Primary Care Survey Reveals Physician Incomes/Satisfaction
September–October 2006
The past 10 years have seen dramatic fluctuations in the role primary care physicians play in health care delivery, changes that are reflected in the physician recruiting market.
For much of the 1990s, primary care physicians were at the top of the physician recruiting “food chain,” as hospitals, health systems, practice management organizations, and others sought to snatch up the primary care physician gatekeepers needed to implement managed care boom. Indeed, in 1996, 76% of the physician search assignments Merritt, Hawkins & Associates represented were for primary care physicians (i.e., family practitioners, general internists, and general pediatricians).
The pendulum soon swung back to physician specialists, however, as managed care largely fizzled. By 2005, 85% of the search assignments Merritt, Hawkins conducted were for medical specialists. This reversal of fortune left many primary care physicians feeling insecure about their role in the medical hierarchy, with some observers branding primary care doctors as dinosaurs soon to be replaced — by specialists on the high end of health care delivery and by allied health care professionals on the low end.
In order to gauge the career satisfaction, income levels, and job prospects of primary care physicians, Merritt, Hawkins & Associates was asked by Physicians Practice, a national practice management magazine for doctors, to conduct a survey. The survey was mailed to 10,000 primary care physicians earlier this year, and 508 responses were received. Approximately 46% of the responses were from family practitioners, 28% from general internists, and 24% from pediatricians (the remainder did not indicate a specialty or indicated a specialty other than these three).
The responses paint a somewhat mixed picture of primary care practice and should be of particular interest to physician recruiters.
Still Alive and Well
Rumors about the demise of primary care physicians seem to be premature. Approximately 30% of those surveyed indicated they are “too busy,” while 57% said they are “as busy as they want to be.” It appears that despite losing some responsibilities to specialists and allied professionals, primary care physicians still have plenty of patients.
In addition, many primary care physicians are fielding a significant number of contacts from recruiters. Approximately 56% of family practitioners and general internists said they receive four or more contacts from recruiters per month in the form of letters, phone calls, and e-mails. Pediatricians receive fewer solicitations from recruiters, with only about 25% indicating they receive four or more recruiter contacts per month.
The majority of physicians surveyed have not seen recruitment activity decline in the past two years. Approximately 76% of physicians said that compared to two years ago the frequency with which they are being recruited has either increased or stayed the same, while about 24% indicated that the frequency with which they are being recruited has declined. However, the survey shows pediatricians perceive less recruitment activity aimed their way than do family practitioners and internists.
These responses are in line with Merritt, Hawkins’ recruiting experience in which we have observed a significant increase in requests for family practitioners and internists in the past two years, but declining requests for pediatricians. Our perception of the primary care recruiting market is that it has rebounded strongly due to a declining number of residents entering the field, a rising number of physicians exiting, and the enhanced demand generated by a growing and aging population. We believe this is a long-term trend and that, despite some prognostications, primary care physicians will enjoy a robust job market for the foreseeable future.
Income a Sore Point
While many primary care physicians are busy and have multiple employment options, they are not necessarily satisfied with their incomes. More than half of those surveyed indicated that, given their level of effort and time, they find their incomes to be “disappointing.” (See Market Watch.)
Internists in particular appear to be dissatisfied with their incomes, suggesting that they may be open to practice opportunities offering a high level of income potential. Over one-third of physicians surveyed said they earn $125,000 or less a year, well below the average income offers we see for family physicians, internists, and pediatricians.
In addition, approximately half of the physicians surveyed indicated that overhead in their practices runs at 51% or more, while over one-third said they will not be able to sustain overhead or doubt they can sustain it over the next five years. This suggests that recruiters should stress the efficiency of the practice settings they represent, if appropriate, touting overhead rates of less than 50% while emphasizing the practices’ long-term financial viability.
The survey also reflects a general sense of dissatisfaction among primary care physicians regarding their place in the medical hierarchy. Less than 20% of primary care physicians surveyed see themselves as “equal partners” with surgical and diagnostic specialists. Close to 80% see themselves as either “junior partners” or “second-class citizens” in the medical hierarchy compared to surgical and diagnostic specialists. Practice opportunities that offer primary care physicians medical directorships or other leadership roles may be one way to appeal to primary care physicians who feel their roles are underappreciated.
Even though they feel they are at the lower end of the medical hierarchy, more primary physicians (35.1%) believe that primary care will increase in importance over the next five to ten years than believe it will decrease in importance (29%).
Satisfaction Mixed
The majority of primary care physicians surveyed (about 68%) indicated they are either “very satisfied” or at least “somewhat satisfied” with their careers, while less than 10% indicated they are “very dissatisfied.”
Reflecting the somewhat contradictory nature of responses, however, the majority of physicians also said that if they had their education and training to do over again, they would either not choose medicine or they would not choose primary care. Forty-six percent (46%) of internists indicated they would not choose primary care again and 30.1% said they would not choose medicine, while only 23.2% said they would stay in primary care. By contrast, 41% of family physicians said they would stay in primary care if they could complete their training again. Though pediatricians seem to be at the bottom of the recruiting pecking order, they appear to be relatively happy practicing primary care. Close to 47% of pediatricians indicated they would remain in primary care if they could complete their training again.
Ominously, close to 50% of physicians surveyed indicated they would retire today if they had the financial means to do so. Many physicians, both primary care doctors and specialists, approach Merritt, Hawkins about non-clinical jobs in an effort to escape the stresses of patient care. This offers opportunities to recruiters who represent efficient, low-stress settings, but such defections from medicine also are likely to reduce the overall pool of physician candidates in the future.
Source: Philip Miller is vice president of communications
for physician recruiting firm Merritt, Hawkins & Associates,
a division of AMN Healthcare. He can be reached at
pmiller@mhagroup.com. For complete survey results,
visit www.merritthawkins.com.
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