The Red-Hot Job Market for Hospitalists Is Translating into Tough Times for Programs
March–April 2006
The law of supply and demand may favor physicians, but programs say they are struggling to keep up with demand.
Its late afternoon one day in early January when Brian Bossard, M.D., picks up the phone to talk to an internal medicine resident about employment opportunities.
What makes the conversation unusual is that Dr. Bossard, founder of Inpatient Physician Associates in Lincoln, Nebr., which employs 14 physicians, is talking about a position that will start in August 2007, or a year and a half away. In addition, he is making an offer to an internist whos not even halfway through her training.
Ive offered [positions] for 2007 to one physician already, and Ill probably do that for another one. You get them almost out of the cradle if you can, says Dr. Bossard with a weary chuckle.
Five years ago, such an approach to physician recruiting might have seemed extreme. In todays red-hot job market for hospitalists, however, it is an example of how programs and recruiters are doing whatever it takes to gain an edge.
A Buyers Market
While Dr. Bossard and others recruiting hospitalists face a buyers market, they say the term doesnt fully convey just how much choice physicians have when looking for work.
Theres been such a proliferation of programs that young doctors have six or seven opportunities, literally, that they can look at, says Dan Fuller, president and cofounder of Atlanta-based In Compass Health. The group staffs hospitalist programs in 27 hospitals, primarily in the Southeast, and contracts with a half-dozen others. If youre a hospitalist with any kind of experience, youre a very hot commodity.
Kurt Mosley, vice president of business development for the national physician-recruiting firm Merritt Hawkins & Associates in Irving, Tex., agrees that physicians are calling the shots. If a hospitalist doesnt have a malpractice issue, he says, There is no such thing in America right now as an unemployed hospitalist. Theyre in that much demand.
Pinpointing Demand
Five years ago, it was relatively easy to identify the sources of demand for hospitalists. In 2001 and 2002, for example, a major growth spurt in the number of hospitalist programs was fueled by hospitals that were building new programs themselves or contracting with companies to create them.
David Joyce, president and CEO of the physician staffing firm Delphi Healthcare Partners in Raleigh, N.C., says that the sheer volume of new or revamped hospitalist services is largely responsible for the current recruiting crunch. He likens it to the 1970s, when recruiters were helping staff new emergency medicine programs.
The demand for hospitalists now is almost insatiable because of the number of hospitals that have put in programs in the last few years, Mr. Joyce says.
Bidding Wars on the Horizon?
That pressure is only exacerbated at programs that have internal problems or inherent flaws, according to Martin Buser, M.P.H., a founding partner of the national consulting firm Hospitalist Management Resources LLC.
We come across groups all the time that say theyve been advertising for a year and have barely gotten a nibble, Mr. Buser says. They ask: Whats wrong with me? Often, the problem is that theyre not externally competitive.
One chief problem, he explains, is that physicians already working for the group earn lower salaries than their peers. When the group puts that in the market, no one responds, explains Mr. Buser, whose firm consults in program development and restructuring.
How much are hospitalists earning? All experts interviewed for this story agreed that salaries have risen significantly in the last two years. Informal estimates put hospitalist salaries in the $165,000 to $180,000 (or slightly higher) range in non-academic programs, a jump of $10,000 to $15,000 from just a few years ago.
Mr. Mosley adds that in some markets, hospitalists are earning $20,000 to $30,000 more than their office-based-practice counterparts.
Looking Beyond Pay
Some hospitalists might respond to the siren call of a big paycheck, but more experienced physicians are learning that their clout in the marketplace can command better working conditions.
Mr. Buser acknowledges that a poor salary package is only one problem that can raise a red flag among market-savvy hospitalists. Hospitalists are also on the lookout for unreasonable workloads, poor leadership, and high turnover, he says, and they are increasingly concerned about hospitalist programs footing in the hospital. Hospitalists are asking about groups contracts, as well as the funding and support they receive from the administration.
If youre a hospitalist looking for a job right now, you probably have five to 10 offers, he explains. Why would you take a position with a group that isnt solid or a program thats not well supported by the hospital?
In addition, hospitalists who have heard horror stories from colleagues about insufficient specialist backup are increasingly looking for evidence that theres a good ER backup panel, Mr. Buser says. No one wants to be left hanging out there when they need help, he notes.
Finally, hospitalists with a few years of experience are increasingly eschewing not only programs that are reputed to have problems, but startups in general. Many hospitalists whove been involved with new programs are saying No thanks, Id rather plug in to an existing one, Mr. Buser says.
Deal-Breakers and Deal-Makers
Hospitalists have so much leverage when it comes to job-hunting that what they view as deal-makers and -breakers might surprise program heads and hospital administrators.
All other things being relatively equal, Mr. Mosley notes, hospitalists opt for programs offering high-tech features like wireless access to patient information, test results, or pharmacy. Voice-activated transcribing is another must-have on some hospitalists list.
Thats becoming one of the new negotiating points for hospitalists: Who can provide the most wireless features, and who will pay for my BlackBerry? Mr. Mosley says.
Parking convenience may not seem like an important consideration, but its lack has prompted some physicians to jump ship. It may sound strange, Mr. Mosley acknowledges, But I have heard of a few hospitals that have lost their hospitalists to a competitor because of parking hassles.
No Relief in Sight
Because every bubble must eventually burst, some hospitalist programs may be looking forward to the day that supply begins to meet demand. When asked whether any relief was on the horizon, however, everyone interviewed for this article replied with a resounding no.
I dont see any relief valve, says Dr. Bossard. Internal medicine is not adding folks to the residency programs and traditional internal medicine is having a hard time recruiting. I see the shortage continuing.
Source: Bonnie Darves, the author, is a freelance writer specializing in health care. She is based in Lake Oswego, Ore. This article was adapted from the February 2006 issue of Todays Hospitalist magazine. The complete version of this article is available online at www.todayshospitalist.com.
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