Perry Farb is, no doubt, a very good family-practice physician. Still, as he completed his training, he was astounded by the number of “faxes and e-mails [he received] daily for months,” alerting him to job opportunities.
Farb ended up at Fallon Clinic in Boston. Chief Medical Officer Marc Greenwald was happy to have him. Just before Greenwald started his job two and a half years ago, the group had 23 openings and could fill only 11 of them.
It’s a new world for those trying to recruit. The long-rumored physician shortage is upon us and likely to worsen. The newly formed Council on Physician and Nurse Supply says the United States may lack as many as 200,000 needed physicians (and 800,000 nurses) by 2020. The Bureau of Labor Statistics predicts there will be 212,000 physician openings by 2014 due to growth and net replacement of retiring physicians. That number represents more than 25 percent of the current physician work force. And this is in a country whose population continues to grow. The American Medical Association (AMA) says that as the U.S. population rose 31 percent between 1980 and 2003, its number of medical school graduates remained static.
That’s good news for those of you looking to change jobs — scarcity drives up salaries and perks — but bad news if you want to expand your practice or replace a soon-to-retire partner.
The shortage is real
There are now more people who need more care, and there are fewer physicians trained to treat them.
Many of today’s patients are baby boomers whose aging bodies require more therapy, treatment, and surgery. The National Ambulatory Healthcare Administration says people aged 66 and older average six physician office visits per year; individuals aged 46 to 65 average 5.4 visits annually; and people 25 to 35 years old average 2.2 visits a year. Increasing numbers of older patients mean heightened healthcare demand.
And older patients typically have multiple chronic conditions that require complex office visits and administrative care — often unreimbursed — such as prescription refills and phone conversations.
Of course, as boomer patients are aging, so are boomer physicians. Many of today’s practicing physicians are retiring, or soon will. The AMA’s data state that “matures” (people over age 61) and baby boomers (people between age 42 and age 60) now make up 67 percent of the existing physician population. Generation Xers (age 27 to age 41) make up only 33 percent of today’s practicing physicians.
And keep in mind that Gen X doctors (and those even younger) aren’t exactly replacing all of the work performed by older physicians. “Some of the new doctors coming out — and this is not a slam — are just not willing to see as many patients and work the same hours as the older physicians,” says Kurt Mosley, vice president of Merritt, Hawkins & Associates, a physician recruitment firm. “It’s not an apple and an apple. It’s a lifestyle issue.”
When Merritt Hawkins surveyed physicians over age 50, 64 percent said the doctors trained today are less dedicated and hardworking than the physicians who entered medicine when they did.None said they were more dedicated.
The fallout of all this is plainly evident. Patient wait times for specialist appointments are growing almost as fast as specialist recruiting incentives. For example, wait times for appointments with cardiologists reached or exceeded 21 days in six of 15 metropolitan markets surveyed by Merritt Hawkins in 2004. Patients needing to see dermatologists waited at least 21 days in 60 percent of the same markets. Specialist income is rising accordingly, from an already high average of $320,000 in 2004-2005 to $342,000 in 2005-2006. Gastroenterologists are now starting at $315,000, up from $298,000 last year.
Patient demand is clearly outpacing specialist output, forcing practices and hospitals looking to recruit physician specialists to pay top dollar.
But shortages aren’t limited to the specialties. Primary-care physicians are also feeling the effects.
Merritt Hawkins conducted 55 percent more searches for family physicians from March 31, 2005, to April 1, 2006, than during that same period the previous year. Searches for internal medicine positions rose 46 percent. In fact, the company performed more searches in internal medicine than in any other field.
“What we’ve seen is a shift back to primary care,” says Mosley. “In the past two to three years, we made an effort to get specialists. Now those specialists are asking, ‘Where are our feeders? Where is our base?’”