Compensation Survey:

* Based on median compensation and/or base salary for 30,000 surveyed doctors as well as, actual placements and physician searches for 155 healthcare groups between 2011 and 2012, covering 42 specialties and 20 states.

Compensation trends. The shift towards the employment model has become evident. With the recent changes in the industry, employment is now preferred by both physicians and healthcare organizations. Nearly all of the practice opportunities represented by Pinnacle Health Group offered employment arrangements. Income guarantee loans and other related compensation structures played very little, to no role in physician recruitment. The most common method of measuring productivity and incentives is wRVU (work relative value units) production along with guaranteed base salary. Due to physician shortages, facilities are providing higher signing bonuses, loan repayments, relocation expenses, health coverage and other incentives. New graduates are also offered stipends.

New ancillary services. Because cost cutting is of ever increasing importance, setting up new ancillary services is uncommon in today’s market. Although new ancillary services depend on a physician’s specialty, the more prevalent ones today include in-house laboratories and imaging capabilities.

Recruitment Incentives. Healthcare facilities offer the following incentives to recruit their preferred physicians (in no particular order): (1) sign-on bonuses and higher base guarantees, (2) performance incentives (3) clinical and non-clinical program development stipends and student loan repayments.

Difficult specialties to recruit. While the market is highly competitive for all specialties, those with a larger pool of candidates are considered slightly easier to recruit. Specialties with a lower number of trained physicians are obviously more difficult to recruit.  These specialties include (in no particular order): Urology, Pulmonary Critical Care, Otolaryngology, Dermatology and Primary Care (Internal Medicine and Family Practice).

To read or view the full version of Pinnacle Health Group’s compensation survey, or for comments, suggestions and queries, email us at info@phg.com or jestialbo@phg.com for John Andrew Estialbo and mbroxterman@phg.com for COO Michael P. Broxterman, or call us through 1-800-789-6684 (main) or 404-816-8831 (local).

The Action: Pinnacle Health Group understands that physicians respond to sourcing campaigns in different ways. We are always ready for any recruiting challenge! We utilize every sourcing channel—from internet sourcing, to direct mail and e-mail campaigns. We take a proactive approach to ensure a perfect hospital-physician match. To identify a candidate for this opportunity, Pinnacle implemented direct mail and online sourcing. The physiatrist we were looking for responded to our direct mail campaign.

The Result: Pinnacle Health Group presented the ideal physiatrist candidate who has clinical interest and experience in interventional medicine, pain management and general rehabilitation, and the doctor was hired by the facility. The physician wanted to work in a facility that’s within a three-hour drive from their family and the directorship opportunity and compensation structure was appealing. In addition, Pinnacle and the facility helped the physician’s spouse find employment in a nearby area. With a proactive approach and an outstanding collaborative effort, Pinnacle has once again exceeded both client and physician expectations!

If you are interested in our recruiting services please contact Mike Broxterman, Chief Operating Officer, at 1-800-492-7771 or send him an email.

Exclusive arrangements present as an attractive arrangement for many healthcare facilities because the agreement is perceived as having less financial risk, since the recruiter is only recompensed upon the placement of physician. Many facilities also see exclusive arrangements as a more targeted approach when recruiting physicians.

While many administrators or in-house recruiters may find exclusive arrangements to be the most convenient way to recruit physicians, certain factors should be considered. Why?

There is an increased likelihood of paying more than you should, even when given more options. However, exclusive arrangements between recruiters and healthcare organizations have an increased risk of doing the opposite.  For example, recruiters can choose not to work hard but still get paid, even if the facility finds the candidate themselves. The financial responsibility of the facility to the recruiter is the same and expenses can still be incurred regardless of the result.

In one of Pinnacle Health Group’s previous surveys on exclusive physician search agreements, an administrator commented, “For the past year, I have had an exclusive arrangement to place six specialty positions and have not filled one. We ended up hiring a candidate I found on my own, but we still paid because it was an exclusive agreement.” Another said, “Before I joined the group as the administrator, they were spending money with an exclusive firm. I am willing to pay for results, but I saw no benefit from the exclusive arrangement. I am now very comfortable devoting the time and energy required managing our search, and we work with other firms and cold call on my own.”

Facilities sometimes do not realize that they’re often doing the recruiter’s job. Candidate and CV referrals placements are very easy for many in-house or even outside firms. Since exclusive agreements do not necessarily entail these types of placements, it does not financially make sense to spend that much effort—as long as the physician is placed. Clearly, physician recruitment is more than just referring the physician candidate to the facility. Proactive recruiters take into consideration the compensation structure, candidate parameters, community profile, office culture and politics, and helping the physician transition to the new community.

