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Medical Specialists Shortage Adds to Primary Care Woes

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Travis Singleton Merritt Hawkins

By Travis Singleton

The prevailing wisdom among healthcare policy makers and academics in recent years has been that the United States faces a growing shortage of primary care physicians.

While that is certainly true, a report from Merritt Hawkins, the nation’s leading physician search firm and a member of the AMN Healthcare family of companies, indicates a significant shortage of medical specialists also is developing.

Merritt Hawkins’ 2019 Review of Physician and Advanced Practitioner Recruiting Incentives tracks a sample of 3,131 physician and advanced practitioner recruiting engagements that the firm conducted from April 1, 2018, to March 31, 2019. Now in its 26th year, the Review reveals the types of physicians that hospitals, medical groups, and other healthcare facilities are seeking nationwide, as well as the starting salaries and other incentives they are offering to recruit physicians.

The 2019 Review indicates that 78% of Merritt Hawkins’ recruiting engagements in the last year were for medical specialists, up from 67% four years ago. By contrast, the number of searches the firm conducted for primary care physicians (family doctors, internists, and pediatricians) declined by 8% year-over-year and by 38% compared to four years ago.

The primary impetus behind this trend is patient demographics. Over 10,000 baby boomers turn 65 every day, and patients in this age cohort visit a physician at approximately three times the rate of younger people. While senior citizens represent only 14% of the population, they account for 34% of all inpatient procedures and 37% of all diagnostic tests and treatments, according to the Centers for Disease Control and Prevention (CDC). It is specialists who care for the declining organs, bones, and mental health of older patients, and more of them will be needed as the population ages.

The Association of American Medical Colleges (AAMC) acknowledged this fact in its most recent physician supply report, which projects a shortage of up to 55,000 primary care physicians, but an even larger shortage of up to 67,000 specialists by 2032.

Merritt Hawkins’ 2019 Review indicates that the firm is engaging in a growing number of searches for specialties that are projected to be in short supply. For example, a study published in Arthritis Care & Research projects that by 2030 demand for rheumatologists will exceed supply by 100%. The number of infectious disease training programs now fill fewer than half their classes, while deaths due to drug-resistant pathogens are predicted to rise rapidly, resulting in a looming shortage of infectious disease specialists. There are approximately 7,300 certified geriatricians in the United States today, and the American Geriatrics Society projects 30,000 will be needed by 2030.

Merritt Hawkins’ Review also shows that for the fourth year in a row, psychiatry was the firm’s second most requested search, highlighting a critical shortage of psychiatrists nationwide.

This is not to suggest that demand for primary physicians is going away. The 2019 Review shows that Merritt Hawkins received more search requests for family physicians last year than for any other type of doctor – the 13th consecutive year that family physicians have held the top spot. What an increasing amount of data does show, however, is that physician shortages will not be confined to primary care but will include a wide range of medical specialties as well.

Physicians practicing invasive cardiology have the highest average starting salaries tracked in Merritt Hawkins’ 2019 Review at $640,000, followed by orthopedic surgeons at $536,000, gastroenterologists at $495,000, and urologists at $464,000. Family physicians are at the lower end of the physician pay scale with an average starting salary of $239,000. In most cases, the Review shows that starting salaries for specialty physicians increased over the last year, while starting salaries for primary care physicians declined slightly or remained flat.

The Review further suggests that the use of value-based physician payments is gaining momentum. Of those Merritt Hawkins clients offering physicians a production bonus last year, 56% were based in whole or in part, on value-based metrics such as patient satisfaction and outcome measures, up from 43% the previous year and 39% two years ago.

Travis Singleton is Executive Vice President of Merritt Hawkins, the nation’s leading physician search firm and a company of AMN Healthcare.

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