The Price of an Inefficient Marketplace for Employing Doctors
As a physician in academia, my boss tells me the most important thing I can do for my Department, University, and community, is to recruit, hire, develop, and retain the best and brightest doctors.
The Current Problem
I agree with my boss, but when he told me this, I was waiting for the follow up “…and this is how you do it.” But it never came. In fact, no one has been able to describe to me the most economical and efficient way to recruit and hire a doctor. No one. I doubt my predicament is unique and, unless we solve this mystery, our healthcare system and our patients will continue to suffer.
At first glance, the physician job market seems like fairly navigable water. The U.S. market is extremely active, with numerous open positions across specialties at any one time. The U.S. Bureau of Labor Statistics estimates between 2019-2029 there will be, on average, about 23,000 openings for physicians and surgeons each year. When I go into my own specialty society’s job board, at any one time there are over 145 infectious disease (ID) physician job postings.
On deeper inspection, however, the recruitment and hiring challenge is considerable. One reason is that the supply of doctors is decreasing, with a projected shortage of over 130,000 doctors by 2033. So you think it is hard to get an appointment in 2021…? This statistic is made worse when you consider that a significant percentage of the shortfall (~50,000) will be in primary care (PCP) specialties, such as internal medicine, family medicine, and pediatrics. Good luck trying to get your child that school physical on time, or getting a referral from your PCP to see that elusive dermatologist.
In addition to creating health care access problems, hospitals incur staggering costs when open physician positions go unfilled. According to a 2019 Merritt Hawkins survey, a hospital can expect to lose about $2.4M in annual revenue for each physician role it cannot fill. This figure rises to almost $3.7M in annual lost revenues for surgical specialties. This means that every day a position goes unfilled, the hospital loses between $6,500 and $10,000, depending on the position. Medical Economics reported in 2019 that the ‘job fill time’ for 10 specialties was between 90 and over 240 days. Imagine a single hospital, with multiple job openings each taking 90-240 days to fill, and each losing $6,500 to $10,000 a day. Now consider this situation across thousands of U.S. hospitals operating on thin revenue margins, and you begin to appreciate the scope of the problem for U.S. healthcare.
Take all of these trends, add the impact of COVID, and the news gets even more dismal. The COVID-19 pandemic has made the retirement question easy for many docs who were previously ‘on the fence.’ In addition, an estimated 15,000 practices have had to close or be put on the auction block because of lost business due to COVID. For those physicians who continue to practice, a majority have had to take some form of pay and/or benefits cut. And the dust has not even settled yet on the number of COVID-inspired physician furloughs and job cuts.
The effects of the pandemic are not being experienced equally among doctors, or our patients. COVID has exposed yet another potential inequity for women in medicine, with more female than male physicians being forced to abandon their practice or profession. It is also clear doctor shortages and unfilled positions will impact certain racial and socioeconomic groups differently, in much the same way SARS-CoV-2 infection, illness, and death has disproportionately impacted our black, brown, and impoverished communities.
We Need to Shift the Paradigm
The physician job market waters are anything but calm. Increasing physician demand, a declining supply, a continuing pandemic, and mounting economic losses all make for rough seas. Despite this situation, market participants have fallen short in developing the tools and processes necessary to efficiently identify, recruit, and hire the right physicians for the right jobs.
When I think about the five doctors I have hired in the last four years, two I knew personally, two were direct referrals from colleagues, and one answered an advertisement – from another institution which referred him to me. I have been lucky. The problem is most institutions are not lucky, and a personal and professional network cannot be the foundation of a HR strategy. Until we figure out the physician recruiting and hiring mystery, our patients and our institutions will keep paying the figurative and literal price.