JULY 7, 2000
EMPLOYMENT TRENDS
Why Medical Specialists Are Something Special
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Especially to small and midsize communities, which are spurring a surge in demand for their skills
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To Steve and Teresa Faith, Austin, Tex., seemed like the perfect place to
live. They had visited the city when Steve was in medical school at
the University of Texas at San Antonio and enjoyed the local music scene.
They read articles touting Austin as one of America's most appealing cities,
with a robust economy and a comfortable lifestyle. So when Steve finished his
residency in general surgery at Indiana University last summer and was
offered a job with a small practice in Austin, the couple readily packed
and headed back to the Lone Star state.
One year later, they're packing again. Disillusioned with life in
fast-growing Austin, Faith recently accepted a position as a general
surgeon in Paris -- Paris, Tenn., that is, population 10,000. His new
contract will pay at least twice as much money. The local hospital will
set up a solo practice for him, cover his overhead expenses the first year,
and pay off his $80,000 in student loans over the next four years. Says
Faith: "The whole world is wired, so why not move to Paris?"
Why not, indeed. Demand for specialists like Faith is stronger than it has been in years, thanks in part to small-town America. In 1995-96, some 72% of all searches conducted by Merritt, Hawkins & Associates, a physician-recruiting firm in Irving, Tex., were in primary care -- family practice, pediatrics, and internal medicine. The most recent numbers from 1998-99 show a complete reversal: 69% of searches were for specialists, according to the new data.
FIGHT FOR TALENT. Other physician-recruiting firms across the country report a similar boom in specialty-care searches. Geoff Staub, marketing director for St. Louis (Mo.) recruiting firm Cejka & Co., says the number of searches for specialists at his company is on the rise. As the competition for help has heated up, many hospitals and medical groups are sweetening their offers with higher salaries, signing bonuses, and agreements to pay off student loans. The physicians "realize their value and expect these entities to step up and compensate them," says Mark Smith, vice-president for recruiting at Merritt Hawkins.
Several factors help explain the demand for specialists these days. For one, consider the aging of the population. People 50 or older account for 37% of all American adults today. By 2010, that figure will jump to 43%. That means plenty of work for orthopedic surgeons, cardiologists, oncologists, and others who have the skills to heal the aging bodies of 76 million baby boomers.
In addition, more and more managed-care programs now allow participants to seek out specialists without a referral from their primary-care physician. "Patients demanded direct access to specialists," says Staub. "The gatekeeper model didn't catch on as everyone thought it would."
Despite the rising consumer need, moreover, participation in many specialty residency programs has remained relatively low. From 1990 to 1998, the number of family practitioners in the U.S. soared 40%, from 47,639 to 66,900, while the ranks of cardiologists grew just 13%, from 18,898 to 19,623, according to the American Medical Assn. During the same time period, the number of general surgeons inched up 5.4%, from 38,376 to 40,448. Radiology, one of the hottest fields in medicine right now, lost 2.6% of its practitioners during the 1990s.
SELLERS' MARKET. As a result, those who've specialized in something as broad as general surgery can be quite selective these days. Merritt Hawkins' Smith tells the story of one married couple -- he an orthopedic surgeon, she a radiologist -- who recently completed their residencies. One hospital in a small town in West Virginia offered starting salaries of $400,000 for him and $360,000 for her. They declined, in favor of another small-town hospital in Arkansas that gave them a few more dollars and also acquiesced to their demand of exclusivity for their services. The hospital signed a contract agreeing not to recruit or support financially any physicians in their specialty without their consent.
In fact, small and midsize communities in particular are fueling the demand for specialists. To stay competitive with urban medical centers and encourage patients to stay local for more advanced procedures, many hospitals in second-tier cities are trying to boost the number of specialists on their staffs.
However, it may take a while to find the right person. According to a study by
Merritt Hawkins, just 23% of final-year medical residents last year wanted to
live in a community of 50,000 people or less, down from 32% in 1997. At Memorial
Hospital in Gulfport, Miss. (population 64,000), physician recruiter
Donna Alexander has been hunting for two years for a neurologist to direct a
new stroke center. "We need a good clinician and someone with leadership
characteristics to develop the program," she says. The job remains open,
despite several near misses.
All of this means good business for physician recruiters. At any given time, J&C Nationwide, a recruiting firm in Atlanta, has about 1,800 to 2,000 open positions, many in small and midsize communities. While their clients want to fill positions as quickly as possible, they're not willing to settle for just anyone. "A lot of our clients want ties to the area, they want retention," says J&C recruiter James St. Clair. "They ask us: 'Why does this person want to come here?'"
SHORT WISH LIST. The challenge for recruiters and small hospitals alike is made more difficult by most physicians' clear ideas about where they want to live -- and the boonies aren't often on their wish list. At Merrit Hawkins, many physicians mention Sunbelt states such as Georgia and Florida, where the climate is good and they can live on the coast. Merrit Hawkins' Smith tries to marrry that desire with small-town demand: "I'll find them a job in a town they never heard of."
Jeff Bowling, managing partner at recruiting firm Delta Medical Consulting in Carrollton, Tex., sees a big movement back to the Midwest and Central Plains by doctors who, among other things, want to escape the managed-care plans that dominate urban areas along the coasts. In fact, roughly 85% of Delta Medical's business lies between the Mississippi and the Rockies.
To make that territory seem as enticing as possible, Bowling tries to leave little to chance. For instance, he recently visited one client, a psychiatric hospital in Faribault, Minn., to discuss its search for a child/adolescent psychiatrist. He and the hospital's CEO talked about salary ranges, which route to use when driving potential candidates from the airport, and where they should stay overnight (Bowling suggested a quaint bed-and-breakfast).
Delta Medical relies heavily on direct mail to locate interested physicians: For the Minnesota search, it will mail brochures to all 4,000 board-certified child/adolescent psychiatrists in the U.S., at a cost of about a dollar each. Delta Medical nets roughly $21,000 to $28,000 in fees for every successful search, Bowling adds.
RURAL IDYLL. It was Bowling who also played matchmaker between Steve Faith and Paris. Faith contacted Delta Medical a few months ago after receiving one of its mailers. The brochure arrived just as Faith started questioning his life in Austin. "I was working my butt off, making a lot of money for the practice," he says. "But what did we move to Austin for? For the lakes, the food, the music. So far, we had been to one concert."
Not long after, Faith visited Paris with his wife. They liked what they saw and what the job promises Steve. Among other things, he will get a shot at a broader variety of cases, a big switch from Austin where there are plenty of subspecialists to handle more involved surgeries. And he'll work at just one hospital, compared with three or four scattered around Austin.
Faith won't miss those long commutes crisscrossing a big city. "Most doctors [in Paris] live five minutes from the hospital," he chuckles. "Someday, they tell me, that will seem far away."
By Jennifer Gill in New York
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Copyright 2000, by The McGraw-Hill Companies Inc. All rights reserved.
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