2015 review

Transcription

2015 review

2015 REVIEW
OF PHYSICIAN AND ADVANCED PRACTITIONER
RECRUITING INCENTIVES
22
ND
EDITION
An Overview of the Salaries, Bonuses, and Other Incentives Customarily
Used to Recruit Physicians, Physician Assistants and Nurse Practitioners
©2015 Merritt Hawkins | 5001 Statesman Drive, Irving, Texas 75063 | (800) 876-0500 | www.merritthawkins.com
2015 REVIEW
OF PHYSICIAN AND ADVANCED PRACTITIONER
RECRUITING INCENTIVES
Overview
2
Key Findings
3
Merritt Hawkins’ 2015 Review of Physician and Advanced Practitioner
Recruiting Incentives: Recruiting Assignment Characteristics and Metrics
5
Trends and Observations
17
Conclusion
44
22
ND
EDITION
1994-2015
For additional information about this survey contact:
Phillip Miller
(800) 876-0500
[email protected]
5001 Statesman Drive
Irving, Texas 75063
MerrittHawkins.com
Overview
Merritt Hawkins is a national healthcare
search and consulting firm specializing in
the recruitment of physicians in all medical
specialties and other advanced practice
clinicians. Now celebrating its 27th year of
service to the healthcare industry, Merritt
Hawkins is a company of AMN Healthcare
(NYSE: AHS), the nation’s largest healthcare
staffing organization and the industry
innovator of healthcare workforce solutions.
This report marks Merritt Hawkins’ 22nd
annual Review of the search and consulting
assignments the firm conducts on behalf of
its clients. Merritt Hawkins’ Review is the
longest consecutively published and most
comprehensive report on physician recruiting
incentives in the industry. The Review is
part of Merritt Hawkins’ ongoing thought
leadership efforts, which include surveys and
white papers conducted for Merritt Hawkins’
proprietary use, and surveys and white
papers Merritt Hawkins has completed on
behalf of prominent third parties, including
The Physicians Foundation, the Indian Health
Service, the American Academy of Physician
Assistants, the Association of Academic
Surgical Administrators, Trinity University, the
North Texas Regional Extension Center, Texas
Hospital Trustees, and two Subcommittees of
the Congress of the United States.
The intent of the Review is to quantify
financial and other incentives offered by our
clients to physician and advanced practitioner
candidates during the course of recruitment.
Incentives cited in the Review are based
on formal contracts or incentive packages
used by hospitals, medical groups and other
facilities in real-world recruiting assignments.
Unlike other compensation surveys, Merritt
Hawkins’ Review of Physician and Advanced
Practitioner Recruiting Incentives tracks
physician and advanced practitioner starting
salaries and other recruiting perquisites,
rather than total annual compensation.
The range of incentives detailed in the Review
may be used as a benchmark for evaluating
which recruitment incentives are customary
and competitive in today’s physician and
advanced practitioner recruiting market. In
addition, the Review is based on a national
sample of search assignments and provides
an indication of which types of physicians
are currently in the greatest demand and the
types of medical settings into which physicians
are being recruited.
Following are several key findings
of the Review.
The 2015 Review is based on the 3,120
permanent physician and advanced
practitioner search assignments that Merritt
Hawkins and AMN Healthcare’s other
physician staffing companies (Kendal & Davis
and Staff Care) had ongoing or were engaged
to conduct during the 12-month period from
April 1, 2014, to March 31, 2015.
2015 Review of Physician and Advanced Practitioner Recruiting Incentives 2
Key Findings
Merritt Hawkins’ 2015 Review
of Physician and Advanced
Practitioner Recruiting
Incentives reveals a number
of trends within the physician
and advanced practitioner
recruiting market, including:
#1 FAMILY PHYSICIANS
Most requested recruiting assignment
• For a record ninth consecutive year,
family physicians were number one
on the list of Merritt Hawkins’ most
requested recruiting assignments.
General internists were second on
the list, also for the ninth consecutive
year, highlighting the continued
nationwide demand for primary care
physicians as team-based care and
the population health management
model continue to proliferate.
• Psychiatrists, one of the most
difficult types of physicians to
recruit, were number three on
the list of Merritt Hawkins’ most
requested assignments, underlying
the continued severe shortage of
behavioral health specialists.
3 2015 Review of Physician and Advanced Practitioner Recruiting Incentives
#4 ADVANCED PRACTITIONERS
Most requested recruiting assignment
• Combined, advanced practitioners,
including physician assistants (PAs)
and nurse practitioners (NPs),
were fourth on the list of Merritt
Hawkins’ most requested recruiting
assignments, up from fifth the
previous year. Four years ago, neither
PAs nor NPs were among Merritt
Hawkins’ top 20 assignments, either
individually or collectively.
• Merritt Hawkins saw an increase
in demand for specialists who
are key to the implementation of
population health management,
including obstetrician/gynecologists,
pulmonologists, and cardiologists who
can either manage women’s health or
manage patients (often elderly) with
long-term chronic conditions.
URGENT
CARE
URGENT CARE IN TOP 20
MOST REQUESTED RECRUITING ASSIGNMENTS
• Urgent care made the list of top
20 most requested recruiting
assignments for the first time since
Merritt Hawkins began compiling
this Review, underscoring the rising
demand for physicians who practice
in convenient care/outpatient settings.
• Surgical specialists such as orthopedists,
urologists, and otolaryngologists,
who often provide treatments and
procedures generated by older
patients, also are in strong demand.
• The types of facilities seeking
physicians continues to evolve.
Hospital-employed positions
comprised 51% of Merritt Hawkins
search assignments in the 12-month
period covered by this Review, down
from 64% the previous year, while
physician-owned medical group
employed positions comprised 20%
of search assignments, up from 13%
the previous year. Community health
center and academic settings also
accounted for a greater percent of
Merritt Hawkins’ search assignments
year-over-year.
• Solo practice made a surprise
rebound. Four percent of Merritt
Hawkins’ search assignments in the
period covered by this Review were
for solo practices, up from less than
1% the previous year.
APPROXIMATELY 95%
Searches feature an employed setting
• Despite the increase in independent,
solo practice settings, the employed
physician model continues to
dominate. Approximately 95% of
Merritt Hawkins’ search assignments
now feature an employed setting,
compared to less than 50% in 2004.
• Demand for physicians in concierge
practice settings appears to be flat.
Though a growing number of physicians
express interest in the direct pay/
concierge practice model, the number
of search assignments Merritt Hawkins
conducted for concierge physicians
decreased slightly year-over-year.
Quality-based
Care
23%
Bonuses
ONLY 23% TIED BONUSES
TO QUALITY-BASED METRICS
• Physician production bonuses remain
mostly volume/fee-for-service based.
Despite the movement toward valuebased physician compensation, only
23% of Merritt Hawkins’ clients
who offered physicians a production
bonus tied bonuses to quality-based
metrics such as patient satisfaction.
• Relative Value Units (RVUs) continue
to be the most frequently utilized
physician productivity incentive and
were featured in 57% of Merritt
Hawkins’ recruiting assignments in
which a production bonus was part
of the incentive package.
• Demand for physicians is not confined
to traditionally underserved rural areas.
Merritt Hawkins worked in all 50 states
in 2014/15, and 40% of the firm’s search
assignments took place in communities
of 100,000 people or more.
Following is a breakout of the
characteristics and metrics of
Merritt Hawkins’ 2014/15 physician
recruiting assignments.
Merritt Hawkins’ 2015 Review
of Physician and Advanced
Practitioner Recruiting Incentives:
Recruiting Assignment Characteristics and Metrics
(All of the following numbers are rounded to the nearest full digit.)
1
Total Number of Physician/Advanced Practitioner Search Assignments Represented
The Review is based on the 3,120 permanent physician and advanced practitioner search
assignments Merritt Hawkins/AMN Healthcare’s physician staffing companies had ongoing or
were engaged to conduct during the 12 month period from April 1, 2014 to March 31, 2015.
2
Practice Settings of Physician and Advanced Practitioner Search Assignments
(2,006) 64%
(1,975) 64%
(1,710) 63%
Hospital/hospital owned group
Physician-owned group
Solo practice
(401) 13%
(493) 16%
(436) 16%
(17) <1%
(29) 1%
(28) 1%
Partnership*
Association*
Concierge
Urgent care
Other
N/A
N/A
Community Health Center/
Indian Health Service
(378) 12%
(305) 10%
(152) 6%
Academic
(188) 6%
(153) 5%
N/A
(32) 1%
N/A
(25)
N/A
N/A
N/A
N/A
(625) 20%
(125) 4%
(93) 3%
(94) 3%
(220) 8%
(13) <1%
(28) 1%
(29) 1%
(1,596) 51%
(406) 13%
(252) 8%
1%
(33) 1%
(30) 1%
(20) 1%
(135) 5%
2015
2014
2013
(59) 2%
2012
*Due to ongoing changes in medical practice settings, “Partnership” and “Association”
have been added to the “Physician-Owned Group” category.