An in-house recruiter remarked on our survey, “Exclusive arrangements can circumvent the fact that candidates can come from nowhere, or worse, from another resource or recruiter. What if the physician was the one who found the job? Are we obligated to pay the agreement? We need stronger or more definitive guarantees from exclusive firms. If placement is not made in a defined period of time, then the agreement should be renegotiated.

Exclusive arrangements can prevent facilities from reaping the advantages of competition. It is in the facility’s best interest to create a sense of competition.  While the bulk of expenses should be paid upon placement of the physician, hospitals should always motivate and incentivize the recruiter towards your ultimate goal, which is placement.

Today’s tightly competitive marketplace cannot guarantee results, particularly in a market where physician supply and candidate pool is very low. Where the placement comes from is difficult to control because the market is fragmented and candidates are few and far between. There are a majority of cases with exclusive arrangements where the most profit is generated at the expense of taking out the spirit of competition.  While many healthcare organizations don’t realize this, it is very common for recruiters to cross paths when implementing their sourcing process. It creates a complicated situation for facilities where two or more recruiters end up finding the same physician candidate, or when another recruiter ends up presenting the candidate to the employer first.

In most situations, exclusive arrangements don’t necessarily entail ‘exclusive.’ Many recruiters work on a volume-driven, availability-oriented process rather than specific physician need, and so it is commonplace for many recruiters to have the same exclusive arrangements being managed concurrently. In most cases, there is an increased probability that these recruiters would just send a CV or refer physician candidates to these facilities at the same time, based on the geographic preferences of the doctor where there’s more chance that the employer may hire them. This can create difficulties for the employer if the physician candidate does not meet the position’s requirements or chooses a competing facility to work in, such as increasing the placement timetable of the employer, or wasting employer resources.

Final considerations. Healthcare organizations should certainly take into consideration the disadvantages of signing exclusive arrangements with recruiters before signing one. Though a majority of difficulties can arise from the agreement, there are circumstances where exclusive arrangements are effective. The key is to determine the fine points of the facility’s physician need before working with physician recruiters and signing exclusive agreements.

Atlanta, GA, April 2012

The NRHA reviews and recommends candidates for the Corporate Partners program that have a proven track record of meeting the needs of rural health care providers.

As a full service placement firm with the motto, “we help bring healthcare to communities that need it,” PHG understands the unique challenges facing rural hospitals, clinics, physicians and mid-level providers.

Quincy Medical Group offers a variety of multiple-specialty healthcare services, including affiliated rural clinics throughout Western Illinois and Northeast Missouri regions. Jan Chaney, the Senior Director, Physician Recruitment and Retention for Quincy Medical Group said, “Pinnacle Health Group effectively utilized a targeted regional approach to assist us in placing the right physician for our facility in Mt. Sterling, IL. It takes someone who understands the unique dynamics of the rural market to really be effective in locating and placing the right healthcare provider.” Quincy Medical Group is just one of the rural healthcare providers served by PHG.

As a gold level partner, PHG has been invited to exhibit at the 35th Annual Rural Health Conference to be held in Denver, CO on April 17-18, 2012.

The Action: The biggest challenge for Pinnacle Health Group is to attract the right physician candidates with very minimal to sourcing campaign as well as board certification and AMG requirements. Pinnacle partnered with this Missouri-based hospital and conducted a consultative approach to their physician search to ensure the perfect doctor would be placed at the facility.

Pinnacle Health Group was able to capitalize on its efforts by finding the right practice with the right location. Pinnacle was able to present a pediatrician who has family ties with the area. His wife’s sister lived near the community and they wanted to move closer to her.

The Result: After a second facility and site visit, the physician signed on to become one of their pediatricians. With great communication, attention to detail, and an outstanding collaborative effort, Pinnacle has once again exceeded both client and physician expectations!

Ten valuable reasons why a health care organization must offer non-clinical education:

1. Create work-life balance. In a 2006 industry survey, 63% of medical residents said the availability of free time was causing them “a significant level of concern” as they entered the profession, up from 15% in 2001.
2. Leverage clinical skills with non-clinical training. A Dale Carnegie study revealed that 85% of success is dependent on self-management and interpersonal skills, while 15% is dependent on technical skills. This doesn’t mean that clinical training can be neglected, but the best clinical skills and knowledge doesn’t mean much if self-management and interpersonal skills are lacking.
3. Improve well-being. As of January of 2001, The Joint Commission requires health care organizations have a process in place to address physicians’ well-being. Topics such as stress control, work-life balance and time management, just to mention a few, are excellent non-clinical topics that help maximize performance while addressing personal well-being.
4. Keep pace with a constantly changing health care environment. Just like a skyscraper has a stronger foundation than a small private home, a health care provider has to have a strong personal foundation to weather the storm and changes in health care. Investing time in personal development is the foundation for professional success and personal well-being.
5. Decrease malpractice risk. Continuing education in communication and relationship building decreases the risk of medical malpractice. Studies have shown that patients are far less likely to sue a physician with whom they have a good relationship.
6. Strengthen teamwork. As the American health care system moves away from the old standard of a single doctor handling a patient’s needs towards a more team-based approach, continuing education on strengthening effective communication, teamwork and self-management is essential. A team is only as strong as its weakest link. By investing in the cooperation between staff, nurses and physicians, medical errors decrease and job satisfaction increases.
7. Prevent early retirement. Healthcare providers who possess the tools to prevent burnout and who enjoy a rewarding personal life outside of work are far less likely leave medicine prematurely. They have the energy to enjoy their life while continuing their profession.
8. Bolster job satisfaction. Health care providers who are working in a harmonious environment with effective teamwork and cooperation enjoy increased job satisfaction which in turn decreases staff turnover and its expenses.
9. Limit disruptive behavior. Disruptive behavior causes stress, anxiety, frustration and anger, which can impede communication and collaboration, resulting in avoidable medical errors, adverse events, and other compromises in quality care. Health care organizations can integrate preventative training and education for stress control, communication skills and teamwork to reinforce appropriate standards of behavior.
10. Prevention is the best medicine. Problems, obstacles, and bumps in the road are part of life. Without the skills needed to respond to them, they can be more difficult. Individuals who are dedicated to their personal development deal more effectively with problems and recognize options to turn problems into opportunities.

The old way of practicing medicine is shifting toward a new paradigm. Investing in the personal growth and interpersonal skills of health care professionals will accelerate the change process and results in more effective and successful health care organizations.

Iris Grimm is the creator of the Balanced Physician coaching and training programs designed to improve physicians’ leadership, performance, and work-life balance. She can be reached at 770-428-2334 or at www.BalancedPhysician.com.

According to Pinnacle Health Group Vice President of Training and Recruiting, Craig Fowler, the choice to skip these residencies is hindering these physicians in their practice options. “Whether their motivation for skipping these ACGME residencies is due to limited residency slots or the doctor not wanting to complete another time consuming residency, these physicians are limiting their options tremendously,”  Fowler said.

Without the completion of an ACGME residency training program, these physicians are forced to jump through hoops to even become board eligible. These physicians can eventually become board eligible if they satisfy extra requirements, such as years of medical teaching.

“There have been some cases I’ve seen doctors who have completed three years of fellowship training without completing an ACGME residency. In most instances, when a hospital is searching to fill a need, they are looking for a physician who is either board eligible or board certified in their specialty.” Fowler said. “These physicians may come through with outstanding fellowship training and credentials, but without the completion of an ACGME residency program to their name, most hospitals won’t look at them due to credentialing.”

Pinnacle Health Group’s Senior Vice President of Recruiting, Rob Rector has come across quite a few of these physicians when sourcing for opportunities. “If these doctors aren’t board eligible, most hospitals won’t even consider them for their needs.” Rector said. “If I could give any advice to these doctors coming over, it would be instead of completing multiple fellowships, just do a short ACGME residency to satisfy the requirements to become board eligible.”

A lack of board eligibility simply equates to a lack of options when searching for practice opportunities. These physicians are limited to less desirable opportunities in very remote areas, urban inner-city areas, Veteran Association hospitals, correctional facilities, and Indian Health Service Facilities among others. A physician without board eligibility or board certification, on paper, hurts his or her marketability with both patients and prospective employers.

From a hospital’s perspective, a board eligible or board certified doctor is going to appeal more to both the prospective patients, and prospective health insurance providers. Having board eligible and board certified physicians will help in becoming an in-network provider with most health insurance companies. The insurance companies will see board eligibility and board certification as a higher quality care, thus making it a more attractive prospect to add these providers into their network.

On the other side of the coin, having board eligible and board certified doctors in their network will help the health insurance providers to become more attractive to potential customers. The more attractive the physicians, the more attractive their insurance plans will be to corporations and individuals alike. It’s a full-circle involving the hospital, the health insurance provider, and the customers.

The Action: Pinnacle Health Group sprung into action and began implementing a full physician placement campaign in conjunction with the hospital. Pinnacle partnered with this West Virginia-based hospital and worked with them to tailor make a sourcing campaign that would maximize their efforts without compromising the search’s efficiency, and a search that would ensure the perfect physician would be placed at the facility.

Pinnacle implemented a sourcing campaign that consisted of direct mail, AMA email blasts, PHG email blasts, and internet job board listings among other media. Pinnacle Health Group exhausted every avenue in their efforts to place the perfect physician at this hospital.

