do it in a bubble. You need the support of your practice,” he says. “My boss was very supportive. He helped me get the time off that I needed and encouraged the other 50 people in the department to support me.” Deshur’s colleagues ensured he was able to attend required classes on Friday mornings and swapped call schedules with him as needed.

“As a department, we’d benefitted from the leadership of my boss, who had attended the same program,” Deshur recalls. “So I think people thought, ‘If we help Mark take on more, that can help our entire group.’”

Often, the entire organization benefits when a physician earns an MBA, so your employer may also help pay for it. This is especially true if you’re promoted to a role that requires advanced leadership or negotiating skills, such as heading up a department, says Gregg Bass, communication and marketing specialist at Auburn University’s Harbert College of Business. And when tuition assistance from your employer isn’t available, you might be eligible for financial aid.

Auburn’s Physicians Executive MBA Program is pioneering a new wave of MBA offerings tailored to busy physicians who go to school while working full time. “The majority of our program is distance learning,” Bass says. Physicians can access the curriculum online on their own schedule. Five short residencies on campus at Auburn are required, but students get these dates in advance so they can plan ahead.

Chandler believes a physician shouldn’t put off pursuing his or her MBA. She says, “It only took me two years of being out of training [and] seeing patients to realize there might be something more I’d want to do later, besides only seeing patients for my entire career. The worst case is you wait so long that you realize the opportunities you’ve missed.”

The growing number of flexible MBA programs makes it easier to pull the trigger, even while working as a full-time physician. “They make all different shapes and sizes of MBA programs now,” Chandler says. “There are fully online programs, one-year programs, hybrids, evening-weekend programs—all kinds of options to fit the needs of people.”

Another reason not to delay: the skills and professional connections you’ll develop in an MBA program can open new doors. If you’re facing a career change or just feel ready for one, an MBA can be a powerful catalyst.

“We’ve had physicians who are taking on leadership roles in hospitals, physicians who want to leave practice to work in pharma” says Bass. “Recently, we had a trauma surgeon with many years of experience who realized he wouldn’t be able to do that physically demanding work forever and wanted to prepare for something new.”

New opportunities might also come in the form of entrepreneurship. Bass says several physicians in the Auburn program turned their class projects into real-life business ventures. Similarly, Deshur says getting his MBA encouraged him to turn a software program he wrote as a resident into a product. Today, hospitals and practices all over the country use his on-call scheduling solution.

If you already have a great idea that can really make a difference in the industry, Chandler says you might need business training to make it a reality. “I knew a couple of intensive care docs,” she recalls. “They were five to 10 years out of school. They were trying to help save lives by bringing telemedicine to rural areas where intensive care resources were scarce. I said to them, ‘You need MBAs to take this thing and make it big.’ They both enrolled while still practicing and building their venture. It’s hard, but if you’re motivated enough, you can do it. Knowing why you’re doing it—to achieve a goal, to learn a new set of skills—can make it easier to stay focused.”

Creating a healthier health care industry

Vidya Bansal, M.D., started a group for physicians of South Asian decent-a community that has helped her develop her own leadership skills. -Photo by Rachel Moore

Vidya Bansal, M.D., started a group for physicians of South Asian decent-a community that has helped her develop her own leadership skills. -Photo by Rachel Moore

Chandler believes pursuing an MBA is worthwhile not just for the career advancement but also for the personal development. It’s intellectually invigorating. “I found I missed school, missed learning,” she explains. “Doing the MBA while working was hard, but it filled the education void. If you’ve only studied medicine, it’s so intriguing to study something else.”

She adds that an MBA program is just one way to be a lifelong learner. Other development opportunities can also help physicians enjoy their careers. “I get emails from physicians who are many years into practice who are burned out,” she says. “I think one remedy to burnout is to give yourself additional skills so you have options. Your options can be in all different directions.”