If Academic Medicine, what type of position? (Of 252 Academic searches)
3
Research
Administration/Leadership
14 (5%)
45 (18%)
Teaching (professors)
Clinical (faculty)
34 (13%)
159 (64%)
States Where Search Assignments Were Conducted
AK, AL, AR, AZ, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI,
MO, MN, MS, MT, NC, ND, NE, NH, NJ, NM, NY, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX,
UT, VA, VT, WA, WI, WV, WY
4
Number of Searches by Community Size
49%
1,518
41%
40%
38%
1,295
1,247
44%
1,184
1,173
33%
37%
1,044
1,001
26%
26%
819
804
22%
25%
29%
775
784
34%
34%
925
906
689
22%
588
2014/15
2013/14
0-25,000
2012/13
25,001-100,000
2011/12
2010/11
100,001+
5
Top 20 Most Requested Searches by Medical Specialty
2014/15
2013/14
2012/13
2011/12
2010/11
Family Medicine
734
714
624
631
532
Internal Medicine
237
235
194
235
295
Psychiatry
230
206
168
168
133
Hospitalist
176
231
178
155
160
Nurse Practitioner
143
128
69
23
N/A
OB/GYN
112
70
77
81
80
Orthopedic Surgery
106
58
57
105
104
Emergency Medicine
80
89
111
106
92
Pediatrics
71
92
87
70
64
General Surgery
63
58
74
130
69
Physician Assistant
63
61
50
22
N/A
Neurology
60
61
71
41
79
Otolaryngology
52
32
40
40
31
Dermatology
44
30
22
54
23
Gastroenterology
43
54
37
51
32
Urology
40
29
26
57
56
Physiatry
39
15
15
11
5
Pulmonology
38
18
24
68
32
Cardiology
36
32
38
46
26
Urgent Care
33
16
16
7
8
6
Other Clinical Specialty Recruitment Assignments
Addiction Medicine
Addiction Psychiatry
Adolescent Medicine
Allergy & Immunology
Anesthesiology
Audiologist
Bariatric Surgery
Bone Marrow Transplantation
Breast Surgery
Cardiac Surgery, Congenital
Cardiology – Electrophysiology
Cardiothoracic Surgery
Cardiovascular Surgery
Certified Registered Nurse Anesthetist
Child and Adolescent Psychiatry
Circulator
Clinical Genetics
Clinical Neurophysiology
Clinical Neuropsychologist
Clinical Psychologist
Clinical Sciences
Colon-Rectal Surgery
Concierge Medicine
Critical Care, Neurology
Critical Care, Pediatrics
Dentistry
Dentistry, Pediatric
Endocrinology
Family Medicine, Emergency Medicine
Family Medicine, Obstetrics
Family Medicine, Sports Medicine
Forensic Pathology
Geriatric Medicine
Gynecologic Oncology
Gynecology
Hospice and Palliative Medicine
Hospitalist, Neurology
Hospitalist, Nocturnist
Hospitalist, Pediatrics
Infectious Disease
Intensivist
Internal Medicine, Geriatrics
Internal Medicine, Pediatrics
Mammographer
Maternal Fetal Medicine
Medical Physicist
Mohs Surgery
Neonatology
Nephrology
Neurology, Movement Disorders
Neurology, Rehabilitation
Neurology, Stroke
Neuromuscular Medicine
Psychiatry/Neurology
Neuropsychiatry
Neuroradiology
Neurosurgery
Nurse Practitioner, Psychiatric
Occupational Medicine
Ophthalmology
Ophthalmology, Cornea
Ophthalmology, Glaucoma
Optometry
Oral & Maxiofacial Surgery
Orthopedic Surgery, Foot & Ankle
Orthopedic Surgery, Hand
Orthopedic Surgery, Pediatric
Orthopedic Surgery, Spine
Orthopedic Surgery, Trauma
Pain Management
Pathology
Pediatric Cardiology
Pediatric Physiatry
Pediatric Sports Medicine
Pediatric Surgery
Pediatrics, Developmental-Behavioral
Pediatrics, Emergency Medicine
Pediatrics, Endocrinology
Pediatrics, Genetics
Pediatrics, Neurology
Pediatrics, Ophthalmology
Pediatrics, Otolaryngology
Pediatrics, Pulmonology
PHD
Physiatry, Interventional
Physical Therapy
Plastic Surgery
Podiatry
Preop-PACU
Psychology
Radiation Oncology
Radiology
Radiology, Interventional
Registered Nurse
Researcher
Retina Surgery
Rheumatology
Sleep Medicine
Social Worker
Surgical Gynecology
Surgical Oncology
Thoracic Surgery
Trauma Surgery
Urologic Oncology
Urology - Female Pelvic Medicine
and Reconstructive Surgery
Vascular Surgery
7
Administrative, Academic and Executive Titles Include:
8
Income Offered to Top 20 Recruited Specialties
Administrative Director
Associate Medical Director
Case Management Manager
Chair of Anesthesia
Chair of Family Practice
Chair of Neurology
Chair of Orthopedic Surgery
Chair of Pediatrics
Chair of Population Health
Chair of Psychiatry
Chair of Rheumatology
Chair, Physician Assistant
Chief Executive Officer
Chief Financial Officer
Chief Medical Officer
Chief Nursing Officer
Chief of Endocrinology
Director of Hospitalists
Director of Liver Transplant
Director of Neuro Rehab
Director of Physiatry
Director of Psychiatry
Medical Director
Practice Administrator
President, Development Innovations
Professor
Residency Program Director
Senior Director of Patient
Financial Services
Surgery Director
Trauma Surgery Medical Director
Vice Dean of Clinical Affairs
Vice President of Marketing
Vice President of Physician Services
Chief of Gastroenterology
Chief of Hematology-Oncology
Chief of Internal Medicine
Chief of Medicine
Chief of Orthopedic
Foot & Ankle Surgery
Chief of Pathology
Chief of Pulmonology
Chief of Surgery
Clinic Manager
Clinical Director
Director of Bone Marrow
Transplantation
Director of Development Innovations
Director of Emergency Medicine
Director of Family Medicine
Director of Heart Failure
(Full-time base salary or guaranteed income only, does not include production bonus or benefits)
Family
Practice
Low
Average
High
Internal
Medicine
Low
Average
High
2014/15
$130,000
$198,000
$330,000
2014/15
$145,000
$207,000
$260,000
2013/14
$140,000
$199,000
$293,000
2013/14
$145,000
$198,000
$360,000
2012/13
$130,000
$185,000
$437,000
2012/13
$130,000
$208,000
$325,000
2011/12
$120,000
$189,000
$300,000
2011/12
$150,000
$203,000
$345,000
2010/11
$130,000
$178,000
$290,000
2010/11
$130,000
$205,000
$285,000
Low
Average
High
2014/15
$172,000
$226,000
$325,000
2013/14
$150,000
$217,000
2012/13
$165,000
2011/12
2010/11
Psychiatry
Low
Average
High
2014/15
$170,000
$232,000
$300,000
$350,000
2013/14
$145,000
$229,000
$350,000
$218,000
$300,000
2012/13
$150,000
$227,000
$350,000
$160,000
$224,000
$300,000
2011/12
$160,000
$221,000
$400,000
$160,000
$220,000
$275,000
2010/11
$160,000
$217,000
$305,000
Hospitalist
Nurse
Practitioner
Low
Average
High
OB/GYN
Low
Average
High
2014/15
$78,000
$107,000
$129,000
2014/15
$180,000
$276,000
$450,000
2013/14
$70,000
$106,000
$150,000
2013/14
$215,000
$288,000
$380,000
2012/13
$75,000
$105,000
$150,000
2012/13
$225,000
$286,000
$350,000
2011/12
$70,000
$95,000
$121,000
2011/12
$180,000
$268,000
$440,000
2010/11
N/A
N/A
N/A
2010/11
$220,000
$282,000
$360,000
Orthopedic
Surgery
Low
Average
High
Emergency
Medicine
Low
Average
High
2014/15
$350,000
$497,000
$800,000
2014/15
$300,000
$345,000
$434,000
2013/14
$350,000
$488,000
$700,000
2013/14
$220,000
$311,000
$400,000
2012/13
$275,000
$465,000
$750,000
2012/13
$210,000
$288,000
$450,000
2011/12
$400,000
$519,000
$750,000
2011/12
$170,000
$264,000
$380,000
2010/11
$300,000
$521,000
$700,000
2010/11
$160,000
$255,000
$380,000
Low
Average
High
General
Surgery
Low
Average
High
2014/15
$130,000
$195,000
$275,000
2014/15
$160,000
$339,000
$415,000
2013/14
$130,000
$188,000
$240,000
2013/14
$270,000
$354,000
$515,000
2012/13
$145,000
$179,000
$300,000
2012/13
$240,000
$336,000
$550,000
2011/12
$130,000
$189,000
$220,000
2011/12
$220,000
$343,000
$450,000
2010/11
$120,000
$183,000
$250,000
2010/11
$205,000
$336,000
$450,000
Physician
Assistant
Low
Average
High
Low
Average
High
2014/15
$80,000
$107,000
$145,000
2014/15
$180,000
$277,000
$350,000
2013/14
$71,000
$105,000
$150,000
2013/14
$180,000
$262,000
$400,000
2012/13
$85,000
$118,000
$160,000
2012/13
$180,000
$300,000
$400,000
2011/12
$75,000
$99,000
$130,000
2011/12
$160,000
$280,000
$420,000
2010/11
N/A
N/A
N/A
2010/11
$160,000
$256,000
$345,000
Pediatrics
Neurology
Low
Average
High
2014/15
$265,000
$398,000
$550,000
$500,000
2013/14
$300,000
$394,000
$500,000
$404,000
$700,000
2012/13
$235,000
$371,000
$425,000
$300,000
$412,000
$530,000
2011/12
$210,000
$364,000
$500,000
$230,000
$359,000
$500,000
2010/11
$245,000
$331,000
$500,000
Low
Average
High
Urology
Low
Average
High
2014/15
$275,000
$455,000
$600,000
2014/15
$360,000
$412,000
$550,000
2013/14
$240,000
$454,000
$560,000
2013/14
$430,000
$504,000
$625,000
2012/13
$291,000
$441,000
$600,000
2012/13
$385,000
$424,000
$650,000
2011/12
$300,000
$433,000
$550,000
2011/12
$330,000
$461,000
$650,000
2010/11
$300,000
$424,000
$505,000
2010/11
$320,000
$453,000
$550,000
Physiatry
Low
Average
High
Low
Average
High
2014/15
$175,000
$244,000
$300,000
2014/15
$260,000
$331,000
$386,000
2013/14
$250,000
$283,000
$350,000
2013/14
$230,000
$358,000
$425,000
2012/13
$200,000
$298,000
$350,000
2012/13
$225,000
$351,000
$500,000
2011/12
$200,000
$292,000
$350,000
2011/12
$180,000
$321,000
$415,000
2010/11
$160,000
$244,000
$325,000
2010/11
$200,000
$311,000
$430,000
Low
Average
High
2014/15
$150,000
$334,000
$450,000
2013/14
$250,000
$372,000
2012/13
$300,000
2011/12
2010/11
Otolaryngology
Gastroenterology
Cardiology
(non-invasive)
Low
Average
High
2014/15
$250,000
$291,000
$400,000
2013/14
$400,000
$442,000
2012/13
$250,000
2011/12
2010/11
Dermatology
Pulmonology
Cardiology
(invasive)
Low
Average
High
2014/15
$450,000
$525,000
$650,000
$500,000
2013/14
$350,000
$454,000
$550,000
$447,000
$550,000
2012/13
$300,000
$461,000
$675,000
$275,000
$396,000
$600,000
2011/12
$400,000
$512,000
$650,000
$270,000
$420,000
$525,000
2010/11
$380,000
$532,000
$650,000
Low
Average
High
2014/15
$175,000
$210,000
$254,000
2013/14
$190,000
$204,000
$218,000
2012/13
$185,000
$203,000
$225,000
2011/12
$170,000
$185,000
$200,000
2010/11
N/A
N/A
N/A
Urgent Care
9
Type of Incentive Offered
Salary
10
Salary
Income
w/ Bonus Guarantee Other
2014/15
715 (23%)
2,219 (71%)
124 (4%) 62 (2%)
2013/14
633 (20%)
2,335 (74%)
127 (4%) 63 (2%)
2012/13
525 (17%)
2,323 (75%)
217 (7%) 32 (1%)
2011/12
489 (18%)
1,977 (73%)
191 (7%) 53 (2%)
2010/11
428 (16%)
1,975 (74%)
239 (9%) 25 (<1%)
If Salary Plus Production Bonus, on Which Types of Metrics Was the Bonus Based?
(of 2,219 searches offering salary plus bonus, multiple responses possible).
59%
57%
57%
54%
52%
39%
24%
21%
23%
23%
11%
9%
2%
4%
33%
25%
9%
5%
6%
3%
2014/15
2013/14
RVU Based
Net Collections
2012/13
Gross Billings
35%
34%
9%
5% 5%
2011/12
Patient Encounters
7%
5%
3%
<1%
N/A
2010/11
Quality*
Other
*“Quality” is defined as patient satisfaction, adherence to treatment protocols, reduction of readmissions/errors,
governance, appropriate coding, EHR use, etc.
11
12
If quality metrics were included
in the bonus, what percent of the
bonus was tied to these metrics?
Low
If Income Guarantee, What Type?
