A historic physician shortage that’s poised to only get worse is forcing many medical group leaders to draw up new recruiting and staffing strategies to ensure a healthy supply of doctors to serve their patient populations.
An April 4, 2023, MGMA Stat poll found that almost half (47%) of medical group leaders have added or created part-time or flexible-schedule physician roles in the past year, while 53% did not. The poll had 470 applicable responses.
Medical group leaders responding to the poll told us some of the reasons for the updates to their hiring strategies:
- “Our older docs requested a more flexible part-time policy to help them keep working. Our old policy only allowed half- and three-quarter time.”
- “To relieve some of the stress from emergency call.”
- “It provides the work-life balance that meets their needs or extends their retirement date further out.”
Among practice leaders who did not add new part-time or flexible-schedule physician roles, the prospect of hiring for nontraditional roles in the future depended largely on:
- Whether looming retirements come from hard-to-recruit specialties
- Physical space limitations within existing facilities
- Being able to do part-time in the given specialty and take equal call
- The economic costs of onboarding and credentialing versus the lower revenue creation of part-time physicians
- Determining whether staffing models could be adjusted to add more clinical support staff for existing physicians, including part-time and flexible-schedule physician assistant (PA) and nurse practitioner (NP)positions.
Still, there are many organizations that are laser-focused on finding physicians who are eager to work a full schedule or have had poor experiences with part-time hires in the past, especially around the physician’s expectations to earn closer to full-time compensation. “It never works out to where they see enough patients” to either cover costs or earn the type of living they hope for, one practice leader told MGMA. Others said it’s just a matter of mindset for the organization: “We need fully engaged physicians,” one practice leader told us.
Considering the costs of physician vacancies
In a recent MGMA webinar “Thinking Outside the Box: Creative Physician Recruiting for Hard-to-Fill Positions,” Tara Osseck, MHA, and Neil Waters, both regional vice presidents of recruiting at Jackson Physician Search, detailed the new approaches that help secure the right candidates amid growing competition for a shrinking supply of physicians, as about 2 in 5 physicians will reach retirement age in the next 10 years with a mostly stagnant residency slots despite increasing medical school enrollments.
Finding the right solutions should consider the costs of losing a key physician without a replacement lined up. “The estimated lost revenue for a noninvasive cardiologist opening that sits vacant for six months is about $1.15 million,” Osseck said. “A gastroenterology vacancy sitting open for the same amount of time is about $1.4 million. … An ophthalmology vacancy is the equivalent of $1.6 million in lost revenue.”
When it comes to time to fill a vacancy, Osseck noted that the industry average across all specialties is around that six-month mark, but that the most-competitive specialties or most-difficult-to-recruit regions might need an additional six months to fill a physician vacancy.
Beyond the lost revenue of physician vacancies, there are other major implications, such as lost market share, the effect of burnout on other physicians and providers trying to make up for the vacancy, and added costs from using a locum tenens provider, Osseck added, while the search for a permanent replacement is underway.
“Physicians now know their financial worth more than ever … and they’re deciding for themselves how their current positions stacks up,” Osseck noted, to offers for improved benefits packages or the promise of a better work-life balance in a flexible scheduling scenario.
Shifting work-life expectations
Waters recalled work to help find a psychiatrist for an East Coast hospital to meet the burgeoning demands for mental health specialists. While psychiatrists saw exceptional growth in telehealth during the COVID-19 pandemic, the hospital could not make it work for this role, as the psychiatrist would be needed to evaluate admitted patients.
To find a workable solution for candidates, a seven-days-on, seven-days-off schedule helped make the position more enticing despite the on-site requirements in a high-demand specialty. This more flexible approach got the vacancy filled in 90 days rather than the specialty average of 8.4 months. Other hard-to-recruit physician roles have even seen longer periods of days off following a seven-days-on work schedule.
Waters said that most healthcare organizations have an idea of how much flexibility they could ultimately offer when casting the net for a new physician but don’t incorporate it into the recruiting strategy, which can be costly in the long run.
“If you have the strategy in mind, go ahead and start talking about it early, even before you start your recruitment,” Waters suggested. “The quicker you can implement those strategies aggressively, you’re going to be putting your best foot forward. … If it drags out, it's just going to cost more money in the long term.”
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