Chandler believes today’s physicians can and must take on more leadership roles to improve the profession and make it appealing to the next generation of talent. “It’s like we’ve had blinders on,” she explains. “But we have to think about how to compete over the long-term with other employers who want smart, talented, young employees.”

Pediatrician Vidya Bansal, M.D., has found a way do just that—helping other physicians while developing her leadership skills. Early in her career as a pediatrician, Bansal wasn’t sure where to look for support. So she turned to Facebook and started a private group for physicians of South Asian descent: Desi Physician Moms. When Bansal first founded the group in 2015, it had only 14 members, but she’d struck a nerve. The group soon took off, and today more than 7,000 physicians are members.

“I started it for personal reasons, to find support,” Bansal explains. “I wanted a place where I could share and not feel alone.” What began as a hobby quickly became a lifeline for women physicians dealing with issues like domestic abuse and harassment at work. Over time, the group has evolved into a dynamic nationwide community with an annual conference, a subgroup to support single moms, and mentorship opportunities for medical students. Recently, it launched a foundation to help to women of all professions who are struggling with abusive relationships.

Along the way, Bansal has seen her leadership skills blossom. “To build the foundation, we had to build a team,” she explains. And in order to manage that team while building the foundation and keeping up with full-time clinical work, she’s had to learn to lead others and delegate tasks. Most of all, she says, she’s learned the value of speaking up for herself and for other women.

“What we don’t teach anywhere in medical school or residency is how to be your own advocate,” Bansal explains. “It comes down to being in control of yourself and what you will expect and accept. I feel great for the residents in our group who have a network of colleagues to tell them these things now. You have to find it from within. That’s what we’re trying to teach each other to do. It’s about unity and paying it forward and about fixing what we see that needs fixing in medicine and in women’s lives.”

Chandler emphasizes that everyone can find enrichment from learning at least a bit about leadership. It might not look the same for everyone, but whether you learn from an MBA program, a book, mentors or other activities, leadership training will benefit you professionally and personally.

“Developing a leadership mindset helps bring out some qualities you might not otherwise tap,” Chandler explains. “It allows you to express other talents. Learning about leadership and learning about business gave me a lot of personal satisfaction. You start to see the whole pie, not just the perspective of medicine.”

Laurie Morgan is a partner at Capko & Morgan, a boutique practice management consulting group.

 

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How tight is the job market in your specialty? Winter 2019 issue

List of Job Specialties

The PracticeLink Physician Recruitment Index can help you gauge the relative ease or difficulty of your job search.

What’s your competition like? For job seekers of all kinds, it can be hard to know. A simple PracticeLink.com search for opportunities in your specialty will give you an indication of the demand for physicians like you, but without knowing who else is vying for those jobs, it’s hard to get an accurate picture of supply.

How many other candidates in your specialty are actively looking for jobs at the same time? And how does that number correspond to the number of opportunities available?

That’s where the PracticeLink Physician Recruitment Index comes in. The Index is a relative indication of the ease or difficulty of job searches in various specialties based on supply and demand information gathered by the PracticeLink system quarterly. The larger the “jobs per candidate” number for your specialty, the better your potential standing in the market.

The change in rank reflects the specialty’s movement since last quarter.

The Most-Challenging-to-Recruit Specialties are those specialties with the highest demand-to-supply ratio in the PracticeLink system. The specialties on this list likely won’t come as a surprise to candidates; they’re often narrow fields.

The Most-In-Demand Specialties represent the specialties that have the most jobs overall posted on PracticeLink—specialties for which the demand for physicians is highest. For the Index, we then rank those in-demand specialties according to the supply. Those at the top represent specialties with the most jobs available and the fewest candidates per job.

After reading these Indexes, ask yourself: Do these Indexes match my experience of searching for a job in my specialty? Do I need to widen or narrow my job-search parameters as a result?

This PracticeLink Physician Recruitment Index was pulled October 2018. Candidate ratios include physicians who have registered with PracticeLink.com within the past 24 months.