(of 124 searches offering income guarantees)
2014/15
3%
74 (59%)
50 (41%)
2013/14
Average
22%
108 (85%)
19 (15%)
2012/13
High
100%
145 (67%)
72 (33%)
2011/12
146 (76%)
8 (3%)
2010/11
231 (97%)
Net Collections
Guarantee
13
45 (24%)
Gross Collections
Guarantee
If Income Guarantee, What was the Term Offered?
(of 124 searches offering income guarantees)
1 Year
2 Year
3 Year
Other
2014/15
69 (56%)
41 (33%)
10 (8%)
4 (3%)
2013/14
64 (50%)
47 (38%)
16 (12%)
0 (0%)
2012/13
105 (49%)
79 (36%)
28 (13%)
5 (2%)
2011/12
87 (45%)
83 (44%)
21 (11%)
0 (0%)
2010/11
113 (47%)
776 (32%)
49 (21%)
0 (0%)
14
16
18
Searches Offering Relocation Allowance
15
Amount of Relocation Allowance
(Physicians only)
Low
Average
High
2014/15
$2,000
$10,292
$50,000
313 (10%)
2013/14
$1,000
$9,849
$25,000
2,821 (91%)
276 (9%)
2012/13
$1,000
$9,555
$25,000
2011/12
2,577 (95%)
133 (5%)
2011/12
$1,000
$10,035
$40,000
2010/11
2,451 (92%)
216 (8%)
2010/11
$1,000
$10,454
$85,000
Yes
No
2014/15
2,623 (84%)
497 (16%)
2013/14
2,845 (90%)
2012/13
Amount of Relocation Allowance
(NPs and PAs only)
Low
Average
High
2014/15
$2,500
$9,436
$35,000
2013/14
$3,500
$6,904
$10,000
Amount of Signing Bonus Offered
(Physicians only)
Low
Average
High
2014/15
$2,500
$26,365
$275,000
2013/14
$1,000
$21,773
$150,000
2012/13
$1,500
$22,069
$200,000
2011/12
$4,000
$23,388
$200,000
2010/11
$5,000
$23,790
$200,000
17
19
Searches Offering Signing Bonus
Yes
No
2014/15
2,280 (73%)
840 (27%)
2013/14
2,212 (70%)
946 (30%)
2012/13
2,199 (71%)
898 (29%)
2011/12
2,170 (80%)
540 (20%)
2010/11
2,025 (76%)
642 (24%)
Amount of Signing Bonus Offered
(NPs and PAs only)
Low
Average
High
2014/15
2,500
$8,791
$20,000
2013/14
1,000
$7,786
$20,000
20
Searches Offering to Pay Continuing
Medical Education (CME)
Yes
22
23
21
Amount of CME Pay Offered
(Physicians only)
No
Low
Average
High
2014/15
2,966 (95%)
154 (5%)
2014/15
$500
$3,649
$35,000
2013/14
2,875 (91%)
283 (9%)
2013/14
$1,000
$3,515
$54,000
2012/13
2,789 (90%)
308 (10%)
2012/13
$1,000
$3,444
$50,000
2011/12
2,658 (98%)
52 (2%)
2011/12
$500
$3,391
$12,000
2010/11
2,559 (96%)
108 (4%)
2010/11
$500
$3,194
$10,000
Amount of CME Pay Offered
(NPs and PAs only)
Low
Average
High
2014/15
$1,000
$2,241
$5,000
2013/14
$1,000
$2,450
$5,000
Searches Offering to Pay Additional Benefits
2014/15
2013/14
2012/13
2011/12
2010/11
Health Insurance
99%
97%
94%
97%
99%
Malpractice
99%
99%
96%
99%
97%
Retirement
96%
94%
87%
82%
90%
Disability
92%
86%
83%
75%
77%
Educational Loan Forgiveness
25%
26%
22%
26%
29%
Housing Allowance
5%
4%
6%
5%
6%
Other
<1%
<1%
2%
1%
3%
24
25
If Educational Loan Forgiveness was Offered, What Was the Term?
(of 784 searches offering educational loan forgiveness)
2014/15
2013/14
2012/13
2011/12
2010/11
One Year
61 (8%)
90 (11%)
48 (7%)
41 (6%)
39 (5%)
Two Years
104 (13%)
173 (21%)
183 (27%)
192 (27%)
208 (27%)
Three Years
619 (79%)
557 (68%)
449 (66%)
474 (67%)
525 (68%)
If Educational Loan Forgiveness was
Offered, What Was the Amount?
(Physicians only)
Low
Average
High
2014/15
$2,500
$89,479
$250,000
2013/14
$4,000
$77,000
$336,000
2012/13
$1,000
$71,733
$210,000
26
If Educational Loan Forgiveness was
Offered, What Was the Amount?
(NPs and PAs only)
Low
Average
High
2014/15
$30,000
$54,286
$100,000
2013/14
$20,000
$40,000
$60,000
Trends and
Observations
Merritt Hawkins’ annual
Review of Physician and
Advanced Practitioner
Recruiting Incentives, now in
its 22nd year, tracks three key
physician recruiting trends,
as well as various advanced
practitioner recruiting trends.
1. Based on the physician recruiting
assignments Merritt Hawkins is contracted
to conduct, the Review indicates which
types of physicians are in the greatest
demand and which are the most
challenging to recruit.
2. The Review also indicates the types of
practice settings into which physicians
are being recruited (hospitals, medical
groups, solo practice etc.) and the types of
communities that are recruiting physicians
based on population size.
3. The Review further indicates the types
of financial and other incentives that are
being used to recruit physicians.
Each of these trends is discussed below,
following an overview of the current
healthcare market in which physician
recruiting takes place.
OVERVIEW: AN ONGOING
TRANSFORMATION
Merritt Hawkins’ 2015 Review of Physician
and Advanced Practitioner Recruiting
Incentives examines the permanent
physician and advanced practitioner
recruiting assignments Merritt Hawkins
and AMN Healthcare’s physician staffing
divisions had ongoing or were engaged to
conduct during the 12 month period from
April 1, 2014 to March 31, 2015.
These search assignments reflect the
types of physicians that hospitals, medical
groups, Federally Qualified Health
Centers (FQHCs), academic medical
centers, government entities, and other
organizations are seeking nationwide.
They also reflect which types of physicians
may be particularly difficult to recruit,
necessitating the assistance and additional
resources of a physician recruiting firm.
ONE PIECE OF THE PUZZLE
While physicians are at the core of the
healthcare delivery system, physician
recruitment is only one piece of the
enormous, $3 trillion a year puzzle that is
U.S. healthcare. Any discussion of physician
recruiting trends therefore begins with an
overview of the healthcare system itself.
Since Merritt Hawkins completed its last
Review in 2014, the healthcare system has
continued and accelerated its headlong
embrace of change and transformation. Key
developments and trends over the last 12 to
14 months include:
• Continued expansion of insurance coverage
through the Affordable Care Act (ACA).
16.4 million people have been enrolled
through ACA mandated insurance
exchanges, through expanded Medicaid,
and other ACA provisions (Department of
Health and Human Services).
• The Supreme Court decision in King v.
Burwell that upholds federal subsidies for an
estimated 6.4 million people who enrolled
in federally established insurance exchanges
in states that did not establish their own
exchanges. The landmark decision ensures
that the ACA and related market reforms
will maintain their current trajectory.
• Passage of the sustainable growth rate
(SGR) physician payment “fix,” forestalling
a 21% Medicare reimbursement cut to
physicians and replacing SGR with the
Merit-Based Incentive Pay System (MIPS)
and alternative payment models.
• Announcement by HHS Secretary Burwell of
the goal to tie 30% of Medicare payments
to quality/value through alternative
payment models such as accountable care
organizations (ACOs) by the end of 2016
and 50% by the end of 2018.
• Release by the Centers for Medicare
and Medicaid Services (CMS) of the
long awaited five-star rating system for
patient experiences in hospitals based
on responses to the 11-question Hospital
Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) survey.
• The largest Main Residency Match ever
recorded, which nevertheless saw 1,093
(6.1%) U.S. allopathic medical school
graduates who did not match, 2,354
(49.9%) U.S. citizen and 3,725 (50.6%)
non-U.S. citizen graduates of international
medical schools who did not match
(www.nrmp.org).
• The accelerating closure of rural hospitals,
50 of which have closed since 2010, 10
in Texas alone, and 283 of which are
vulnerable to shutting down (iVantage
Health Analytics).
• Implementation of population health
management through integrated
organizations such as ACOs. There are
close to 600 ACOs in the U.S., covering
between 15% and 17% of the population
(49 – 56 million people) and 11% of
Medicare beneficiaries (Oliver Wyman)
• The expanded use of telemedicine. Onethird of physicians (33%) now use some
form of telemedicine, defined as care via
telephone, video visits, web cam visits or
other visits not in person, though only 19%
said they are paid for these visits (Academy
of Integrative Health and Medicine).
• Continued expansion of “convenient care,”
including urgent care centers, of which
there are over 9,000 nationwide, and retail
clinics, of which there are approximately
2,800 (Advisory Board).
Should the system continue to evolve
in its current direction, or should it be
redirected to a new channel, this will not
change. Whether care is delivered in small,
independent, and unconnected silos or
in vast, integrated health systems, and
regardless of whether volume or value is
rewarded, physicians will be the paramount
providers of care and the drivers of
healthcare economics.
• Discontinuation of the ACA-mandated
increase in reimbursement rates to primary
care physicians seeing Medicaid patients,
which in 2015 went back down to 2012
levels (though some states plan to keep
the rates at the higher level).
• Increased scope of practice and increased
demand for advanced practitioners such
as PAs and NPs. NPs now can practice
independently in 20 states.
• A continued dearth of healthcare
professionals, including a potential shortage
of 91,000 physicians by 2025 (Association
of American Medical Colleges).
These trends and events underline the
many ways in which healthcare is evolving,
with a continued shift toward integrated
providers reimbursed on value and away from
independent providers reimbursed on volume.
ONE CONSTANT: PHYSICIANS
To varying degrees, all of the developments
referenced above impact both physicians and
physician recruiting, due to the central role
doctors play in the healthcare system.
According to the Boston University School
of Public Health, physicians receive or direct
87% of all personal spending on healthcare
in the current volume driven system,
through hospital admissions, test orders,
prescriptions, procedures, treatment plans
and related activities. The total combined
economic output of patient care physicians
in the United States is $1.6 trillion, and each
physician generates a per capita economic
output of $2.2 million while supporting
approximately 14 jobs (National Economic
Impact of Physicians. American Medical
Association/IMS Health. March, 2014).
Even in a value-driven system in which
physicians do not directly generate revenue as
they largely do now, they will continue to pull
the levers of quality and cost by managing the
patient experience. If in the past the key to
strategic success in healthcare has been “he
with the most physicians wins,” in the future
the mantra will be a variation of this theme, i.e.:
“he with the right physicians, engaging in the
right behaviors, and in the right settings wins.”
Because of their central role, physicians
remain in strong demand, while physician
supply continues to be problematic.
Following is a brief look at current physician
supply and demand trends followed by an
analysis of the findings of the 2015 Review.
IS THERE A DOCTOR IN THE HOUSE?
In March, 2015, the Association of American
Medical Colleges (AAMC) released its
latest physician supply and demand report
projecting physician workforce deficits
through 2025 (see following graph):
AAMC Physician Deficit Projections
100,000
75,000
50,000
25,000
2008
2015
2020
2025
Source: Association of American Medical Colleges.
