Doctor Shortage Sends Hospitals to War

Timothy Crowley, MD, told the Boston Globe that he was joking when he left a voicemail for a physician recruiter at a rival hospital: "You don't want to go to war with me. I'll take everything you got and everything you love and kill it."

Crowley's jest, which cost him his job when executives at Caritas Christi Health Care got wind of it, may have revealed more truth about the competitiveness of physician recruitment today than he realized.

Crowley left the voicemail after James Blakely, a recruiter for Mount Auburn Hospital, "fired the first shot" by trying to woo three Caritas physicians earlier in the year. According to the Globe report, the two were longtime friends and had once worked together, so the voicemail was intended as a "light-hearted joke." But the competition for physicians was very real, and neither hospital approached the situation with a sense of humor.

Competition for physicians is nothing new—hospitals in tough markets frequently try to steal away top surgeons or specialists from each other, particularly if doing so will boost a high-priority service line. But Mount Auburn and Caritas went to war over three primary care physicians, not specialists, and that may reflect the recruitment battlefield of the future.

The convergence of physician shortages and efforts to expand medical coverage is making recruitment more difficult, and more of a necessity, particularly in primary care.

How can we provide coverage for nearly 40 million more Americans with the physician workforce already strained in many areas? That problem may ultimately prove trickier to solve than many of the hot-button issues that are getting so much political attention today.

Massachusetts is an important bellwether. Although the state's healthcare plan is frequently maligned by opponents of healthcare reform, it has been fairly successful at expanding coverage (97% of the population is insured) without letting costs spiral out of control. And so far, no death panels.

The big obstacle for the state, however, is a shortage of physicians. A 2008 report found that 12 of 18 specialties in Massachusetts were in short supply, and shortages in family practice and internal medicine were critical.

Now extrapolate that to the rest of the country. The number of U.S. medical school students going into primary care has dropped nearly 52% since 1997, and other specialties are in short supply in certain areas.

Unfortunately all of the steps being taken to alleviate the problem—increasing primary care reimbursement, exploring different practice models, boosting training—are slow-moving and will take years to make a difference.

That means, like in Massachusetts, hospitals and medical groups around the country will see higher patient demand and have to compete for the same pool of physicians. A lot of hospitals are preparing to go to war over physician recruits; Crowley's just the only one who admitted it.