 

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What physicians make (and why)

Negotiating compensation requires an understanding of the value of your skills and an assertive approach. Both helped Theresa Rohr-Kirchgraber, M.D., further her career. -photo by Rebecca Shehorn

Negotiating compensation requires an understanding of the value of your skills and an assertive approach. Both helped Theresa Rohr-Kirchgraber, M.D., further her career. -photo by Rebecca Shehorn

Obviously, you want a nice financial payoff for your skills. After all, they’re worth top dollar by every professional measure. But there are big picture realities to consider, too. Specialty, practice type and geography have already shaped your final offer in ways that you might or might not have suspected. How do they move the dial up or down?

Words like value and supply versus demand come immediately to mind. They’re the underlying drivers that make these three factors so important in what you’re able to earn. They’re also key to many of the compensation surveys administrators use as one critical tool in designing how much you’re going to make.

“It’s not just a random executive pulling a number out of a hat and offering it to a physician in hopes that he or she will take it,” says Jon Appino, principal of Kansas City, Missouri-based consulting firm Contract Diagnostics. “It tends to be very purposeful and calculated from the employer’s perspective on what administrators are offering most of the time.”

As to the specific roles of specialty, practice type and geography, let’s take a closer look.

Specialty

The specialty you’ve chosen will be the biggest determinant of your compensation by far. Even though primary care physicians and their non-surgical specialty colleagues are well-paid professionals, providers in procedure-rich specialties tend to rise to the top of medicine’s financial hierarchy.

Why? They experience the highest reimbursement rates for the complex tasks they perform, which ultimately is reflected in their pay. Simply put, if you’re in orthopedics, anesthesiology, cardiac and other surgeries, what you do will likely put you in the cat bird seat in commanding a top salary. Of course, other forces, such as supply and demand, can help shape any package. At its core, however, compensation is often less about the number of patients that you see and more about the nature of your services and the value assigned to them.

RVUs lead the way

Wherever you are in your medical career, you can’t underestimate the role of two acronyms — RBRVS and RVU —in how much you’re ultimately paid for your work. Shorthand for resource-based relative value scale and relative value unit, both terms have been integral to most physician practices since 1992, when the Centers for Medicare & Medicaid Services (CMS) launched RBRVS to bring consistency to the way that it pays physicians and health facilities for their services.

By assigning specific values—the RVU part of the system—to every CPT (current procedural terminology) code, Medicare, Medicaid, and some private insurers alike have a standard methodology by which to issue reimbursements.

But how do those values eventually turn into compensation? Hiring entities have their own formulas for parlaying work product into salaries and productivity bonuses. Many still use volume-related metrics such as number of patients or the amount of fee-for-service collections to craft a plan. As more payers rely on RVUs in calculating reimbursement, however, those values become increasingly critical compensation measuring sticks. If your package depends on RVUs, you want to make sure you understand the particular schema, given the plethora of complicated methodologies using them today.

In determining production and incentive bonuses, employers are primarily interested in physician work or wRVUs because they account for the time, training, technical skills and judgment a physician employs in diagnosing and delivering care. Other components—practice expense or peRVUs and malpractice RVU or mRVUs—are baked into the reimbursement pie to account for the higher direct, indirect and liability costs of providing the service.

“This is all about the effort expended in order to provide a service,” says Fred Horton, president of AMGA (American Medical Group Association) Consulting. “We’re not going to pay you based on some other type of overhead or malpractice methodology. We’re going to pay you based on your work.” Adds Travis Singleton, senior vice president of Dallas-based physician recruiting firm Merritt Hawkins: “The net outcome is to equate difficulty and value to what the physician does.”

Winds at selective backs

Even within a specialty, your ability to command top dollar is still a mixed bag depending on other forces. Being a pediatric neurologist, for instance, may increase your compensation into the medical subspecialty realm, but not into the procedural realm. As to other specialties, supply and demand is the focus. Pathologists, for instance, have been harmed lately by a difficult market. Appino can only speculate as to the reasons—perhaps technology has improved efficiency or training has produced too many. Yet with fewer job openings now than in the past, employers have the upper hand. On the other hand, rheumatologists and other short-supply specialists such as neurologists and urologists are definitely seeing an uptick in their financial outlook. With an aging population demanding their skills, in many cases they can write their own tickets.