March, 2015
In a similar 2010 report, the AAMC projected
a deficit of 131,000 physicians by 2025,
which it downgraded to 90,400 physicians
in its 2015 report. This reduction was largely
attributed to the growing role advanced
practitioners such as PAs and NPs are playing
in supplementing the physician workforce.
Nevertheless, the AAMC continues to
warn of the consequences of the looming
physician shortage and to advocate for a
removal of the 1997 cap Congress placed
on funding of physician graduate medical
education through CMS. Largely because of
the cap, a growing number of U.S. medical
school graduates are unable to match to
residency programs.
Of the 1,093 U.S. allopathic medical
graduates who did not initially match in
2015, approximately 500 failed to match
in the subsequent Supplemental Offer
and Acceptance Program (SOAP). If they
fail to match in subsequent years these
graduates will have no path to becoming
licensed and practicing physicians (though
the state of Missouri recently approved a
program that would allow such graduates
to practice as “assistant physicians”). The
situation is even more unfavorable for
U.S. osteopathic graduates and for citizen
and non-citizen graduates of international
medical schools and will only worsen
if the number of U.S. medical school
graduates continues to increase while
residency positions do not keep pace.
In addition to calling for the funding or more
residency positions, the AAMC stressed in
its report that physician shortages will not
be confined to primary care but will in fact
be more acute in specialty areas. It projects
a deficit of 26,700 primary care physicians
by 2025 and a deficit of over twice as many
specialists (63,700).
AGING DRIVES DEMAND
FOR SPECIALISTS
Demand for specialist physicians is being
driven by population aging, as some 10,000
baby boomers turn 65 every day. Not only do
older patients visit a physician at three times
the rate of younger patients, they generate a
proportionately greater number of procedures
and tests per capita that are typically conducted
by medical specialists. The following charts
indicate the degree to which patients 65 and
older, who comprise 14% of the population,
drive utilization of inpatient procedures and
diagnostic tests and treatments.
The healthcare challenges presented by
population aging are vividly highlighted by
the U.S. Census Bureau projection that by
2030 the entire population on average will
be as old as the population of Florida is now
In-Patient Procedures
by Age Group
and that the U.S. now leads the world in
number of centenarians. Procedures driven
by aging are likely to increase per capita as
the baby boom generation seeks to maintain
an active lifestyle and experiences the
resulting injuries and related strains.
The increased prevalence of chronic disease
in the U.S. also will drive the need for various
types of specialists (see chart below).
Chronic Disease Incidence
Projections/U.S.
Additional Americans with................... 27 million
hypertension 2010-2030
Additional Americans with coronary....... 8 million
heart disease 2010-2030
Growth in number of Americans....................86%
diagnosed with diabetes 2009-2024
Growth in number of Americans........... ........68%
diagnosed with Parkinson’s 2010-2030
Growth in number of cancer......................... 30%
survivors 2010-2020
(18.1 million)
Source: Health Affairs, November, 2013.
Number of Diagnostic
Treatments/Tests by Age
47.1%
37.4%
29.2% 30.0%
33.1%
14.0%
14.0%
4.4%
3.4%
Under
15
15.5%
15-44
45-64
65+
US
Population
65+
Source: Center for Disease Control and Prevention
Under
15
15-44
45-64
65+
US
Population
65+
Source: Center for Disease Control and Prevention
THE GRAYING OF THE
PHYSICIAN WORKFORCE
Population aging coincides with the aging
of the physician workforce. According to
the AAMC, 27.6% of physicians in active
patient care are 60 years old or older – a
total of 225,221 physicians. In some states,
30% or more of active physicians are 60 or
older (see following chart)
% of Active Physicians 60
or Older by State
New Mexico........................................... 33.3%
California............................................... 31.5%
Montana................................................ 31.2%
Hawaii....................................................30.5%
Maine.....................................................30.5%
New Jersey............................................. 30.1%
If, in five years, the majority of the 225,221
active physicians who now are 60 or older
have retired, only some 135,000 physicians
who completed residency training in those
years will be available to take their place.
Because newly trained physicians put a
premium on a “controllable lifestyle,”
including set hours, vacations, and parttime practice, they will not replace older
physicians in a one-to-one ratio.
In Merritt Hawkins’ experience, it often
takes two Millennial or Generation X
physicians to replace one Baby Boom
doctor (for a more detailed examination
of physician aging, see the Merritt
Hawkins’ white paper, The Aging Physician
Workforce: A Demographic Dilemma).
A CONTINUING
MALDISTRIBUTION
West Virginia.......................................... 30.1%
In some specialties, 50% or more of active
patient care physicians are 55 years old or
older and many of these physicians can
be expected to retire in the relatively near
future (see chart below).
Physician shortages are compounded in
some areas by a maldistribution of doctors,
who historically have been in short supply
in rural and inner city areas. The Health
Resources and Services Administration
(HRSA) now lists over 6,700 primary care
Health Professional Shortage Areas (HPSAs)
as well as additional such areas for dental
care and behavioral health (see below).
% Medical Specialists 55 and Older
Health Professional Shortage Areas/U.S
New York............................................... 30.0%
(Source: Association of American Medical Colleges
2013 State Physician Workforce Book).
Pulmonology
73%
Oncology
66%
Psychiatry
59%
Cardiology
54%
Orthopedic Surgery
Neurology
(Source: American Medical Association 2015
Physician Master File).
Total
HPSAs
Practitioners
Needed to
Remove HPSA
Designation
Primary Care
6,087
8,073
52%
Dental Care
4,868
7,208
50%
Mental Health Care
3,968
2,707
(Source: HRSA Data Warehouse: Designated Health
Professional Shortage Area Statistics, April, 2014)
A whole county or smaller service area is
designated as a primary care HPSA if it falls
below a ratio of one primary care physician
per 3,500 population, a mental health HPSA
if it falls below one psychiatrist per 30,000
population, and a dental HPSA if it falls
below one dentist per 50,000 population.
While HPSAs are designated at the county
level or smaller, state-by-state physician- perpopulation ratios also highlight the challenge
of physician maldistribution (see chart below)
Physicians Per 100,000
Population by State
1. Massachusetts....................................... 324
2. New York.............................................. 288
3. Maryland............................................... 285
obstetrician/gynecologist, and 147 lack a
general surgeon (The Physician Workforce
in Texas. North Texas Regional Extension
Center/Merritt Hawkins. February, 2015).
Though physician shortages in underserved
areas may be ameliorated through the use
of PAs and NPs, telemedicine and other
forms of technology, they are likely to
persist for the indefinite future.
The expansion of health insurance coverage
through the ACA also will drive demand for
physicians (for an expanded discussion of
the physician shortage, see Merritt Hawkins’
white paper, The Physician Shortage: Data
Points and State Rankings.)
The types of physicians who are in the most
demand as suggested by the 2015 Review
are reviewed below.
4. Connecticut........................................... 281
5. Vermont................................................ 279
46. Wyoming..............................................179
PHYSICIAN DEMAND: POPULATION
HEALTH MANAGEMENT MAKES
PRIMARY CARE NUMBER ONE
(Source: 2013 Physician Workforce Data Book,
Association of American Medical Colleges)
For the ninth consecutive year, family
medicine was Merritt Hawkins’ most
requested search assignment, with
general internal medicine second (also
for the ninth consecutive year). Third
on the list are psychiatrists, followed by
hospitalists and NPs.
The ACA provided funding for enhanced
primary care physician training at Teaching
Health Centers (THCs) and also increased
funding for the National Health Service
Corps (NHSC) to help address the
maldistribution of physicians. However, this
is a chronic problem that defies a longterm solution. In Texas alone, 185 counties
are without a psychiatrist, 158 lack an
Demand for these types of clinicians is
being driven in part by the reconfiguration
of healthcare delivery into primary care
led teams. These teams are the key
to implementing population health
management in which clinicians, medical
facilities or other organizations provide care
for defined population groups, managing
care and assuming financial risk.
47. Nevada.................................................175
48. Arkansas..............................................174
49. Idaho................................................... 173
50. Mississippi............................................164
Population health management generally is
characterized by the following three elements
1. Information based clinical decision making:
• Robust patient data supports
comprehensive, evidence-based care.
• All clinicians/facilities share an integrated
data network.
• A position leader, typically a physician,
merges data analytics with clinical care
decision making.
2. Primary care-led clinical workforce:
• Primary care physicians are the “point
guards,” managing the team and
distributing care as needed.
• Care team extends reach into the
community to manage/direct outcomes.
3. Patient Engagement and
Community Integration:
• Services are mapped to population need.
• Non-clinical barriers to good
outcomes addressed.
• Patient values integrated into the care plan.
• Community stakeholders connect
patients to resources.
Source: Three Key Elements for Successful Population
Health Management. The Advisory Board Company
In the future, implementation of this
model will be driven through interprofessional education, in which
collaborative practice techniques will
replace the current approach, where
clinicians often train in silos.
Today the model is being implemented
through a growing number of ACOs,
large medical groups, hospital systems,
major employers, insurance companies
and other organizations, the primary care
team typically consists of the following:
Composition of the Primary Care-Led Team
Chief Integration
Officer
Chief Transformation
Officer
Chief Population
Health Officer
Family Medicine
Physician
General Internist
Nursing Care Manager
Physician Assistant
Community Resources
Specialist
Social
Worker
Nurse Practitioner
Care
Coordinator
Grande Aide
Primary care physicians such as family
physicians and general internists top the list
of most in-demand doctors in part because
of their key role as (pick one) “point guards,”
“quarterbacks,” or “CEOs” of the delivery
team. Through the patient management
and care coordination they provide, quality
goals are achieved within an environment
of defined financial resources. Primary care
physicians then are rewarded for the savings
they realize, the quality standards they achieve
and for their managerial role.
That, at least, is the aspiration of these
emerging models. In systems where volume/
fee-for service still prevails, primary care
physicians remain the keys to patient referrals
and revenue generation. According to Merritt
Hawkins’ 2014 Survey of Physician Inpatient/
Outpatient Revenue, family physicians
generate over $2 million a year annually on
behalf of their affiliated hospitals. Regardless
of which model is in place (or a hybrid of the
two) primary care physicians are the drivers
of cost, quality and reimbursement and
therefore remain in acute demand.
In the population health model, medical
specialists are integrated into the team
when appropriate by the primary care
physician. Certain medical specialties are
particularly central to population health
management, due primarily to the role
these physicians play in chronic disease
management. These specialties include:
Obstetrics/Gynecology (OB/GYN):
Important for women’s health
management, including preventive
measures such as wellness visits and cancer
screenings, ob/gyn is seen as central to
comprehensive healthcare delivery.
Cardiology:
Vital for evaluation of heart conditionsincluding heart disease (the number one cause
of death in the United States), hypertension,
and other chronic issues. Heart-related
conditions typically occur in older patients that
have multiple chronic conditions, and thus it is
essential that providers are on the same page
in terms of medication management, diet and
fitness regimen, and patient understanding
and education of condition(s).
