In a perfect world, as a reward for all the hard work of medical school, you would be able to have a well-paying career with a perfectly balanced life in a fabulous community. Unfortunately, the world of medicine is not perfect. Potential employers have their dream list, too, built on their own all-too-important needs. The dichotomy of physicians’ desires for quality lifestyles against hospitals’ needs for medical services is the biggest battle non-metropolitan hospitals face. Physicians are increasingly placing more emphasis on their quality of life and limiting their availability for certain tasks. Hospitals, however, still have the same coverage needs they have always had, if not more. As the economy becomes more unpredictable, hospitals are going to have to be more particular about whom they hire. As a consequence, some physicians will find it harder to get their ideal jobs, while others are going to be rewarded better than ever.
The difference? The ones getting the great offers are going to be the ones willing to give a little.
Pediatrics is an example of a specialty that has attracted a significant number of providers who do not meet the needs of a large number of communities. A hospital recruiter emailed me this week: “Tell me what I have to do to get a pediatric candidate!” A recruiter for a multi-specialty group in North Carolina desperately needs a pediatrician who will take C-section call; after six months of looking, she still hasn’t found one. A fairly large pediatric group in Arkansas has everything in place including the patient base, but no candidates on the horizon. The problem these facilities are having is that they need someone to take call, cover deliveries and C-sections, and work full-time; yet a large percentage of candidates want to work part-time or on an all outpatient basis.
Physicians’ wants vs. employers’ needs
A random survey of 100 pediatric jobs listed with The Curare Group, Inc., found only two that had no on-call responsibilities and just two more in which the physicians were not expected to attend C-section call. A complementary survey of 100 pediatricians who were actively seeking jobs between January and October 2008 showed that 43 percent of potential candidates were interested only in outpatient-only or part-time jobs. Only 19 percent were definitely willing to take call and attend C-sections and 38 percent were unsure as to their willingness to take call or would do so under certain circumstances. While this is not entirely scientific, it does show the detachment of the workforce from community need. Regardless of the type of work the unknown 38 percent are willing to do, nearly half of active pediatric candidates are unwilling to meet the needs of 96 percent of the jobs. Because of this trend, the 19 percent of pediatricians willing to take call will see more and higher-paying offers—much higher paying, in fact. Five years ago $110,000 per year was considered a good offer for a pediatrician. Now, pediatricians who are willing to take call will get offers in excess of $160,000 per year—a gain that outpaces inflation, which has hovered at 4 to 5 percent per year during that time frame.
Family practice and internal medicine went through a similar retooling about eight years ago. More and more family physicians wanted to do strictly office work. At the same time, a significant number of internists began yearning for more regular hours and less call. The market responded to them and essentially created a new specialty, “the hospitalist.” This new way of practicing has given two specialties the opportunity to work together to the benefit of both providers. It has allowed smaller communities to attract both specialties by providing the lifestyle each desire with the opportunity to maximize the strengths of their training. The downside is that more and more primary care physicians expect a hospitalist program, which makes it even harder for rural hospitals—without the means for such programs—to recruit family practitioners or internal medicine physicians. As such, “traditional” family physicians and internists have become far more valuable than they were in “pre-hospitalist” times. Financial offers for primary care providers who are willing to do both outpatient and inpatient work have skyrocketed in the last four years, and as competition for this dwindling group of doctors increases the offers will continue to increase.
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