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Medical Students Deterred From Primary Care

Primary care physicians are getting paid more, two surveys agree, while hospital employment is rising.

Internists earned $205,379 in median compensation in 2010, an increase of 4.21% over the previous year, reported the Medical Group Management Association’s (MGMA’s) Physician Compensation and Production Survey: 2011 Report Based on 2010 Data. Family practitioners (without obstetrics) reported median compensation of $189,402. Pediatric/adolescent medicine physicians earned $192,148 in median compensation, an increase of 0.39% since 2009.

Among specialists, anesthesiologists reported decreased compensation, as did gastroenterologists and radiologists. Psychiatrists, dermatologists, neurologists and general surgeons reported an increase in median compensation since 2009.

Regional data reveals primary and specialty physicians in the South reported the highest earnings at $216,170 and $404,000 respectively. Primary and specialty-care physicians in the Eastern section reported the lowest median compensation at $194,409 and $305,575. This year’s report provides data on nearly 60,000 providers.

Recruiting firm Merritt Hawkins reported that general internal medicine was one of its top two most requested searches for the sixth consecutive year. Family physicians were the firm’s most requested type of doctor, followed by internists, hospitalists, psychiatrists, and orthopedic surgeons.

Average compensation for internists rose again this year, from an average of $191,000 in 2009-2010 to $205,000 in 2010-2011, the firm reported.

Primary care physicians have become a particular focus of recruiting efforts because medical students have been avoiding primary care. So, residency programs, particularly in family medicine, fell short of filling their available positions.

The trend toward physician hospital employment continues, though. 56% of Merritt Hawkins’ physician search assignments were for hospital jobs, up from 51% the previous year and 23% five years ago. Average compensation for hospitalists rose from an average of $208,000 in 2009-2010 to $217,000 in 2010-2011.

Physicians seek the stability of employment, noted the report, while hospitals are seeking to align with accountable care organizations, bundled payments and other physician-aligned and integrated delivery mechanisms demanded by health care reform legislation. Internist Jonathan Plotsky, MD, a Member of the American College of Physicians, told The Washington Post that he’s contemplating such a switch because, “All the rules are changing.” Still, he added, he worries about the impact of turning over his patients to others.

Only 2% of recruitment searches by the private firm were for independent, solo practitioners, down from 17% five years ago, the firm noted.

Physician productivity and compensation is still based on volume, despite calls for paying for quality measures or cognitive services. While health care reform promotes reimbursement based on quality of care and cost efficiency metrics, physicians are still compensated on the number of patients they see, the amount of revenue they generate, or the number of Relative Value Units (RVUs) they accrue. More than 90% of recruitment searches in the 2011 Review that featured physician production bonuses reward physicians for fee-for-service volume, while less than 7% reward physicians for meeting quality of cost objectives.

Other findings include:
–Salaries have almost entirely replaced income guarantees. Only 9% of physician search assignments Merritt Hawkins conducted in 2010-2011 featured income guarantees, down from 21% in 2006-2007 and down from 41% in 2003-2004.
–74% of searches in 2010-2011 featured production bonus. 52% were based on RVUs.
–Psychiatry was Merritt Hawkins’ fourth most requested search assignment in 2010-2011, up from 10th four years ago, likely due to patient aging, a stagnant economy, two wars, and a limited supply of practitioners.
–Reimbursement cuts and declines in elective procedures have significantly reduced volume of search assignments for certain specialists. Radiologists, cardiologists and anesthesiologists, all among Merritt Hawkins’ most requested search assignments four to five years ago, were the firm’s 17th, 18th, and 19th most requested assignments in 2010-2011.
–Signing bonuses, relocation and continuing medical education allowances remain standard in most physician recruitment incentives packages, rather than the occasional carrot they were in years past.
–Housing allowances rose to 6% of job offers in 2010-2011, up from less than 1% in previous years, because some physician candidates cannot relocate without them.

The firm’s 2011 Review of Physician Recruiting Incentives tracks over 2,660 physician recruiting assignments Merritt Hawkins conducted nationwide from April 1, 2010 to March 31, 2011.

*This blog post was originally published at ACP Hospitalist*

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