And what about primary care? You’re likely still bringing up the compensation rear, even with promises since RBRVS originated in the 1990s that your field would one day be rewarded equal to that of procedural-based groups. Citing AMGA survey comparisons of 20 specialties between 2009 and 2017, Horton notes that orthopedic surgery still holds the top place with family medicine, internal medicine and pediatrics anchoring the bottom. “Basically, they haven’t moved at all,” he says. “The wealth hasn’t really been redistributed as promised.”

That doesn’t mean, however, that there aren’t promising exceptions. As a residency program faculty member with Jacksonville, Florida’s St. Vincent’s Family Medicine Center, Robert Raspa, M.D., is in charge of 30 family medicine physicians, with 10 not only graduating each year, but also heavily recruited for their skills.

New physicians may need to be assertive about their worth even as they’re being wooed. Theresa Rohr-Kirchgraber, M.D., preaches the value of assertiveness to her residents and fellows as the executive director of the Indiana University National Center of Excellence in Women’s Health.

Rohr-Kirchgraber, who is also the Barbara Kampen Scholar in Women’s Health, doesn’t have to look further than her own experience as an example.

Board certified in both internal and adolescent medicine, she went to bat for herself after discovering that her primary clinical appointment in pediatrics was costing her thousands of income dollars. Although she held a secondary appointment in internal medicine and saw mostly adult patients, administrators weren’t keen on upsetting the parity applecart with her pediatric colleagues by just changing her status but keeping her in the adolescent division.

It took some negotiating, but Rohr-Kirchgraber succeeded in switching the appointments. In practical terms, she now has fewer interactions with her adolescent medicine colleagues, but she’s finally on par salary-wise with other internists. “We’re always trying to be nice and helpful because we’re just so grateful,” she says. “But we have to recognize that we bring a completely different set of skills to the group. We need to understand our worth.”

Practice type

The majority of newly recruited candidates—some estimate as high as 70 percent—will join hospitals, medical groups, urgent care centers, clinics and other structures as dedicated hires, not necessarily future owners. What does employment specifically mean for your compensation package? For starters, you may not be bearing the brunt of the business responsibilities shouldered by your self-employed colleagues, but you’re also likely to experience a lower average income as a price for the freedom.

At least one survey, Medscape Physician Compensation Report 2017, demonstrates that while increased numbers of physicians are choosing an employed position, they’re also likely to earn less than their self-employed counterparts. The 2017 results reflect overall differences of 28 percent between the $343,000 average earnings per year of providers willing to take on the business demands of private practice and $269,000 for their employed peers.

Whether you’re hired by a health system or perhaps even a group, your compensation will be built initially on a base salary, which provides a predictable income level for your clinical services. The package will also include an incentive bonus that rewards your productivity and, in some cases, the standard of your work. Beyond the type and volume of your services, you may have to demonstrate your worth via quality outcomes plus other harder-to-quantify measures such as patient satisfaction and corporate citizenship.

More than likely, however, you’ll be rewarded based on some sort of volume metric. Even though there’s wide variety in the incentive models and formulations used today, there’s a better-than-average chance that your plan will revolve around RVUs.

“We can say that we want to move to quality, but fundamentally mathematics still work on volume,” Singleton says. “To me, RVUs are the bridge from volume to value. It’s the best we have at the moment.”

The nuanced ins and outs

It’s incumbent on you to understand the parameters of your specific plan, given the potential nuances. For instance, depending on the formula, the incentive portion of your deal may involve a modest kick-in for the first and second years while you develop sea legs and a following. After that, your salary may be gradually reduced or even eliminated, leaving you dependent solely on whatever productivity and/or earnings structure your employer has in mind.

