By Carol Westfall
Among the top challenges in recruiting and retaining physicians today is the dual effect of the aging population and changing workforce.
The aging population creates greater demand for care, but there is less capacity among physicians to deliver that care. For example, a recently released study published by Health Affairs projects that outpatient visits by adults will increase 29 percent between 2005 and 2025 as the population ages, while the number of generalists to care for them will increase only 11 percent, resulting in an impending shortage of up to 44,000 generalist physicians to care for adults.
The capacity for patient care is diminishing in large measure because of the number of physicians approaching retirement. According to the American Medical Association, one-third of physicians are age 55 and older. At the same time, an increasing proportion of young physicians are women. While female physicians represent 22 percent of physicians between 55 and 59 years of age, they comprise 54 percent of physicians who are 34 or less.
The American Medical Group Association and Cejka Search identified a trend toward part-time practice among pre-retirement physicians and early career female physicians that could further limit the available capacity for patient care. Our recently published 2007 Physician Retention survey revealed a rise in the number of physicians, among both genders, practicing part-time. Between 2005 and 2007, the percentage of all physicians practicing part-time increased from 13 percent (5 percent male and 8 percent female) to 19 percent (7 percent male and 12 percent female).
So, even as the baby-boomer generation requires more physicians to treat chronic illnesses, the health care workforce is increasingly comprised of physicians seeking to balance time within clinical practice with other interests and commitments.
With such pressures on medical groups to maintain their staffing levels to meet patient demand, the need to retain physicians becomes increasingly vital. The Cejka Search and AMGA Physician Retention Survey offered further insight on the effect of these demographic and societal trends on the retention of physicians.
The survey respondent base was comprised of 43 medical groups who collectively employ approximately 13,700 physicians. They shared the profile of the physicians practicing part-time and their strategies for retaining all physicians – including mentoring and developing new clinical models.
Profile of the Part-Time Practice
The AMGA defines a full-time (FTE) physician as one who fulfills the minimum requirements of a particular organization to be classified as a full-time patient care employee. For 46 percent of respondents, that means providing 32 to 34 patient care activities per week. Another 36 percent require FTEs to provide 36 or more hours of patient care activity per week.
More than eight out of 10 (82 percent) of physicians practicing part-time are at least .50 FTE; 4 percent practiced between .25 and .49 FTE, with the remaining 14 percent practicing less than .25 FTE. So, the survey showed that most physicians working “less than FTE” are still engaged in patient care activity for a significant part of their work week.
The most frequently reported method for handling call schedule for part-time physicians is to proportionately reduce it to the FTE status. However, respondents’ comments on this issue reflected variances by department and specialty based on the particular business need.
It may not be surprising to see that the segment of physicians practicing part-time is dominated by pre-retirement male physicians and early-career female physicians. The predominant reasons are related to work / life balance consistent with these physicians’ respective career stages.
Among female physicians, the vast majority (70 percent) are practicing less than full-time due to family responsibilities, including pregnancy, followed by those who are pursuing unrelated professional or personal interests (22 percent). Male physicians offer a greater variety of reasons. Approximately 31 percent are engaged in unrelated professional or personal pursuits, 29 percent are preparing for retirement, and another 20 percent cite administrative or leadership duties as their reason for part-time status.
Mentoring Programs are Valuable and Increasing
With current trends reinforcing the need to keep physicians within the workforce, mentoring has become a strategy that respondents have consistently identified as being effective in retention.
In past surveys, experience and statistical evidence has shown that assigning a mentor to a newly recruited physician increases the likelihood they will remain with a medical group. In the 2006 survey, the turnover rates for groups that assign mentors was 6.3 percent, compared with 7.2 percent for those who do not. In the 2007 supplemental survey 95 percent of the respondents agreed that mentoring increases retention, and 56 percent of the respondents assign a mentor to newly recruited physicians.
Groups who assign mentors are strongly dedicated to mentoring as a retention tactic, with 83 percent somewhat or very likely to continue the mentor program and 79 percent somewhat or very likely to expand it. The utilization of mentors is estimated to become more widespread. Sixty-two percent of respondents who stated they do not assign mentors reported that they are somewhat or very likely to start.
Growing Clinical Hospitalist Model
The expanding use of Hospitalists has been identified as an important element in medical groups’ efforts to recruit and retain physicians. In the 2006 survey, 77 percent of respondents reported that “hiring Hospitalists for call and hospital responsibilities” is a strategy employed for attracting and retaining Primary Care physicians. In the 2007 supplemental survey, 86 percent reported that they hired Hospitalists or engaged with a Hospitalist organization in the past year. Their insights centered on the expansion of Hospitalist programs and also their inclusion into subspecialties, including Orthopedics and General Surgery.
Likewise, more than half (51 percent) of groups responding to the 2006 survey included the use of Physician Assistants (PA) and Nurse Practitioners (NP) in their strategies to attract and retain Primary Care physicians. On follow-up, the supplemental survey revealed that 79 percent increased their use of PAs and NPs in 2007, citing the physician shortage that has required augmentation with mid-level providers and the opportunity for expansion not only in Primary Care but in surgical assistance and other subspecialties.
Planning to Meet the Challenges Ahead
The challenge of finding, hiring and keeping physicians will intensify as the population of Americans – including physicians – moves toward retirement. It is clear that leading medical groups, including the participants in the 2007 supplemental survey, are committed to creatively and effectively developing medical group practices that improve access and quality for patients, while ensuring a satisfying and rewarding career for physicians.
With the increasing number of retiring physicians leaving the workforce and the certainty that today’s generation of physicians are focused on being content in both their work and their personal life, medical groups should continue to expand and focus on developing recruitment and retention plans in order to successfully recruit and retain physician talent.
Organizations will need to constantly explore innovative ways to position their individual practices to focus on market realities. Physician turnover can not be completely eliminated, but medical groups can help minimize the impact of turnover with positive efforts by leaders to appreciate the needs and expectations of their physicians.
Carol Westfall is President of Cejka Search, a nationally recognized physician and health care executive search organization exclusively serving the health care industry for more than 25 years.