By Michael P. Broxterman and Terry Lane
Recently, the National Association of Physician Recruiters conducted a survey asking recruiting firms what they thought of the current employment climate in healthcare. Forty-one responses were received and the results are shown below. Survey results were tabulated separately for contingency firms and retained firms, however, where similar, results were combined. Surveys of this kind are important to both recruiters and physicians—physician’s may be interested in knowing which specialties are growing, which opportunities are typically placed through recruiters, and which specialties may become saturated in the coming years—while recruiters use survey results as important indicators as to what tools are working, where placements are being made, where success has been found, and where the majority of their business is coming from.
Most Active Specialties
Most active specialties are those with the highest need for physicians. This may be because the specialty is growing faster than new physicians become available, because there is a high turnover in this specialty, or simply because of the large number of family physicians in the market. Recruiters naturally find a higher volume of business in the larger specialties. The following survey results indicate that while the volume remains the highest for primary care, specialties are continuing to increase.
| Family Practice | € € € € € € € € € € € € € € € € € € € |
| Internal Medicine | € € € € € € € € € € € € € € € € |
| Orthopedics | € € € € € € € € € € € € € |
| Ob/Gyn | € € € € € € € € € € € € |
| General Surgery | € € € € € € € € |
| Radiology | € € € € € € € € |
Most Difficult Specialties to Fill
Some specialties are difficult to fill, and the reasons why vary. In most cases, it is a problem of supply vs. demand—a limited number of physicians are available. There may be difficulty in placing them in a less desirable area or we may simply not be reaching them or communicating with them as well as we could be. Whatever the reason, certain specialties are more difficult to fill because enough doctors are not available. Surveys such as this one hopes to find answers to some of these questions. Note that the specialties listed below are low in number of available physicians and none are primary care, except for orthopedic surgery.
| Cardiology | € € € € € € € € € € € € € € € |
| Radiology | € € € € € € € € € € € € |
| Emergency Medicine | € € € € € € € |
| Pediatric Critical Care | € € € € € € € |
| Nephrology | € € € € € € € |
| Obstetrics/Gynecology | € € € € € € € |
| Gastroenterology | € € € € € € |
| Anesthesia | € € € € € € |
| Oncology | € € € € € |
| Urology | € € € € € |
| Orthopedic Surgery | € € € € |
| Dermatology | € € € |
Salaries
While most salary surveys provide data reported by physicians, the salary ranges below are those reported by recruiters. Typically, an asking price is a starting point which can increase according to experience. Normally, physicians ask for a lower salary than they could actually get. For example, a starting salary for a Neurosurgeon is $195,000, but some Neurosurgeons earn $500,000 per year. Salary results have been combined for contingency and retained firms.
| In thousands per year | <100 | 125 | 150 | 175 | 200 | 225 | 250 | 275 | 300 | 325 | 350 | 375+ |
| Trauma Surgeon | 300 | |||||||||||
| Orthopedic/Spine | 250 | 350 | ||||||||||
| Cardiac Surgery | 250 | 275 | ||||||||||
| Ped. Critical Care | 220 | |||||||||||
| Radiology | 200 | 300 | ||||||||||
| Anesthesia | 200 | 300 | ||||||||||
| Orth. Surgery | 200 | 300 | ||||||||||
| Orthopedics | 200 | 300 | ||||||||||
| ENT | 200 | 250 | ||||||||||
| Thoracic Surgery | 200 | 225 | ||||||||||
| Vascular Surgery | 200 | |||||||||||
| Child Psychiatry | 200 | |||||||||||
| Neurosurgery | 195 | 300 | ||||||||||
| Gastroenterology | 180 | 280 | ||||||||||
| Nephrology | 180 | 200 | ||||||||||
| Neurology | 180 | 200 | ||||||||||
| Urology | 175 | 270 | ||||||||||
| Pulmonary | 175 | 200 | ||||||||||
| Dermatology | 170 | 250 | ||||||||||
| Cardiology | 150 | 350 | ||||||||||
| Oncology | 150 | 225 | ||||||||||
| Psychiatry | 150 | |||||||||||
| Hematology | 150 | |||||||||||
| GI | 140 | 300 | ||||||||||
| Ob/Gyn | 140 | 200 | ||||||||||
| Endocrinology | 135 | 150 | ||||||||||
| Emergency Med. | 120 | 250 | ||||||||||
| Internal Med. | 120 | 150 | ||||||||||
| Pediatrics | 120 | 150 | ||||||||||
| Hospitalist | 120 | 135 | ||||||||||
| Family Practice | 115 | 135 | ||||||||||
| CRNA | 100 |
Recruiter’s Most Frequently Used Methods of Communication
The following survey results indicate that search firms are relying more on the Internet and technology than other forms of communication.