Whatever the case, you need transparency. Too often, say experts, physicians look at the numbers and just assume what’s behind them rather than understanding where they come from or how they’re set. “One of the things that continues to amaze me is how many physicians can’t recite how they’re being paid,” says Horton, noting his surprise at job incumbents who don’t know the ins and outs of their original compensation packages. “They’re able to tell me how much they make but they can’t necessarily articulate the mechanics. And that’s really important.”

Geography

In medicine, like business, location is often everything—including playing a role in what you can earn, especially given supply and demand for your skills. When considering the trifecta of factors—compensation, location and practice type—that are key to any job decision, Appino suggests prioritizing the two most important ones since you likely can’t have all three.

Why so? Popular places to live and work may not offer the best shot at the best deal. If you’re willing to accept a smaller package, by all means hang tough for that idyllic place you’ve always associated with a great life. But if money is a priority, you might need to open your eyes to areas of the country that hadn’t been on your radar.

It takes more than compensation to make a physician happy in a new job. “Our feeling is that if you want to attract good people then you have to give something better than anyone else,” says Salim Surani, M.D. -photo by Dustin Baker

It takes more than compensation to make a physician happy in a new job. “Our feeling is that if you want to attract good people then you have to give something better than anyone else,” says Salim Surani, M.D. -photo by Dustin Baker

Mega trends at work

Regional analyses from the Merritt Hawkins 2017 Review of Physician and Advanced Practitioner Recruiting Incentives confirm that physician salaries tend to be highest in the Midwest and Southeast. Both areas are top pay strongholds, say the authors and other experts, because of a healthy dose of fee-for-service medicine, good payer mixes with comparatively high reimbursement rates and a large number of productive, independent physicians. There’s also a lower physician-per-capita ratio.

Conversely, physician incomes tend to be a bit suppressed on the West Coast because it’s typically the highest capitated market with the most managed care, says Singleton. Likewise, lowered physician incomes on the East Coast, particularly the Northeast, also reflect a relatively high prevalence of managed care/capitated compensation plans as well as competition.

That’s not to say there aren’t pockets that run counter to existing trends; just that you should be aware of umbrella forces driving compensation where you might want to work and live.

Final thoughts

Whatever your specialty or skills, you’ll need facts on hand to achieve a financial payoff that befits your experience and skills. By knowing how specialty, practice type and geography move the dial on any offer, however, negotiations may no longer loom quite so large.

 

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How tight is the job market in your specialty? Fall 2018 issue

What’s your competition like? For job-seekers of all kinds, it can be hard to know. A simple PracticeLink.com search for opportunities in your specialty will give you an indication of the demand for physicians like you, but without knowing who else is vying for those jobs, it’s hard to get an accurate picture of supply.

How many other candidates in your specialty are actively looking for jobs at the same time? And how does that number correspond to the number of opportunities available?

That’s where the PracticeLink Physician Recruitment Index comes in. The Index is a relative indication of the ease or difficulty of job searches in various specialties based on supply and demand information gathered by the PracticeLink system quarterly. The larger the “Jobs per candidate” number for your specialty, the better your potential standing in the market.

The change in rank reflects the specialty’s movement since last quarter.

Job Specialties List

The Most-Challenging-to-Recruit Specialties are those specialties with the highest demand-to-supply ratio in the PracticeLink system. The specialties on this list likely won’t come as a surprise to candidates; they’re often narrow fields.

The Most-In-Demand Specialties represent the specialties that have the most jobs overall posted on PracticeLink—specialties for which the demand for physicians is highest. For the Index, we then rank those in-demand specialties according to the supply. Those at the top represent specialties with the most jobs available and the fewest candidates per job.

After reading these Indexes, ask yourself: Do these Indexes match my experience of searching for a job in my specialty? Do I need to widen or narrow my job-search parameters as a result?

This PracticeLink Physician Recruitment Index was pulled July, 2018. Candidate ratios include physicians who have registered with PracticeLink.com within the past 24 months.

 

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