Pulmonology:
Another key provider in management of
chronic conditions, particularly COPD, the third
leading cause of death in the United States
and the only leading cause of death which has
increased over the last 40 years. Patients under
the care of a pulmonologist typically have many
social determinants that lead to conditions,
including long-term tobacco use and smoking,
older age with low activity level/fitness, and
high unemployment rate with low income
level. Thus, patient education, understanding of
care, and consistent management of condition
is important to prevent life-threatening
symptoms and ER admissions.
Gastroenterology:
Disease prevention is central to population
health, and gastroenterologists provide
disease screenings through colonoscopies, an
essential step to monitor for colon cancer.
Psychiatry:
One in every five adults in America experiences
some form of a mental illness, with the average
delay between onset of mental health
symptoms and intervention being 8-10 years.
These conditions generally require
management over time and coordination
with other types of physicians.
Hospitalist:
As a part of improving quality of care,
hospitals and other healthcare systems are
continually evaluating how to decrease the
likelihood of readmission for patients, either
for the same ailment/condition that caused
admission, or a problem that develops as
a result of the initial stay. Hospitalists may
enhance quality, reduce errors and serve as
key care coordinators during the stay.
As Merritt Hawkins 2015 Review indicates,
demand for these specialties generally has
increased or remained steady. Psychiatry,
for example, was Merritt Hawkins’ third
most requested specialty last year, with
number of search assignments (230)
reaching an all-time high.
As Merritt Hawkins has consistently
observed in these Reviews, the shortage of
psychiatrists is an escalating crisis of more
severity than shortages faced in virtually any
other specialty. With many psychiatrists aging
out of the profession, and with a preference
among psychiatrists for outpatient practice
settings, it is becoming increasingly difficult
to recruit to inpatient settings.
The geographic disparity in physicians
per population is particularly distinct in
psychiatry, as the following chart indicates.
Psychiatrists Per 100,000
Population by State
1. Massachusetts........................................ 18
2. Rhode Island........................................... 17
3. Vermont..................................................16
PSYCHIATRY: THE “SILENT
SHORTAGE” CONTINUES
4. Connecticut............................................ 16
5. New York................................................ 15
The growing number of psychiatry searches
Merritt Hawkins conducts underlines
the ongoing need for behavioral health
professionals. There currently are 30,088
psychiatrists in active patient care in the U.S.,
48% of whom are 60 or older, with many set
to retire. Meanwhile, demand for psychiatric
services and challenges in mental health
continue to rise (see chart below):
46. Iowa...................................................... 6
47. Mississippi............................................. 5
48. Indiana.................................................. 5
49. Nevada.................................................. 5
50. Idaho..................................................... 5
Source: 2013 Physician Workforce Data Book,
Association of American Medical Colleges
Challenges in Mental Health
One in every five adults in America experiences some form of a mental illness
Nearly one in 20 - or 13.6 million - adults in America live with a serious mental illness
60% of adults with a mental illness received no mental health services in the previous year
Suicide is the 3rd leading cause of death in youth ages 10-24, and the 10th leading cause of death for adults in the U.S.
The average delay between onset of mental health symptoms and intervention is 8-10 years
Over $193 billion dollars in lost earnings a year result from serious mental illness
24% of state prisoners have “a recent history of a mental health condition”
Source: National Alliance on Mental Illness (NAMI; www.nami.org)
Though the ACA extended coverage to
those with behavioral health problems,
various loopholes in the law, and the fact
that many states elected not to expand
Medicaid, have inhibited resources available
for mental health. Because psychiatric
disorders are so frequently misdiagnosed,
patients often require extensive time
with psychiatrists when their conditions
eventually are diagnosed correctly, further
increasing demand.
Recruiting psychiatrists is likely to become
increasingly difficult, and other types of
clinicians, including primary care physicians,
social workers, and psychologists (who may
obtain prescriptive authority in some states)
will have to pick up the slack, though this
is not an optimal solution. For additional
information on the shortage of psychiatrists
see Merritt Hawkins’ white paper Psychiatry:
The Silent Shortage.
part to the hospital-driven consolidation of
gastroenterology practices.
PAS AND NPS: A GROWING
PART OF THE TEAM
Advanced practitioners such as PAs and NPs
also are key to the population management/
team based care model, and this trend is
reflected in Merritt Hawkins’ 2015 Review.
Combined, PAs and NPs represented our
fourth most requested search assignment
last year, though neither was in the top 20
singly or combined four years ago.
OB/GYNS, PULMONOLOGISTS,
CARDIOLOGISTS AND HOSPITALISTS
The 2015 Review indicates that demand
increased or held steady for other types
of physicians who play key roles in the
population health model for reasons
described above, including obstetrician/
gynecologists, pulmonologists, cardiologists
and hospitalists. Merritt Hawkins’ search
assignments for ob/gyns and pulmonologists
increased considerably year over year, while
cardiology searches also rose. Though
the number of searches Merritt Hawkins
conducted for hospitalists declined year
over year, hospitalists remained among our
top four search assignments. An exception
was seen in gastroenterology, where
searches declined year over year, due in
The 104,000-plus PAs and 190,000-plus
NPs now practicing in the U.S. are playing
a growing role in healthcare delivery due
to increased scope of practice regulations,
cost considerations, and their proven
ability to increase patient access and
patient satisfaction. Over 97% of NPs
can prescribe medications while 20 states
and the District of Columbia allow NPs
to practice independently. PAs also are
benefiting from a changing landscape ,
including reduced physician oversight and
greater prescriptive authority.
Taking roles in both primary care and
specialty medicine, PAs and NPs, when
used appropriately, supplement the
physician workforce and allow physicians
to practice to the top of their training.
However, like physicians, PAs and NPs are
not distributed evenly throughout the U.S.,
as the chart below illustrates:
The fact that an increasing number of
clients are retaining Merritt Hawkins to
conduct PA and NP search assignments
indicates that recruiting these professionals
is becoming a high priority for hospitals,
medical groups, FQHCs, urgent care
centers and other facilities embracing the
team-based delivery model and reacting to
consumer demand for convenient care. In
addition, large hospital systems, ignoring
in-fighting over NP and PA scope of practice
regulations, are simply dictating the
increased use of these clinicians.
ORTHOPEDIC SURGERY,
OTOLARYNGOLOGY, AND UROLOGY
As noted above, population aging drives
utilization of the treatments and procedures
physicians provide, particularly services
provided by surgical specialists who typically
address health challenges related to conditions
associated with aging. In the population
health management/ACO/capitated model,
care is coordinated by primary care physicians,
who help ensure that surgical and other
specialty procedures are applied appropriately.
The model is intended in part to inhibit the
overuse of specialty services that may take
place in a fee-for-service environment.
However, as noted above, even with
utilization restraints in place, the patient
population is aging at a rate that will
inevitably drive demand for more surgical
PAs per 100,000 Population by State
NPs per 100,000 Population by State
1. Alaska.....................................................63
1. Massachusetts....................................... 107
2. South Dakota.......................................... 60
2. Tennessee...............................................102
3. Maine..................................................... 57
3. Connecticut............................................ 99
4. New York............................................... 55
4. New Hampshire.......................................96
5. Pennsylvania.......................................... 52
5. Maine.................................................... 92
46. Hawaii................................................. 16
46. California............................................. 44
47. Missouri................................................ 15
47. Texas.................................................... 41
48. Alabama............................................... 15
48. Oklahoma............................................ 37
49. Arkansas.............................................. 10
49. Nevada................................................. 34
50. Mississippi............................................ 5
50. Hawaii.................................................. 29
Source: Medical Marketing Systems
and other specialty services. Lifestyle
considerations and the rise in obesity rates
also drives utilization of surgical services
among younger population groups.
Merritt Hawkins’ 2015 Review reflects
this trend, as the number of search
assignments in surgical specialties such as
orthopedics, otolaryngology and urology
increased year over year. Merritt Hawkins
conducted 106 search assignments for
orthopedic surgery in the 2015 Review
period, compared to 58 assignments
the previous year; 52 assignments for
otolaryngology compared to 32 the
previous year; and 40 assignments for
urology compared to 29 the previous year.
NEW TO THE TOP TWENTY: URGENT
CARE AND PHYSIATRY
Physicians who practice in urgent care
settings represented Merritt Hawkins’ 20th
most requested recruiting assignment as
tracked by the 2015 Review, the first time
urgent care has been included in the firm’s
top 20 recruiting assignments.
In order to capture consumer preferences
for convenient care, hospitals, large medical
groups, health corporations and other
organizations are developing outpatient
sites of service, including urgent care
centers, retail clinics, and free standing
emergency rooms. Providing urgent
care services is no longer a secondary
consideration filled by “moonlighting”
primary care physicians – it is a distinct
growth service line. Urgent care now
represents a $15.3 billion a year industry
and is expected to grow 5.8% each year
through 2018 (IBISWorld 2013).
The following chart indicates urgent care
ownership by organization type:
Urgent Care Centers
by Ownership Type
• Corporation 31%
• Franchise 2%
• Hospital Joint Venture 33%
• Physician Group 14%
• Non-physician Individuals 4%
• Single Physician 13%
• Other 3%
Source: IBISWorld 2013
Retail clinics also are growing rapidly and
the number of such clinics is expected to
increase from 1,400 to 2,800 by 2015, with
projected 25% to 35% growth in coming
years (Advisory Board Daily Briefing, June
13, 2013). CVS Caremark Corporation alone
plans to have 1,500 “minute clinics” by 2017
(Modern Healthcare, November 9, 2013).
Increased access to medical services, or
“being everywhere, all the time,” is part of
a wider trend in which healthcare facilities
are evolving away from a transactional
model of care and toward an “experiential”
model characterized by customer service,
price transparency, provider ratings, and
ease of use. With the understanding that
consumers punish complexity and reward
simplicity, healthcare is shifting to a retail
model with a wider menu of niche providers
to suit varying customer preferences.
These settings are typically staffed by primary
care physicians, emergency medicine physicians,
and PAs and NPs, which will further drive
demand for these types of clinicians.
Growth in demand for physiatrists also is
directly attributable to the proliferation
of employee wellness programs, in which
employers seek to take a more active
role in maintaining employee health and
reducing insurance costs. As the number
of these programs grows, physiatrists are
likely to be in strong demand.
Physiatrists (physicians who have completed
training in physical medicine and
rehabilitation – PM&R) also made Merritt
Hawkins’ top 20 list of most requested
search assignments for the first time.
ANOTHER WAY TO DETERMINE
PHYSICIAN DEMAND
Physiatrists fit the team-based delivery
model as they interact closely with other
medical professionals, including neurologists,
orthopedic surgeons and physical therapists,
and treat the whole patient rather than just
the problem area. In addition, by providing
non-surgical treatments they can ensure
the appropriate use of surgical procedures
promoted in the population healthcare
management/ACO model.
The number of search assignments Merritt
Hawkins conducts for a given specialty
over the course of a year is one way to
gauge demand for physicians. However,
demand also can be determined based on
the number of Merritt Hawkins’ search
assignments as a percent of all physicians
in a particular specialty. It is to be expected
Merritt Hawkins Top Search Assignments
as a Percent of All Physicians Per Specialty (Patient Care Only)
Family Medicine
.82%
Psychiatry
.78%
Pulmonology
.66%
Otolaryngology
.61%
Orthopedic Surgery
.60%
Neurology
.55%
Urology
.43%
Dermatology
.42%
Gastroenterology
.35%
OB/GYN
.32%
General Surgery
.29%
Internal Medicine
.25%
Emergency Medicine
.23%
Cardiology
.17%
Pediatrics
Nurse Practitioner
Physician Assistant
.14%
.08%
.06%
that specialties that have a comparatively
high number of practicing physicians, such
as family medicine and internal medicine,
will generate a comparatively high number
of searches. But how does the picture
look if specialties are ranked by search
assignments per capita, by what might be
called “absolute” demand?
