Skip to main content

Solo Physician Practice Recruiting Dwindling

 |  By John Commins  
   July 06, 2012

If trends hold true, there will be a time in the near future when the only place to find a solo medical practice will be on You Tube.

The 2012 Review of Physician Recruiting Incentives from Merritt Hawkins found that recruiting doctors into solo practice "has almost entirely abated."

>>>

"Only 1% of Merritt Hawkins' search assignments in 2011/12 featured a solo practice setting, down from 2% in the previous year and 22% 11 years ago," the Dallas-based recruiters noted. The survey results are based on 2,710 permanent physician and allied professional searches that Merritt Hawkins/AMN Healthcare did from April 2011 to March 2012.

Kurt Mosley, vice president of strategic alliances at Merritt Hawkins, says he believes that two- and three-physician practices may soon be placed on the endangered list.

"The magic number now is six or more physicians. That is what it is going to take to survive," Mosley tells HealthLeaders Media. "I don't know exactly why, but it seems that groups of six or less are going to have a heck of a time making it because of cost and IT implementation and overhead. It's just not going to work."

Mosley says healthcare reform is demanding efficiencies of scale that solo or very small practices can't meet. "Compensation is down. Medicare and Medicaid are down. Some of these smaller groups are going to have to take all comers," he says. "Medicaid has always been tough but those state (health insurance) exchanges are going to be paid at Medicaid levels or less, and I don't see a lot of doctors except these solo guys taking it, which is going to mean less compensation."

In addition, he says, the initial cost hurdles to implement healthcare IT may be too high for smaller practices. "Even though they get their money back through the stimulus package, they can't afford to outlay that," Mosley says. "More importantly, they don't have the time to get trained on it."

Trending exactly in the opposite direction is the rise of physicians as hospital employees. The survey found that 63% of searches for physicians in the last year were for hospital employment; up from 56% in the previous year and only 11% eight years ago. At this pace within the next two years 75% of newly hired doctors will be hospital employees.

Mosley says employment seems to be a more popular option with younger physicians. "You see a lot of women gravitating towards hospital-based or site-specific jobs because it's set hours. They can work within their family schedule," Mosley says. "We also see a lot more women becoming hospitalists."

Nearly three-fourths of searches offered a salary and production bonus, and 54% of the bonuses are based on Relative Value Units. In addition, 35% of searches offering production bonuses featured a quality-based measure.

"The big theme I am hearing in the marketplace is that people know we have to go from volume to value but how we do that is still a mystery," Mosley says. "We are seeing them try to wean physicians off these volume-based rewards and wean them into quality measures. People are trying not to drive up to the wall going 60mph before they figure out how to stop."

The survey also found that:

  • For the seventh year primary care physicians led demand, and family physicians and general internists were the two most requested primary care searches.
  • Psychiatry was third on the list of most requested searches.
  • General surgery was the fifth most requested searches and the most requested surgical specialty.
  • Certain medical specialists, including ED physicians, orthopedic surgeons, OB/GYNs, pulmonologists, urologists, dermatologists, and hematologists/oncologists remain in strong demand.
  • Demand for some medical specialists has decreased. Radiology, which was Merritt Hawkins' most requested specialty in 2003, ranked 18th in 2011/12. For the first time in the history of the survey Anesthesiology was not among the 20 most requested searches.
  • Signing bonuses, relocation and continuing medical education allowances are standard in most physician recruitment packages.
  • Salaries have almost entirely replaced income guarantees. Only 7% of physician searches featured income guarantees, down from 21% in 2006/07 and 41% in 2003/2004.
  • Housing allowances were offered in 5% of recruiting searches, which was the same as last year but up from less than 1% two years ago. "We had a lot of doctors who couldn't move because they were upside down in their homes," Mosley says.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

Tagged Under:


Get the latest on healthcare leadership in your inbox.