Crunch Time Comes for an Understaffed Specialty

June 08, 2017

The physician recruiting firm Merritt Hawkins tried to fill 193 internal medicine jobs in the 12 months ending March 31, 2017, compared to just 62 positions for pulmonologists.

However, the screaming need was for pulmonologists, according to Merritt Hawkins' annual report on physician recruiting trends. Pulmonologists easily topped the "absolute-demand" list that the company compiled by dividing the number of searches in a given field by the number of those specialists in patient care.

Table. Absolute Demand for Physician Specialties

Specialty Number of Searches* Number of Searches as % of Practitioners in Patient Care
TOP THREE    
Pulmonology 62 1.32
Psychiatry 256 .82
Dermatology 83 .77
     
BOTTOM THREE    
Anesthesiology 43 .11
Nurse practitioner 137 .07
Physician assistant 87 .07
*From April 1, 2016, to March 31, 2017
Source: Merritt Hawkins

The number of searches by Merritt Hawkins for pulmonologists — and physicians in the overlapping specialty of critical-care medicine — has grown by roughly 150% since 2012-2013. The company attributes the white-hot demand to an aging population and a health condition they're at risk for — chronic obstructive pulmonary disease (COPD). Encompassing emphysema and chronic bronchitis, COPD is the third leading cause of death in the United States.

Don't forget other lung diseases that people develop as they age, said Brendan Clark, MD, a member of the training committee of the American Thoracic Society (ATS). "The biggest risk factor for pneumonia is getting older," Dr Clark said in an interview with Medscape Medical News.

Almost 2 decades ago, a research team assembled by the ATS and two other medical societies foresaw how the demand for pulmonologists and critical-care physicians and the supply would be "horribly mismatched" in the future, owing to a graying America, said Dr Clark, an assistant professor in the Division of Pulmonary Sciences and Critical Care Medicine at the University of Colorado-Denver. Their findings were published in the Journal of the American Medical Association in December 2000.

As a result of the supply-demand mismatch, more pulmonary care is delivered by primary-care physicians. Only 30% of patients with COPD, for example, are treated by a pulmonologist, said MeiLan Han, MD, a spokesperson for the American Lung Association and lead author of a study on COPD care in the United States that was published in the Lancet last year.

"They'll Retire Faster Than We'll Replace Them"

If demand for pulmonologists is intense now, it stands to become even more intense in the future, according to Merritt Hawkins. The reason? Not enough young pulmonologists. Seventy-three percent of pulmonologists are 55 years of age or older, and 30% qualify for Medicare, according to demographic data from the American Medical Association that the company cited. No other specialty is as chronologically mature.

"They'll retire faster than we'll replace them," Travis Singleton, the senior vice president of Merritt Hawkins, told Medscape Medical News.

Why is pulmonology and critical-care medicine so top heavy with older physicians? Dr Han, boarded in both specialties, said many medical students today may find other branches of medicine more attractive as they weigh how much compensation their hard work produces. "Pulmonology combined with critical care is incredibly demanding," said Dr Han, an associate professor in the Department of Internal Medicine at the University of Michigan Medical School, Ann Arbor, in an interview with Medscape Medical News.

An age crisis also plagues psychiatrists, who ranked number two on the list of specialists most in absolute demand. Six in 10 psychiatrists are 55 years of age or older, and 27% are at least 65 years old.

For the eleventh straight year, family medicine led all specialties with the most job searches — 607. At the same time, it ranked fourth on Merritt Hawkins' list of absolute demand based on a variety of market forces:

  • Population growth

  • The rise of multidisciplinary teams led by primary-care physicians who coordinate care for defined population groups

  • The affinity of primary-care physicians for alternative and increasingly popular practice models, such as concierge medicine and urgent-care centers

"Five years ago, hospitals said urgent-care centers were an irrelevant part of the delivery system," said Singleton. "Boy, were they wrong."

Follow Robert Lowes on Twitter @LowesRobert

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