Primary Care, Psychiatry Top Recruiter's List

Specialists are no longer the key to generating healthcare revenues. Now the drivers are team-based healthcare and the chronic care model.

Population health and managing chronic illness are fueling continued strong demand for primary care providers, a new report from physician recruiters Merritt Hawkins shows.

For the ninth straight year, family physicians were the most-recruited specialty by the Irving, TX-based company over the past year. Of the 10 most-recruited positions, six were in primary care, including family physicians, internists, hospitalists, nurse practitioners, OB/GYN, and pediatrics.

"The demand is everything that primary care reflects right now and that is team-based health," says Kurt Mosley, vice president of strategic alliances at Merritt Hawkins. "For a while the specialists were the key to everything because they generated inpatient revenues. Now it is team-based health, the chronic care model."

Also in the top 10 were psychiatrists, orthopedic surgeons, emergency physicians, and general surgeons.

Merritt Hawkins' 2015 Review of Physician and Advanced Practitioner Recruiting Incentives tracks the 3,120 physician and advanced practitioner recruiting assignments the firm conducted across the nation from April 2014 through March 2015.

Psychiatrists were the third-most-sought specialty, the highest it's been in the 27 years that Merritt Hawkins has tracked. Mosley says that the demand for psychiatrists is fueled in part by population health, because of the strong link between mental health and chronic health issues. The federal government estimates that one in five adults experiences some form of mental illness each year.

Integrating Mental Health and Primary Care

"A lot of the psychological problems manifest themselves physiologically, which affects chronic care," Mosley says.

The federal government has designated 3,968 whole or partial counties as Health Professional Shortage Areas for mental health defined as areas where there is less than one psychiatrist per 30,000 people. Mosley says it would take 2,707 mental health professionals to remove these designations.

Disparities vary tremendously by state. Massachusetts has 18 psychiatrists per 100,000 population, Idaho has five. In Texas, 185 of 254 counties have no psychiatrist. There is no indication that the shortage will be alleviated any time soon. Nearly half of psychiatrists are expected to retire over the next five years, and Mosley says there aren't enough new psychiatrists to replace them.
"We estimate about 15,000 of the 30,000 psychiatrists are going to retire over five years, but we've only got about 1,160 that are coming out every year," Mosley says.

Plays like a QB, Earns like a Scrub
Primary care physicians may be the quarterbacks on the healthcare team, Mosley says, but they continue to be paid like scrubs on the practice squad.

Despite being in high demand, family practice physicians who were recruited over the past year were paid on average about $198,000, well below the compensation for invasive cardiologists ($525,000), orthopedic surgeons ($497,000), and gastroenterologists ($455,000) 

"It's frustrating," Mosley says. "There are a lot of docs who have a great passion for primary care but it's not the most rewarding, dollar-wise."

The employed physician model represented 95% of all recruiting searches in the past year, as the prevalence of private, independent practices continues to decline.

"People are running for cover," Mosley says. "The SGR got fixed, but still, docs are concerned about the future. 'What will I make? I need to know.' The employment models give them a sense of security. It helps them run their practice and their malpractice is taken care of. There is uncertainty about what is going to happen over the next five or six years. They don't want to have to worry about if they are going to make enough money to make ends meet."

The Merritt Hawkins report suggests that the push toward value­ over volume has slowed and that compensation continues to be driven by volume-based metrics such as relative value units, patient visits, and net collections. Of the Merritt Hawkins clients who offered physicians a production bonus last year, 23% based the bonus in whole or in part on value-based metrics such as patient satisfaction, compared to 39% two years ago.  

"Nobody has value right," Mosley says. "You still have to have a volume metric or you aren't going to make it. HHS says 70% is going to be based on quality in 2018 but nobody knows how to do it yet."