The Result: Pinnacle Health Group capitalized on its efforts by finding an interventional cardiologist who, despite initial concerns over the remote location of this rural opportunity, was thrilled with the prospects of working on the ground floor of a brand new interventional cardiology program.

While sourcing this need, Pinnacle Health Group found they had another task, finding this candidate’s wife a position. The candidate’s wife is a pediatrician. After presenting the candidate for the hospital, and discovering his wife was a pediatrician, Pinnacle Health Group consulted with the hospital, and found out that they were also in need of a pediatrician.

Pinnacle worked hard with the hospital as well as the husband and wife to make this double placement happen. With great communication, attention to detail, and an outstanding collaborative effort, Pinnacle has once again exceeded both client and physician expectations!

Keys to determining this shortage include: the growth of the population in the United States, baby-boomers, aging physicians, and increased physician visits. These same projections forecast that the current shortage of physicians will skyrocket by the year 2025 to an estimated 124,000 full-time physicians. This shortage can be combated by increasing efficiency, refining how health care is delivered, and utilizing both physicians and other health care professionals more effectively.

Some of the other health care professionals, that can help fight to maintain quality care, are often referred to as advanced practitioners, or mid-level providers. These health care providers include: nurse practitioners, physician assistants, certified registered nurse anesthetists, nurse midwives, and more.

With the inevitable increased physician shortage in America, the recruitment and use of these providers will prove to be crucial in helping alleviate the stress on physicians, all the while maintaining a high quality of care.

Pinnacle Health Group Vice President of Training and Recruiting, Craig Fowler, feels like the talk of a physician shortage is finally coming to a head. “The decade old conversation has become a bit old.  But, the physician shortage is here.   The increased demand for healthcare services by baby-boomers, and the aging physician population, coupled with the decreasing appeal of the medical field by college grads due to declining reimbursements, increasing regulation, and the uncertainty of Obamacare, are all present day issues that are requiring those of us in the physician recruitment field, both in-house and firm, to consider creative ways to fill primary care vacancies.”

One of the most necessary needs to address is the lack of American trained medical doctors choosing to practice Primary Care. If the number of these physicians choosing to bypass Primary Care continues to increase, then the utilization of nurse practitioners, physician assistants, and other mid-level providers and the current role they play will need to be further addressed. As it stands, the median income for a traditional Family Practice physician is $196,742, 2 with Internal Medicine physicians making a median of $205,379.

These numbers pale in comparison to the income made by sub-specialized physicians such as Non-Invasive Cardiologists, whose median income, according to the 2011 MGMA Compensation Survey, is $431,740.2 This chasm-like gap between salaries is a major factor in the deterrence of American trained physicians in pursuing a Primary Care practice upon the completion of their training.

According to Fowler, “To many, Mid-Level providers are the answer.  So much so, that the National Association of Physician Recruiters is dedicating nearly a quarter of its annual conference time to educate its membership on how these professions can work to fill  country’s primary care void.  Many physician recruitment firms are moving into this new niche.”

As the Primary Care problem worsens, the already prevalent number of mid-level providers should continue to increase as a way to ease this blow. As Fowler stated above, as recruiters in both hospitals, and placement firms, continue to find creative ways to fill the void left by the ever-growing physician shortage, turning the focus to recruiting mid-level providers may be the best long-term solution.

Complex changes in the healthcare industry, such as the current physician shortage and initiatives toward improving the efficiency of healthcare delivery, reflect the increasing role of mid-level or advanced medical practitioners in patient care. Mike Broxterman, PHG’s Chief Operating Officer, said, “In today’s market, the demand for doctors continues to outstrip physician supply. This is coupled by various factors in physician recruiting, including demographics, work-life preferences, retirement trends, the bigger role of primary care and an added 32 million patient base under the healthcare reform. It is not surprising that at least half of all US healthcare facilities use advanced practitioners to strengthen their physician practices.”

Moreover, there is an expected $11B-investment to mid-level practitioners over the next five years, which translates to a projected influx of about 300,000 opportunities for them. PHG intends to promote these efforts in ensuring a more effective and efficient health care delivery despite limited physician supply, such as through advanced practitioners.

“Since our inception, we have been proactively working with hospital leaders nationwide in helping them fulfill their most difficult placement goals with our comprehensive sourcing and placement capabilities,” added Broxterman. “We continue to build on our success by becoming a single source for customer-focused and results-oriented healthcare staffing solution for healthcare facilities across the nation.”

Pinnacle Health Group has a proven track record of over 17 years in the healthcare industry, utilizing a combination of proprietary and specialized tools and resources as well as a combined industry and recruiting expertise of over 100 years from its team of recruiters.  For more information about Pinnacle Health Group, contact 800-492-7771 (main), 404-816-8831 (local) or sales@phg.com.