Merritt Hawkins Hospital
Employed Search Assignments
2015.................................................. 51%
2014.................................................. 64%
2013.................................................. 64%
2012.................................................. 63%
2011.................................................. 56%
The previous chart ranks demand for
particular types of physicians in this manner.
2010.................................................. 51%
Considered this way, demand for
specialties such as psychiatry, pulmonology,
otolaryngology, orthopedic surgery and
others exceeds demand for primary care
specialties such as internal medicine and
pediatrics. Family medicine, however,
generates both a high number of search
assignments overall and a high number per
capita, and therefore must be considered
the specialty in greatest demand.
2008.................................................. 45%
WHICH TYPES OF FACILITIES ARE
RECRUITING PHYSICIANS?
In recent years, physician employment has
largely been driven by hospitals seeking
to expand current services, add new ones,
or reconfigure their staffs to implement
the population health management/ACO
model. The chart below illustrates how
the percent of Merritt Hawkins’ searches
featuring hospital employment of physicians
has increased since 2004.
As the following chart shows, the 2015
Review marks a departure from this trend.
The percent of Merritt Hawkins’ search
assignments featuring hospital employment
of physicians declined in 2015 to 51%,
down from 64% the previous two years.
2009.................................................. 45%
2007.................................................. 43%
2006.................................................. 23%
2005.................................................. 19%
2004.................................................. 11%
This is partly a result of the fact that
hospital closures, particularly in rural areas,
have accelerated in recent years. Over 50
rural hospitals have closed since 2010, and
many others are struggling, due in part
to budget sequestration, reductions in
Disproportionate Share (DSH) payments,
higher deductibles, and the fact that many
states elected not to expand Medicaid
enrollment through the ACA, so that cuts
to DSH payments were not offset.
In addition, the decline in the percent
of Merritt Hawkins’ searches featuring
hospital employment is a result of an
increase in physician recruiting activity
among other types of facilities. While
hospitals traditionally have had much of
the physician recruiting field to themselves,
they now face competition from other
types of facilities, including:
PHYSICIAN-OWNED MEDICAL GROUPS
While hospitals still are aggressively
recruiting and employing physicians,
other types of facilities have become
more active in physician recruitment.
These include physician-owned medical
groups, which, like hospitals, are merging
and consolidating to achieve economies
of scale and to compete for contracts
covering large patient population groups.
The AMA indicates that 54% of physicians
now are in groups of five physicians or
more and 12% are in groups of 50 doctors
or more (source: AMA Policy Research
Perspectives. 2013).
The list below of the ten largest
physician-owned medical groups in the
U.S. illustrates the scope and potential
resources of large scale groups.
Largest U.S. Medical Groups
1. Kaiser Permanente Medical Group –
7,304 physicians
2. Cleveland Clinic – 1,999 physicians
3. Mercy Clinic – 1,735 physicians
4. Aurora Medical Group – 1,193 physicians
5. North Shore Long Island Jewish Group –
1,155 physicians
6. University of Washington Physicians
Network – 1,124 physicians
7. I U Health Physicians – 1,076 physicians
8. UCLA Internal Medicine/Geriatrics –
1,005 physicians
9. Novant Medical Group – 1,003 physicians
10. Palo Alto Medical Foundation Clinic –
988 physicians
Source: SK&A’s 50 Largest U.S. Medical Groups,
January 2015
Due in part to the consolidation and expanded
resources of large medical groups, the number
of Merritt Hawkins’ search assignments
featuring physician-owned medical group
settings increased to 20% in the 2015 Review,
up from 13% the previous year.
Because practice models are changing
and physicians almost never enter into
“associations” in which offices are shared
but revenue is not, this category was
eliminated in the 2015 Review. In addition,
“partnerships,” which typically are small
group practices, were rolled into the
“physician-owned group” category.
FEDERALLY QUALIFIED HEALTH CENTERS
The number of Merritt Hawkins’ search
assignments featuring Federally Qualified
Health Center (FQHCs) or Indian Health
Service (IHS)settings increased to 13% in
2015, up from 12% the previous year and
up from 6% in 2012.
With urgent care centers and retail clinics,
FQHCs represent another aspect of the
“convenient care” movement, providing
reasonable access to care for traditionally
underserved rural and urban populations.
Celebrating their 50th year of service in
2015, FQHCs now provide care through
1,300 Health Center organizations
nationwide with sites in more than 9,200
rural and urban communities.
FQHCs are projected to serve 28 million
patients by the end of 2015 and generate
an estimated $26.5 billion in economic
activity for economically challenged
communities (National Association of
Community Health Centers. National
economic and community impact of the
health center program).
Though they are best known for providing
primary care, FQHCs have expanded
services into other areas (see chart below):
Number of Health Center Organizations
Providing Select Services
856
882
Dental
Behavioral
447
Pharmacy
% increase from 2001
137% 80%
73%
Source: National Association of Community Health
Centers (NACHC).
FQHCs also have been early adapters of the
team-based delivery model and are twice
as likely to use PAs, NPs and certified nurse
midwives (CNMs) than are other primary
care practices (see chart below)
Primary care practices reporting
one or more PAs, NPs or CNMs
The ratio of PAs and NPs to physicians in
FQHCs is comparatively high and increased
from .54 per physician in 2001 to .70 per
physician in 2011.
FQHCs received expansion funding through
the American Recovery and Reinvestment
Act (ARRA) of 2009 and in 2010 received
$11 billion in funding from Congress
through a new Health Center Fund. They
benefited from continued funding through
the King v. Burwell decision. FQHCs
have been proven to lower emergency
department utilization and hospitalizations
while improving access and care for lowincome, Medicaid, and uninsured patients.
Support for FQHCs has historically been
bipartisan and it is to be hoped that this
support will be sustained.
Merritt Hawkins is proud to be the
sole permanent physician recruiting
partner of the National Association of
Community Health Centers (NACHC)
and to assist FQHCs is accomplishing their
mission of providing quality, accessible care
to traditionally underserved populations.
INDIAN HEALTH SERVICE FACILITIES
88%
44%
FQHCs
Other primary
care practices
Source: Journal of Community Health/NACHC
Among the growing sites of service
recruiting physicians are Indian Health
Service (IHS) facilities. Established in 1955,
the IHS is the primary federal health care
provider and health advocate for American
Indians and Alaska Natives in 566 federally
recognized Tribes nationwide. IHS hospitals
and clinics have provided a comprehensive
service delivery system for over 50 years,
primarily to rurally based populations.
One of IHS’ missions is to improve access
to care, which it is doing by recruiting
physicians, PAs, NPs and other healthcare
professionals and by refining its recruiting
systems. Merritt Hawkins is proud to
have been selected by IHS to conduct
two national surveys; one of 380 IHS
facility administrators and one of over 400
IHS facility physicians. Both surveys focused
on IHS facility recruiting goals, incentives,
methods and challenges with a view to
expanding IHS physician and advanced
practitioner recruiting capabilities.
Merritt Hawkins works with IHS facilities
nationwide and anticipates these facilities will
continue to expand their recruiting efforts to
meet the needs of their constituents.
VETERANS AFFAIRS (VA) HOSPITALS
There are currently 157 hospitals in the U.S.
operated by the Department of Veterans
Affairs (VA) serving approximately 5.7
million patients.
VA hospitals are included in the “hospital and
hospital owned” category listed in Question 2
of this Review, but require a separate mention
as they have significantly expanded their
physician recruiting activities in the last year.
Accelerated recruitment efforts have come
as a response to highly publicized reports of
long patient wait times at VA facilities. Merritt
Hawkins was referenced in many of these media
accounts because our 2014 Survey of Physician
Appointment Wait Times demonstrated that
long wait times to see a physician also are
prevalent in the private sector.
Based on the work we have done with a
number of VA facilities nationwide, Merritt
Hawkins was proud to be selected in
2015 to submit a Statement of Record
to the House Subcommittee Health
Oversight Hearing on the Ability of
Department of Veterans Affairs to
Effectively Recruit, Onboard, and Retain
Qualified Medical Professionals. The
Statement outlined the challenges Merritt
Hawkins has encountered when recruiting
for VA facilities and included suggestions for
how VA facilities can streamline and enhance
their physician recruiting processes.
The VA has identified hundreds of
physician recruiting opportunities at its
facilities and is likely to remain an active
participate in the physician recruiting
market in the short and long-term.
ACADEMIC MEDICAL CENTERS
Eight percent of Merritt Hawkins’ search
assignments in the 12-month period covered
by the 2015 Review featured academic medical
center settings, up from 6% the previous year
and up from 5% the year before that.
First-year medical school enrollment in
2016-2017 is expected to exceed 21,370, a
30% increase above first-year enrollment
in 2002-2003. This meets the target the
Association of American Medical Colleges
(AAMC) set in 2006 when it called for
expanding medical schools as one means to
address the physician shortage.
The number of U.S. allopathic medical
schools, fixed at 125 for a number of years,
is soon expected to grow to 137, as the
Liaison Committee on Medical Education
(LCME) has granted full, provisional or
preliminary accreditation status to 12 new
allopathic schools since 2012.
leaders to help set strategic goals and
to source top candidates for academic
leadership positions. The Advisory
Council is composed of Tom Lawley,
MD, former Dean of Emory Medical
School; Phillip Pizzo, MD, former
Dean of Stanford Medical School; and
Arthur Rubenstein, MD, former Dean
of the University of Pennsylvania
School of Medicine.
Academic medical centers have increased
recruiting activity of faculty and
leadership positions as a result of this
growth. The greatest growth has come
among faculty positions, though demand
for leadership positions also has been
extremely strong (academic leadership
salaries are tracked separately and are not
included in this Review).
Academic recruiting is further driven by the
physician shortage, which has seen many
faculty members lured to private practice
by comparatively high income offers.
Leaders of academic medical centers,
including Chairs, Division Heads and
others, are being targeted for leadership
positions by pharmaceutical companies,
private health systems, and other
organizations, contributing to a “talent
drain” that has challenged some academic
facilities. Combined with the need to
replace an aging academic workforce,
these trends have accelerated the pace of
academic medical center recruitment.
In response, Merritt Hawkins’ Department
of Academics has expanded its resources,
forming an Academic Advisory Council of
nationally prominent academic medicine
CONCIERGE PRACTICES
The 2015 Review marks the second time
Merritt Hawkins has tracked direct pay/
concierge practices as a separate practice
setting. A growing number of physicians
have expressed interest in this type of
practice, which typically eliminates third
party payers and presents an opportunity
for physicians to remain in private practice.
These practices vary in scope of services
provided. Contrary to popular perception,
they do not necessarily cater to elite
patients. A standard model offers broad
physician availability and time for a retainer
or monthly fees totally from about $1,500
to $1,800 per year.