| Internet | 8 8 8 8 8 8 8 8 8 8 8 8 |
| Advertisements | * * * * * * * * * * * |
| Network Database Services | < < < < < < < < < < |
| Phone Residency Programs | ( ( ( ( ( ( ( ( ( ( |
| NAPR Mailings | * * * * * * * * * * |
| AMA-approved Direct Mail | * * * * * * |
| Cold Calls | ( ( ( ( ( |
| Attendance at Meetings | € € € |
| Phone Professional Societies | ( ( ( |
| Non-AMA-approved Direct Mail | * * * |
Where Recruiters Advertise
While retained firms tend to use more paid advertising than contingency firms, it is important to note that all firms advertise most in general publications which represent all specialties, or in publications which target specific physician populations.
| Publication | Search Firms |
| NEJM | ||||||||||||||||||||||||||||||||||||||||||||||||||||| 53% |
| JAMA | ||||||||||||||||||||||||||||||||||||||||| 41% |
| Amer. Acad. FP | ||||||||||||||||||||||||||||| 29% |
| Annals of Int. Med. | ||||||||||||||||||||||||||||| 29% |
| State J. Med. | ||||||||||||||||||||||||||| 27% |
| Cont. Ob/Gyn | |||||||||||||||||||||||| 24% |
| Annals of Em. C. | |||||||||||||||||||||||| 24% |
| Family Physician | |||||||||||||||||||| 20% |
| Med. Tribune | ||||||||| 9% |
Where are Placements being Made?
Private practice and residents are still in the lead when it comes to making placements for both contingency and retained firms. Interestingly, while contingency firms place physicians in academic only 1% of the time, retained firms reported a 13% placement average in this category. It is important to note that results may be skewed based upon number of respondents. Most recruiters working for retained firms would probably say this figure should be lower.
| Type | Search Firms |
| Private Practice | ||||||||||||||||||||||||||||||||||||| 37% |
| Residents | |||||||||||||||||||||||||||||| 30% |
| Employed Physicians | |||||||||||||||||| 18% |
| Academic | ||||||| 7% |
| Military | ||| 3% |
| Administrative | | 1% |
| = 1
While US medical graduates still account for the highest number of physicians placed in the United States, foreign medical graduate placements are increasing due to the shortage of US graduates available each year. The number of foreign medical graduates placed is expected to rise in the future, but because of recent legislation, which is trying to limit the number of foreign graduates entering in the country, that may change.
| Type | Search Firms |
| US Medical Grad | € € € € € € € € € € € € € € € 75% |
| Foreign Medical Grad | € € € € € 24% |
| Canadian | 2.5% |
€ = 5
Both contingency and retained firms returned similar results when asked where physicians are most often placed. Roughly two-thirds of all physicians are placed out-of-state, and are distributed evenly among towns and cities of various sizes and populations. This is important to note because often it is assumed that physicians are placed in small and large cities more regularly than in rural areas, but the statistics show that this is assumption is not true. In actuality, search firms are often hired for the more difficult searches/placements, especially for opportunities in rural areas.
| Geography | Search Firms |
| Out of State | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| 71.1% |
| Same State | ||||||||||||||||||||||||||||| 28.7% |
| Sm. Town/Rural | € € € € € € € € € € € € € € € € 33% |
| Med. Town | € € € € € € € € € € € € 24.4% |
| Lg. Town/Sm. City | € € € € € € € € € € € 22.5% |
| Urban/Lg. City | € € € € € € € € € € 20.2% |
Sm. Town/Rural pop. 1-50k; Med. Town pop. 50-150k; Lg. Town/Sm. City pop. 150-500k; Urban/Lg. City pop. 500k+
€ = 2% | = 1%
Perceived Market Saturation
While the following statistics are not a true indicator of saturation in the market, responses from recruiters may reveal when there is a lower demand for a specific specialist. Demand for physicians is high across the board, the specialties listed here are simply in less demand than others. One problem, when discussing saturation, is that it is region-dependent, and while some areas may be found to be underserved for a particular specialty, that same specialty market may be saturated in another area. Our results seem to indicate recruiters naturally see a higher number of the primary care physicians because the number of physicians in these specialties are higher. This may or may not indicate a trend toward market saturation.
