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Orthopedics, primary care most requested specialties -- HealthLeadersMedia.com)
The average annual starting compensation for orthopedic surgeons climbed 17.8 percent, settling at $424,385, according to The Delta Companies’ January
Physician Recruiting Standard Survey, a recruiter survey reporting quarterly data about physician searches from the previous 12 months.
Mirroring industrywide trends in recent years, physician shortages played a crucial role in compensation and search-request trends in the survey, says
Marc Bowles, chief marketing officer for The Delta Companies. For example, orthopedic surgery saw a large compensation jump, in part because more physicians training in orthopedics are opting to specialize in higher-paying subspecialty areas, such as hand or hip and joint surgery, exacerbating the shortage of general orthopedic surgeons, Bowles says.
“There are just fewer general orthopedic candidates out there,” he adds. “More physicians coming out of training want to do either a sports fellowship or foot and ankle and really drill into one type of niche within orthopedics.”
Psychiatry, the only specialty to see a larger increase than orthopedic surgery, is also being influenced by physician supply and demand. Psychiatrists earned an average starting salary of $200,757 in 2006, jumping 24.2 percent from 2005, and a total annual compensation of $224,270, according to the report.
“We’ve seen a large influx of psychiatry searches that are inpatient-only placements,” Bowles says. “There are fewer candidates wanting to practice solely in an inpatient setting, so clients have to offer a little more compensation to attract them.”
Growing demand for hospitalists
Despite its large compensation spike, psychiatry was only the 14th most requested specialty, whereas orthopedic surgery climbed the list of most demanded physician-placement searches in the 2007 survey, beating out internal medicine for the top spot. For the second consecutive year, orthopedic surgery, internal medicine, family practice, and cardiology were the four most requested specialties, according to the survey.
One of the most significant changes to the 2007 survey was the rise of hospitalists on the search-demand list. Hospitalists were the sixth most sought-after specialty in 2006, after not even placing in the 15 most requested searches the previous year. The rise in demand for hospitalists is inextricably linked to the shortage of internists and other primary care physicians, Bowles says. With fewer candidates entering internal-medicine training programs and current internists seeking work-life balance and freedom from excessive call coverage, hospitals and practices are having difficulties attracting these physicians.
However, facilities are discovering that they can hire a hospitalist to handle inpatient care, freeing up practicing internists to focus on less demanding, more productive outpatient care, says
Jeff Freeman, president of the permanent placement division at CompHealth, a national physician-recruiting firm based in Utah. “Primary care physicians can be much more productive and efficient by staying in their offices and seeing patients all day, as opposed to taking call and making rounds and admitting patients to the hospital,” he says. “By not taking call and having to go to and from the hospital, primary care doctors have an opportunity to have better work-life balance, which is a request we’re seeing across the board.”
This not only makes an internal-medicine position more appealing to physicians, because they are free from hospital-based responsibilities, but it also provides an attractive alternative for trained internists who find the scheduled shift work of a hospitalist position appealing. Compensation for the two specialties is comparable; internists earned slightly more, bringing in a total annual compensation of $221,076, compared to $213,580 for hospitalists.
A shift to salaries
Growing physician interest in work-life balance also is influencing how facilities pay doctors, as can be seen in the shift from income guarantees to salaried employment arrangements. Today’s physicians prefer to focus on practicing medicine rather than the business aspects of running a practice, and a salary or employment arrangement essentially shifts the business risk from the physician to the hospital, Freeman says.
A standard income guarantee functions much like a loan, with the physician assuming the risk if he or she cannot generate enough revenue to meet the requirements of the guarantee. “Because hospitals are getting better at running the business aspects of practice--more so than they were 10 years ago--they are becoming more willing to assume the risk of a salary in order to attract a physician,” Freeman adds.
Hospital-based physicians were the most likely to receive a salary; 91percent of Delta’s hospital-based placements in 2006 were salaried. Other specialty areas were salaried as follows:
- Medical specialties—83 percent
- Surgical specialties—70 percent
- Primary care—64 percent
“Primary care is a little behind in the salary area, but I would project it [to increase] over the next year,” Freeman says. “We’re already seeing that a lot of the large health systems are now hiring primary care physicians directly and offering an employment option.”
Bowles predicts current shifts toward salaried work and hiring hospitalists to continue as physician shortages and desires for work-life balance influence compensation and physician supply and demand.