In the 2014 Survey of America’s Physicians
conducted by Merritt Hawkins on behalf
of The Physicians Foundation, over
20% of physicians indicated they are
now practicing some form of concierge
medicine or plan to. However, Merritt
Hawkins’ search assignments for concierge
settings were flat year over year, remaining
at 1% of all assignments.
The development and expansion of
concierge practices may fall along regional
lines, as physicians show a varying degree
of interest in this practice style by state
(see chart below):
Physicians Practicing or Intending
to Practice Concierge Medicine by State
Wyoming................................................ 38.2%
Nevada.................................................. 30.5%
Louisiana................................................28.8%
Florida................................................... 28.5%
Texas..................................................... 273.%
Oregon................................................... 11.0%
Wisconsin................................................10.9%
Nebraska................................................. 9.4%
Delaware..................................................9.2%
Vermont.................................................. 4.2%
Source: A Survey of America’s Physicians/The
Physicians Foundation/Merritt Hawkins. 2014.
SOLO PRACTICE
In a surprising turnaround, 4% of Merritt
Hawkins’ search assignments in the
12-month period covered by the 2015
Review featured solo practice settings, up
from less than 1% the previous year.
In 2001, solo practices comprised 22%
of Merritt Hawkins’ search assignments,
but in subsequent years these types of
assignments virtually disappeared. Very
few physicians today express an interest
in taking on the financial risks and
administrative burdens of solo practice. In
Merritt Hawkins’ 2015 Survey of Final-Year
Medical Residents, only 2% of physicians
in their final year of training expressed a
preference for solo practice.
The cause of this turnaround is related to
the growing acquisition of smaller hospitals
by larger systems. Once small hospitals
are acquired, larger systems frequently
reevaluate and reconfigure their physician
staffing models to ensure a wider or
more efficient patient catchment strategy.
This can include placing solo physicians
in underserved but high demand locales
within the service area.
As the economy improves and prospects
brighten for businesses of all kinds,
physicians may be more open to managing
solo practices, and independent practice
could make a modest comeback.
THE EMPLOYED PHYSICIAN MODEL
STILL DOMINATES
Despite the reemergence of independent
solo practice, the 2015 Review confirms
that the employed physician practice
model prevails in most recruiting scenarios.
Solo and concierge practices are the only
truly independent practice settings into
which Merritt Hawkins now recruits, and
collectively they represented 5% of Merritt
Hawkins’ 2014/15 recruiting assignments.
The other settings – hospitals, medical
groups, urgent care centers, FQHCs,
academic centers, and others -- typically use
the employed model. For larger systems,
physician employment remains the sole
viable model for creating the integrated
organizations needed to implement
population health management.
The 2015 Review therefore suggests that
of every 100 open physician positions
today, 95 will feature a setting in which the
physician will be employed.
SEARCH ASSIGNMENTS BY
COMMUNITY SIZE
As referenced above, there is a
maldistribution of physicians in the United
States that is particularly acute in rural areas.
However, physician recruiting challenges
are not limited to small or mid-sized
communities. The 2015 Review indicates
that Merritt Hawkins conducted 40% of
its search assignments over the last year in
communities of 100,000 or more, indicating
that healthcare facilities in large communities
also may have difficulty recruiting physicians.
Merritt Hawkins conducted 38% of searches
covered in the 2015 Review period in
communities of 25,000 or less and 22% of
searches in communities between 25,001 –
100,000. Merritt Hawkins worked for clients
in all 50 states during the Review period,
underlying the national presence of physician
recruiting needs and challenges.
WHAT ARE THEY OFFERING?
Incentives tracks the starting salaries or
income guarantees being offered to recruit
physicians, as well as other recruiting
incentives typically offered to doctors and
advanced practitioners.
Average starting salary and income guarantee
numbers represent the base only and are
not inclusive of production bonuses or other
incentives. This is in contrast to physician
compensation numbers compiled by the
Medical Group Management Association
(MGMA), the American Medical Group
Association (AMGA) and other organizations,
which track overall average physician incomes,
including production bonuses.
Merritt Hawkins’ salary and income guarantee
ranges are therefore indicators of the
financials needed to attract physicians already
established in a practice or those coming out
of residency training to particular practice
opportunities, rather than indicators of
physician average incomes.
Comparisons between Merritt Hawkins’
average salary numbers and AMGA overall
compensation numbers in several specialties
are listed below.
Merritt Hawkins vs. AMGA
Compensation Averages
Family Practice
$198,000
$229,607
Internal Medicine
$207,000
$237,548
General Surgery
$339,000
$380,778
Orthopedic Surgery
$497,000
$538,123
Merritt Hawkins
AMGA
SALARIES IN PRIMARY CARE
The 2015 Review indicates that demand for
family physicians continues strong, though
average starting salary offers remained flat
at $198,000 compared to $199,000 the
previous year. As referenced above, family
physicians are key quality and reimbursement
drivers in both the fee-for-service and feefor-value models, and as a result averaging
starting salaries for family physicians have
increased by 11.2% since 2011.
Nevertheless, there is finite room for growth
in primary care physician salaries under current
physician reimbursement models that are tied
to the Relative Value Scale Update Committee
(RUC) recommendations to the Center for
Medicare and Medicaid Services (CMS). While
salaries for primary care physicians such as
family physicians may still increase through
quality/outcomes-based rewards, they are
unlikely to approach levels earned by many
other types of physicians as long as the current
relative value payment model prevails.
this type of search particularly difficult and
competitive, increasing salary offers.
SALARIES IN SPECIALTY CARE
As referenced above, the ACA, marketbased reforms, and targeted Medicare cuts
all tend to enhance the financial prospects
of primary care physicians and may inhibit
the prospects of specialists. In some cases,
the 2015 Review indicates at least a year
over year decrease in salary offers in some
specialty areas (see chart below).
Specialties Seeing Year
over Year Salary Decreases
OB/GYN
$288,000
$276,000
-4.2%
General Surgery
$354,000
-4.2%
$339,000
Hematology/Oncology
$377,000
-7.2%
$350,000
Otolaryngology
$372,000
-10.2%
$334,000
Cardiology (non-inv)
$442,000
Pediatricians saw a year over year
increase in salary offers, from $188,000
in 2013/14 to $195,000 in 2014/15. One
reason for the increase is that the type of
organizations recruiting pediatricians is
changing, from smaller, single-specialty
practices to hospitals and hospital systems
that have the resources to offer more.
Average salary offers for general internal
medicine physicians also increased, from
$198,000 in 2014/15 to $207,000 in
2014/15. The migration of many general
internists into hospitalist roles has limited
the supply of physicians willing to practice
traditional internal medicine and has made
$291,000
-34.2%
Urology
$504,000
$412,000
Pulmnology
$358,000
$331,000
-18.3%
-7.5%
Physiatry
$283,000
$244,000
2014
-13.8%
2015
Reimbursement cuts for office-based
oncology services have impacted salary
offers in the specialty and put pressure
on independent hematology/oncology
practice owners. The same can be said of
non-invasive cardiology. However, the steep
decrease in salaries in this specialty also can
be attributed to the high number of noninvasive cardiology searches Merritt Hawkins
conducted in the past year in highly
desirable urban locations where recruitment
offers traditionally are relatively low.
Physiatry also saw a decrease in average
salaries, though the 2015 Review indicates that
demand for physiatrists is increasing. This may
be a result of the fact that Merritt Hawkins
has conducted a limited number of physiatry
searches in the past, so that one or two high
offers in previous years led to high averages.
The 2015 Review also shows year-over-year
salary increases in some specialties (see
chart below)
Specialties Seeing Year
over Year Salary Increases
Hospitalist
$229,000
$232,000
As the numbers indicate, average salaries
for emergency physicians increased year
over year. Visits to hospital emergency
departments (EDs) have not decreased since
passage of the ACA and there is evidence
that they have increased. In a May, 2015
survey released by the American College
of Emergency Physicians (ACEP), three
quarters of emergency physicians said ED
visits increased in the last year, despite the
proliferation of urgent care centers, retail
clinics, telephone triage lines and expanded
health insurance enrollment through the ACA.
A 2013 study from the RAND Corporation
indicated that EDs account for about half of the
nation’s hospital admissions, another reason
why emergency medicine physicians are in
demand and salary offers are up. In addition,
hospitals today are seeking candidates who are
boarded in emergency medicine (ABEM), and
these candidates are very difficult to find.
+1.3%
Emergency Medicine
$311,000
$345,000
+10.9%
Psychiatry
$217,000
$226,000 +4.1%
Neurology
$262,000
$272,000
+3.8%
Cardiology (inv.)
+15.6%
$454,000
$525,000
Gastroenterology
$454,000
+0.2%
$455,000
As referenced above, psychiatry is a high
demand specialty that is increasingly
difficult to fill, causing average salaries to
increase. As with primary care, however,
current payment models limit the extent to
which offers to psychiatrists can increase.
Orthopedic surgery remains a high ticket
item that generates considerable revenue as
is gastroenterology and invasive cardiology,
keeping offers in these specialties high.
Orthopedic surgery
$488,000
+1.8%
$497,000
Urgent care
$204,000
+2.9%
$210,000
Dermatology
$394,000
$398,000
2014
+1.0%
2015
PHYSICIAN ASSISTANTS AND NURSE
PRACTITIONERS
Average salaries for NPs increased year over
year, from $106,000 in 2013/14 to $107,000
in 2014/15. The number of searches Merritt
Hawkins conducted for NPs has increased by
500% since 2011/12, when the average salary
offer to NPs was $95,000. It is anticipated
that increased demand for NPs will continue
to exert upward pressure on NP salaries.
Average salaries for PAs increased from
$105,000 in 2013/14 to $106,000 in 2014/15.
These numbers parallel average
salaries for PAs as tracked by the 2015
Survey of Physician Assistant Salaries,
Signing Bonuses and Related Incentives
that Merritt Hawkins conducted in
collaboration with the American
Academy of Physician Assistants (AAPA).
Base SalaryOffered to PAs
$104,000
$153,500
Early career PA
Experienced PA
$55,000
$72,800
Minimum
$83,163
$103,636
Average
Maximum
Hourly Rate Offered to PAs
Early career PA
Experienced PA
$25.00
$30.00
Minimum
$40.02
$54.50
Average
$60.00
$100.00
Maximum
Source: Survey of Physician Assistant Salaries, Signing
Bonuses and Related Incentives. Merritt Hawkins/
American Academy of Physician Assistants. 2015
The previous chart indicates average PA
salaries and hourly rates for early career and
experienced PAs as determined by this survey.
As referenced above, many growing sites
of service, including urgent care centers,
retail clinics and FQHCs, are aggressively
recruiting PAs, boosting average salaries
above the six-figure mark.
WHAT ABOUT QUALITY-BASED
INCENTIVES?
The successful implementation of health
reform, including the ACA and related
market-based initiatives, will to a large
extent be determined by how physicians
and other providers are paid. A fee-forservice payment model is thought by
many to drive over-utilization of services,
so, as referenced above, the healthcare
system is moving from volume to value
based payments.
ACOs, hospitals, medical groups, and other
organizations are striving to create physician
payment models that reward doctors
for providing value, which is measured
by various metrics, including patient
satisfaction scores, adherence to treatment/
quality protocols, reduction of hospital
readmissions/errors, group governance
participation, cost reduction/containment,
appropriate coding, implementation/use of
electronic health records and others.