| Specialty | Search Firms |
| Internal Medicine | € € € € € € € € € € € € 24.62% |
| Family Practitioner | € € € € € € € € € 18.5% |
| Pediatrician | € € € € € € € € € € 21.4% |
| Ob/Gyn | € € € € 7.7% |
| Cardiovascular | € € € 6.25% |
| FMG/Internal Med. | € 3% |
| Surgical Specialty | 1.5% |
| FMG | 1.5% |
| Radiology | 1.5% |
€ = 2%
The Future of Technology in Recruiting
The following statistics show combined results for contingency and retained recruiters/firms, and confirm that technology has changed the way recruiters do business. Ninety-five percent of recruiters surveyed have, or are currently building, websites. Clearly, a web presence is essential for today’s recruiter to be competitive and successful. While placements are not solely made through the Internet, 90% of all recruiters depend on the Internet to utilize email, and 97% feel this has improved their ability to recruit. Based upon the results, it would be reasonable to claim that the Internet has affected the recruiting industry more than any other technology in the past ten years.
| YES | NO | |
| Do you have (or are you building) a website? | 95.12% | 4.8% |
| Do you make placements solely through the Internet? | 9.75% | 90.24% |
| Do you use Email to make placements? | 90.24% | 9.75% |
| Has email improved your ability to recruit? | 97.5% | 2.43% |
| Is the Internet “critical” to the future of physician recruiting? | 89.74% | 10.25% |
| Has technology made it less difficult to place physicians? | 85% | 15% |
| Do you think the number of recruiting firms will increase over the next five years? | 25% | 75% |
Concerns about Physician Recruiting
Perhaps the most surprising result of the survey concerned the answers received to this question: “What is your biggest concern regarding the field of physician recruiting?” An overwhelming amount (1/3) of respondents named ethics as their primary concern. Other concerns included physician shortages, lower fees, and less business.
| Concern | Response |
| 1. Lack of Ethics Said one respondent: “my primary concern is lack of integrity and honesty in the industry—many recruiters have no idea how to recruit.” Another answered: “Quality of recruiters. Too many non-professional, fly-by-night recruiters. There is a definite knowledge gap among recruiters, and our industry as a whole does not have a good reputation with physicians.” One respondent explained: “…very large firms send out CVs without proper screening to hospitals and medical groups who accept unsolicited calls.” | The NAPR was founded to bring together recruiting firms in a cooperative effort to agree on best practices, make sure recruiters worked in an honest and ethical manner, and provide ongoing collaboration in order to promote the industry and improve performance. All NAPR meetings are interactive and highly reflective of training. Meeting topics may include legal and discrimination issues and laws; interviewing and closing techniques; appropriate handling of CVs; and follow-up methods. The NAPR is helping to improve the industry’s reputation by implementing a PR campaign describing its many programs and benefits. |
| 4. Physician Shortage Respondents said there is a definite lack of US medical graduates. “Doctor shortage,” “ability to find qualified doctors,” lack of qualified candidates in Endocrinology,” and “aging physicians retiring,” spoke of the broad-based concern that good physicians will become hard to find in the future. “Physicians are more mobile and are less apt to honor their commitments – it is too easy for them to find a new position.” | It is true that there are many aging physicians now, many are retiring earlier, and fewer physicians are graduating each year. This appears to be a trend, especially where U.S. medical graduates are concerned. Ironically, recruiting business increases when there is a shortage of physicians. They are harder to find, so more resources are needed to locate and place them. As one recruiter said, “when there is a physician shortage, business is good.” |
In summation, most recruiters agree that ethics, physician shortages, and new technology are the hot issues in the recruiting industry today. Physicians will benefit from the knowledge of recruitment trends, trends in their specialty of choice, and the increased standards put in place by NAPR member firms. The NAPR will continue to focus on the issues that most effect the recruiting industry, as technology and a quickly changing world continue to present new challenges to us all.