Doctors of osteopathic medicine and physician assistants are driving small but rapidly increasing shares of recruitment searches.

Feb. 25—Competition for physician employees has gotten intense enough to lead urban entities to seek hiring help, according to industry analyses.

Placements of physicians and advanced practice providers in urban areas surged past placement in both rural and suburban areas in 2015, a national placement firm found for the first time. A Medicus Firm report found that among all 2015 placements, 36.76 percent were recruited in urban areas, compared with only 25 percent in 2013.

The change was the latest sign of increasing competition in the healthcare industry, which underwent a historic hiring surge in 2015.

“We’re doing more business in larger areas that we have never done before; that was something that really kind of shocked us,” Jason Farr, a vice president for Medicus, said in an interview. “It’s a little bit of a treat for us to be marketing to larger communities because we have been catering to small, rural areas and medium-sized communities and finding ways to make them attractive.”

The urban demand also was reflected in the latest data from competitor firm Merritt Hawkins, a company of AMN Healthcare, which found 40 percent of its physician and advanced practitioner search assignments occurred in communities of 100,000 or more residents. In comparison, 38 percent of searches occurred in communities of up to 25,000 residents, and 22 percent occurred in midsize communities.

That increased clinician demand also was credited with increasing average relocation offers for physicians to $12,125, according to the Medicus report, which was the highest figure since 2011. Similarly, average signing bonuses increased to $23,663, the highest since 2012.  Average signing bonuses identified by Merritt Hawkins increased to $26,365 in 2014-15, an increase from $21,773 the previous year.

The increasing competition came amid an overall hiring boom in health care. In 2015 the industry added 474,700 jobs, with hospitals accounting for 172,200 of those positions, according to the Bureau of Labor Statistics.

Ongoing Trends

Hospitals remain the dominant recruiter, according to Medicus. Among employed placements, 69 percent were hired as hospital employees, 25 percent were hired as employees of physician groups, and 5 percent were employed in unknown or “other” practice settings.

The hospital hiring trend was part of the ongoing migration of physicians from independent practices to employed settings. Ninety-two percent of 2015 placements were in employed settings and 8 percent were in private practice, Medicus found. That reflected the shift seen elsewhere, including a 2014 national survey by the Physicians Foundation, in which 53 percent of physicians self-identified as employees, compared with 44 percent who did so in 2012.

Although widespread physician employment may foster greater clinical integration, cost efficiency, and enhanced quality of care, the employment shift also has brought challenges, Travis Singleton, a senior vice president for Merritt Hawkins, wrote in a blog post. Challenges include increased turnover, decreased physician productivity, potential financial losses on some acquired physician practices, and a change in the essential character of the medical profession.

Another ongoing trend is the dominance of primary care among sought-after specialties. Primary care clinicians—a group that includes internal medicine, pediatrics, and family medicine—represented 36 percent of all placements in 2015. The next most common placements by specialty were surgical specialties (17 percent), medicine subspecialties (16 percent), and hospitalists (13 percent).

And primary care demand was expected to increase. Farr cited projections of the American Academy of Medical Colleges that there will be a shortage of 31,000 primary care physicians by 2025.

Physician assistants and OB/Gyns rounded out the top five spe­cialists with the greatest placement and hiring activity for 2015. Among specialties within primary care, family practice represented the highest volume of placements in 2015, with internal medicine ranking second.

New Developments

Small but rapidly growing roles were seen for both doctors of osteopathic medicine and non-physician advanced practice providers, for very different reasons.

The share of placed medical school graduates who were DOs increased from 6 percent in 2010 to 12 percent in 2015. The change was driven by an increased acceptance of DOs among healthcare organization leaders, according to Farr.

“I can’t remember the last time we’ve had a client or physician group or anybody push back saying, ‘Oh, I don’t want to take any DOs,’” Farr said.  

Meanwhile non-physician advanced practice provider placements increased to 8 percent of total Medicus placements, up from 1 percent in 2012. Physi­cian assistants were the fourth-most frequently placed provider in 2015, rising from sixth in 2013. Similarly, requested searches for physician assistants by Merritt Hawkins increased from 22 in 2011-12 to 63 in 2014-15.

The increased prominence of physician assistants was driven by the expanded focus of primary care physicians on geriatrics.

“That has produced a gap that needed to be filled for adolescents and younger adults, where we are seeing a need for physician assistants to circle around and fill some of these needs,” Farr said.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Thursday, February 25, 2016