At the same time, facilities that employ
physicians want to ensure that they stay
productive, and “productivity” still is measured
by what are essentially fee-for-service metrics,
including relative value units (RVUs), net
collections and number of patients seen.
THE “GOLDILOCK’S ZONE”
ASPIRATION VS. REALITY
The goal is to find the “Goldilock’s
zone,” – physician payment models that
encourage physicians to see the patients
and generate the revenue that healthcare
facilities still need, but that also reward
doctors for adopting the behaviors and
practices that will drive reimbursement in
emerging value-based payment models.
Merritt Hawkins’ 2015 Review provides
an indication of the extent to which
physicians currently are compensated
based on quality metrics. Seventy-one
percent of searches covered in the 2015
Review period featured a salary with a
production bonus, while the remaining
29% featured a straight salary or income
guarantee. Of the 71% offering a
production bonus, only 23% featured
a bonus that was based in whole or in
part on quality metrics such as patient
satisfaction, adherence to protocols, etc.
This is down from 24% the previous year
and 39% the year before that.
For physicians, these models include the
Medicare payment formula that will replace
the sustainable growth rate (SGR) formula
that was recently put to rest by Congress.
There are two ways for physicians to
participate in the replacement formula:
1. They can join the Merit-Based Incentive
Payment System (MIPS) which
combines three old incentive programs
into one and gives doctors a quality
score. If their scores are high, their
Medicare reimbursement will go up.
If they are low, they will be subject
to reimbursement cuts. MIPS will rate
physicians in four categories: quality
of care, EHR meaningful use, use of
healthcare resources, and activities
undertaken to improve clinical practice.
2. They can sign up to be part of an
Alternative Payment Model. This
is essentially the population health
management/ACO model in which doctors
band together and take a lump sum of
money to care for a population group.
If they can provide care for less than the
lump amount– and hit certain quality
metrics – they can keep part of what they
save. Physicians immediately get a 5%
Medicare bonus for choosing this option.
The 2015 Review further indicates that
the average amount of the bonus tied
to quality was 22%. In the hypothetical
case of a family physician earning a salary
of $200,000 with an achieved $50,000
bonus, 22% of the bonus amount ($11,000)
would be based on quality, equating to less
than 5% of the physician’s total income
($250,000). Surgical and other specialists
tend to have less of their incomes tied to
quality than do primary care physicians, in
Merritt Hawkins’ experience, to an extent
that quality payments are not likely to
influence their behaviors.
As these numbers indicate, in the realworld recruiting scenarios in which Merritt
Hawkins is involved, quality-based physician
payments are still mostly aspirational.
Though many facilities are determined to
move toward quality-based payments,
some have hit a wall and have put off
struggling with their physicians over this
issue until the definition of quality and how
to reward it becomes clearer. It should be
noted, however, that a growing number of
physician employers, such as urgent care
centers, retail clinics and FQHCs, typically
offer physicians straight salaries.
SIGNING BONUSES AND HOUSING
ALLOWANCES
Signing bonuses were offered in 73% of
the recruiting assignments Merritt Hawkins
conducted in 2014/15, up from 70% the
previous year. Signing bonuses remain a
standard recruiting incentive, though they
may not be used in instances in which
physicians are changing employers within the
same community and do not need the extra
inducement of a bonus. Some facilities also may
be hesitant to offer signing bonuses in light of
renewed attention to Stark-related recruiting
regulations, while others are using pay for
emergency department call as a type of bonus.
The following graph illustrates the use of
signing bonuses over the last several years.
% of Merritt Hawkins
Clients Offering Signing Bonus
2004/05.................................................... 46%
2005/06.....................................................58%
2006/07.....................................................72%
2007/08.....................................................74%
2008/09.................................................... 85%
2009/10.....................................................76%
2010/11..................................................... 76%
2011/12..................................................... 80%
2012/13..................................................... 71%
2013/14.....................................................70%
2014/15.....................................................73%
Signing bonuses offered to physicians
in 2014/15 averaged $26,365, up from
$21,773 the previous year. Signing bonuses
offered to NPs and PAs averaged $8,791, up
from $7,786 the previous year.
Certain other incentives, such as paid
relocation, paid CME, health insurance
and malpractice insurance are standard in
the majority of Merritt Hawkins’ physician
search assignments. The average relocation
allowance offered to physicians in 2014/15
was $10,292, up from $9,849 the previous
year, while the average CME allowance
offered to physicians in 2014/15 was
$3,649, up from $3,515 the previous year.
The average relocation allowance offered to
NPs and PAs was $9,436 , up from $6,904
the previous year, while the average CME
allowance was $2,241, down from $2,450.
Twenty-five percent of Merritt Hawkins’
2014/15 search assignments featured medical
education loan forgiveness, down from 26%
the previous year. Educational loan forgiveness
entails payment by the recruiting hospital or
other facility of the physician’s medical school
loans in exchange for a commitment to stay in
the community for a given period of time.
The term of forgiveness in 79% of searches
Merritt Hawkins conducted in 2014/15
featuring educational loan forgiveness was
three years; 13% of searches offered a twoyear term, and 8% offered a one year term.
The average amount of loan forgiveness
offered to physicians was $89,479. The
average amount of loan forgiveness offered
to NPs and PAs was $54,286.
The 2015 Review tracks a relatively new
physician recruiting incentive: housing
allowances. Given a volatile real estate
market or for other reasons, some physician
candidates are unable to leave their current
homes in order to relocate. Housing
allowances help pay for their housing in
their new location, allowing them the
flexibility to relocate. Such allowances may
be rolled into the overall signing bonus.
Some facilities, however, emphasize housing
bonuses by identifying them as a separate,
clearly delineated incentive. Housing
allowances as a stand-alone benefit were
offered in 5% of the search assignments
Merritt Hawkins conducted in 2014/15,
down from 4% the previous year.
Conclusion
Incentives indicates that demand for
primary care physicians remains particularly
strong, as they are seen as the keys to
achieving quality and cost objectives
necessary under emerging team and
population health-based delivery models.
Recognizing that other types of clinicians
will have to help address primary care
physician shortages, demand is rising
for advanced practitioners such as nurse
practitioners and physician assistants,
as well as for specialists who can
manage chronic illnesses in coordination
with primary care-led teams. Aging
demographics continue to fuel demand for
surgical specialists.
Despite a surprising increase in
Merritt Hawkins’ solo practice search
assignments, employed positions have
almost entirely supplanted independent
practices as search settings.
While reimbursement in healthcare is
moving toward value-based metrics,
the 2015 Review indicates that many
healthcare facilities are still struggling with
the challenge of rewarding physicians for
both volume-based productivity and valuebased behaviors.
While hospitals remain a key driver of
physician recruitment, other settings,
such as physician-owned medical groups,
FQHCs, academic medical centers, and
urgent care centers have increased their
recruiting activities, creating a more diverse
market for physicians.
Merritt Hawkins’ Additional Discussion
Groups/Surveys/White Papers
Merritt Hawkins’ hosts a professional Discussion Group on LinkedIn to review and discuss
matters pertaining to physician recruiting, compensation, workforce solutions and related
healthcare trends. To join, visit http://linked.in/AB6mOC.
Merritt Hawkins is an AMN Healthcare company. AMN Healthcare, the largest healthcare staffing
organization in the United States, is the industry innovator of healthcare workforce solutions.
Surveys and white papers completed by Merritt Hawkins or other AMN companies include:
• Survey of Physician Appointment Wait Times
• A Survey of America’s Physicians: Practice
Patterns and Perspectives (in partnership
with The Physicians Foundation).
• Physician Inpatient/Outpatient Revenue Survey
• Survey of Final Year Medical Residents
• Survey of Physician Assistant Salaries, Signing Bonuses
and Related Incentives (in collaboration with the
American Academy of Physician Assistants)
• Clinical Staffing and Recruiting Survey/Survey
of Physician Practice Patterns & Satisfaction
(in collaboration with the Indian Health Service)
• Survey of Alumni Satisfaction and Health System
Trends (in collaboration with Trinity Unversity)
• Survey of Membership Compensation, Career Satisfaction,
and Personal Perspectives (in partnership with the
American Academy of Surgical Administrators)
• White Paper: Nurse Practitioners and Physician
Assistants, Supply, Demand and Scope of Practice
• White Paper: Incentive-Based Physician Compensation
• Hospital-Specific Physician Requirements Model
(in conjunction with Richard “Buz” Cooper, M.D.,
University of Pennsylvania)
• White Paper: Ten Keys to Physician Retention
• White Paper: The Cost of A Physician Vacancy
• White Paper: RVU-Based Physician Compensation
• White Paper: The Economic Impact of Physicians
• Curriculum: Physician Recruiting,
The University of Florida
• Review of Temporary Healthcare Staffing
Trends & Incentives
• Review of Temporary Healthcare Staffing
Trends & Incentives (Mid-level Providers)
• White Paper: Physician Aging, A Demographic Dilemma.
• Survey of Chief Nursing Officers
• White Paper: Women In Medicine
• Survey Registered Nurses
• White Paper: The Physician Shortage,
Data Points and State Rankings
• Survey of Travel Nurses
BOOKS WRITTEN BY MERRITT HAWKINS:
• Will the Last Physician in America Please Turn Off the Lights? A Look at America’s
Looming Physician Shortage, Fourth Edition
• Merritt Hawkins Guide to Physician Recruiting
• In Their Own Words: 12,000 Physicians Reveal Their Thoughts on Medical Practice in America
(in partnership with The Physicians Foundation).
For additional information about this survey or other information generated by Merritt Hawkins or AMN Healthcare, please contact:
Merritt Hawkins / Corporate
5001 Statesman Dr
Irving, Texas 75063
(800) 876-0500
Merritt Hawkins / Atlanta
7000 Central Parkway, NE, Ste 850
Atlanta, GA 30328 (800) 306-1330
Merritt Hawkins / Irvine
19200 Von Karman Ave, Ste 400
Irvine, CA 92612
(800) 288-1210
Speaking Presentations from
Merritt Hawkins and AMN Healthcare
An Educational Resource
Merritt Hawkins and AMN Healthcare are committed to providing
survey data and other information of use to healthcare executives,
physicians, policy makers and members of the media.
AMN Healthcare offers speakers to address healthcare industry
trends in staffing, recruiting and finance.
Topics include:
· Medical Practice in America: Past, Present and Future
· The Physician Workforce
· Clinical Workforce Solutions
· Evolving Physician Staffing Models
· Physician and Nurse Shortage Issues and Trends
· How to Make Your Hospital or Group a Physician Magnet
· New Strategies for Healthcare Staffing
· Healthcare Reform and Workforce Issues
· Economic Forecasting for Clinical Staffing
· Allied Staffing Shortages
· Vendor Management
· Recruitment Process Outsourcing
· Other topics Upon Request
For more information or to schedule a speaking
engagement, please contact:
Phillip Miller
[email protected]
(800) 876-0500
5001 Statesman Drive
Irving, Texas 75063
(800) 876-0500
www.merritthawkins.com
22
ND
EDITION
©2015 Merritt Hawkins | 5001 Statesman Drive, Irving, Texas 75063 | (800) 876-0500 | www.merritthawkins.com

2015 review

Transcription

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