Specialists More Sought After Than Primary Care Doctors, Report Shows

Kenneth J. Terry, MA

July 08, 2019

Recruiting of medical specialists is up, while searches for primary care physicians are down, according to the latest data from Merritt Hawkins, a leading physician search firm.

Starting salaries are reflected in this demand, with the report showing the highest salaries going to invasive cardiologists, and among the lowest to family physicians and pediatricians.

In a review of 3131 recruiting engagements for physician and advanced practitioners conducted from April 1, 2018 to March 31, 2019, Merritt Hawkins found that 78% of its searches were for medical specialists, up from 67% 4 years ago.

By contrast, the number of searches the firm conducted for primary care physicians (family physicians, internists, and pediatricians) declined by 8% year-over-year and by 38% compared with 4 years ago.

On the other hand, family medicine topped the list of Merritt Hawkins' most requested specialties for the 13th year in a row.

"While demand remains strong for primary care physicians, specialists are increasingly needed to care for an older and sicker population," said Travis Singleton, executive vice president of Merritt Hawkins, in a news release. "In some medical specialties, shortages are emerging that will pose a serious challenge to public health."

These shortages were especially acute in psychiatry, which was the second most in-demand specialty, the report shows. However, the number of psychiatric searches in 2018/2019 dropped 18% from the previous year.

Pediatricians were also in strong demand, perhaps because of the increasing domination of the field by women, who see 12% fewer patients per day than men, on average, the report noted. The number of pediatrician searches grew 35% from the prior year.

In nonprimary care specialties, the biggest increases in searches were for obstetrics/gynecologists, anesthesiologists, and internal medicine subspecialties such as neurology, cardiology, pulmonology, urology, and hematology/oncology. The researchers also noted looming shortages in both infectious disease specialists and gerontologists.

Searches declined for gastroenterologists and orthopedic surgeons.

More than 90% of searches were for employed physicians, as fewer hospitals set up physicians in independent practices. Two thirds of the searches occurred in communities of 100,000 people or more, a record high.

The percentage of all recruiting assignments that came from hospitals dropped to 34% from 40% the previous year and 64% in 2013/2014. Searches by physician groups comprised 28% of the whole, about the same as in the previous 2 years, but markedly higher than the 13% recorded in 2013/2014.

The drop-off in hospital searches is noteworthy considering the huge consolidation between hospitals and physicians in the past decade. "This decrease is due in part to the periodic pendulum swings that are commonly observed in physician recruiting, in which healthcare organizations will focus on particular specialties such as primary care during a given number of years," the report noted. "Having addressed priorities in that area, they will move on to recruiting other types of physicians for whom demand has built."

Another reason for the decline in primary care hiring, Merritt Hawkins' researchers theorized, is that some patients are turning away from the traditional primary care model. According to a Health Care Cost Institute report cited by Merritt Hawkins, visits to primary care physicians dropped by 18% between 2012 and 2016.

Meanwhile, retail clinics and urgent care clinics were growing rapidly, providing alternatives for people who needed acute care.

Shifts in Compensation Packages

The highest increases in average offered salaries went to urologists (20.2%), invasive cardiologists (9.8%), anesthesiologists (8.9%), and emergency medicine specialists (8.5%). The whopping raise for urologists, however, just brought them back to where they were in 2016/2017, after an unexplained drop-off the following year.

The biggest average offered salaries went to invasive cardiologists ($648,000), orthopedic surgeons ($536,000), gastroenterologists ($495,000), noninvasive cardiologists ($441,000), urologists ($464,000), dermatologists ($420,000), anesthesiologists ($404,000), and otolaryngologists ($402,000).

The average salary offered to family physicians dipped slightly to $239,000, and pediatricians surpassed family physicians with a 5.2% raise to $242,000. Pediatricians — traditionally one of the lowest earning specialists — came up just behind general internists, who were offered an average salary of $264,000, only 1.2% above the previous year's offer.

Regional breakdowns for the five most requested specialties show offered salaries were highest in the Southeast, followed by the Southwest and Midwest. For three of the top five specialties — family practice, internal medicine, and radiology — salaries were slightly higher in physician groups than in hospitals.

Seventy percent of the offers in 2018/2019 were for salary with bonus, with an average signing bonus of $32,692 offered to physicians. In 56% of the offers that included bonuses, quality scores were factored in, up from 43% in 2017/2018 and 24% in 2013/2014. On average, physicians had 11% of their income tied to quality in 2018/2019 compared with 8% the year before.

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