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The Standard Q4 2011

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4th Quarter 2011
January 2011 - December 2011

Industry Perspectives

Key Trends for Physicians in 2012

James Heil, Senior Director of Recruiting, Delta Locum Tenens

Many of the trends that emerged over the past few years related to physicians and how they practice medicine will continue into 2012 and, in many cases, become more deeply engrained. Reimbursement from third party payers continues to decrease, while paperwork, regulations, and documentation requirements become even more onerous. For this and other reasons, a higher percentage of doctors are opting for the relative safety of being employed by health systems, hospitals and large clinics, as opposed to going at it alone in private practice or joining small groups. Primary care physicians are still in short supply in most parts of the country, a problem that is especially pronounced in rural areas.

As these trends from the last decade linger, we predict that new and more recent ones will be front and center in terms of what physicians grapple with (and in some instances leverage to their benefit) in the coming years. Some of these include:

• The prevalence of locum tenens practitioners will increase as health systems and clinics look to fill shortages, especially in primary care. The old argument that “locums is too expensive” will fall by the wayside as recruiting executives, managers, and even financial officers realize that it’s too expensive not to bring in temporary medical staff to meet patient needs. Fortunately, as the demand increases, more practitioners will opt for locum tenens, either as their full-time practice choice, or as an alternative to fully retiring as they near the end of their career.

• Younger physicians in particular will continue to have a strong preference for practice opportunities that offer not only good pay and benefits, but also schedules that allow them to have a life beyond practicing medicine. “Outpatient only” practice options will become more popular, and healthcare organizations that have yet to set up hospitalist programs will find themselves looking for ways to do so.

• Physicians will become more acutely aware of the fact that what they do drives the cost of medical care and be more likely to practice with that in mind. The American College of Physicians (second in size only to the AMA in terms of membership) recently released the sixth edition of their Ethics Manual for healthcare providers which states that, “Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly.” The idea that “good” doctors practice medicine without taking into account the financial impact of what they order and prescribe may no longer ring as true in today’s environment of ever-increasing healthcare costs.

• Some physicians who choose to stay in private practice will look to add revenue streams to their businesses in an effort to offset lower third-party reimbursement rates. Elective cosmetic procedures, in-office prescription dispensing, and weight loss programs are among the more popular options. And although no reliable statistics currently exist on how many doctors are choosing concierge medicine as their preferred practice model, anecdotally, the numbers appear to be on the rise. Whether these tactics will help physicians fare better as the various components of health insurance reform are implemented in coming years is yet to be seen, but practitioners in large numbers are getting creative as they struggle to keep their practices financially viable.

• Doctors will continue to become more knowledgeable about technology and, driven in part by patient demand, will jump on the social networking bandwagon and be more willing to use e-mail and the internet to communicate with patients. The ACP Ethics Manual referenced above also includes a section on “social media and online professionalism,” a clear indicator that the issue is on the minds of physicians.

Hospital executives and physician recruiters who understand the challenges that today’s practitioners face position themselves as trusted advisors (or at least as sympathetic listeners), thereby building stronger relationships with members of their current and future medical staff. Stay tuned, as trends unfold and changes abound, 2012 is guaranteed to be an interesting year in more ways than we can count.

Placements & Interviews

Placement Data by Specialty

This data represents average statistics of placements and interviews by Delta Physician Placement over the twelve-month survey period. Since these averages only include placements and interviews, the compensation information presented indicates the rate at which candidates are choosing to interview or sign. Average days information can be used to forecast a probable timeline for a recruitment effort in a particular specialty.

Average Compensation Average Days
Starting Compensation Sign-on Bonus Total Annual Compensation From Interview to Placement Total Placements Fastest Days-to-Fill
Primary Care
Family Medicine $193,011 $25,428 $237,284 34 115 57
Internal Medicine $204,270 $26,060 $272,000 27 146 105
Pediatrics $184,647 $20,156 $220,342 25 106 41
Psychiatry $205,307 $20,000 $246,615 14 138 50
Obstetrics/Gynecology $274,520 $22,000 $328,320 34 95 55
Surgery
General Surgery $342,142 $28,500 $409,750 27 158 84
Orthopedic Surgery $510,000 $53,333 $612,233 18 93 76
Otolaryngology $389,000 $22,000 $442,000 8 120 15
Urology $457,500 $27,800 $488,000 28 123 82
Sub-Specialty
Cardiology $450,416 $35,416 $497,083 85 230 167
Oncology
$436,123
$35,000
$482,000
48
138
138
Neurology
$279,000 $37,500 $400,500 33  111  40 
Gastroenterology $498,529 $43,294 $572,176 31 69 19
Hospital-Based
Anesthesiology $405,000 $45,000 $468,000 17 105 105
Hospitalist $223,000 $17,500 $284,500 52 91 17
Emergency Medicine $293,400 $42,620 $354,000 27 85 29

Data reflects averages from placements and interviews by Delta Physician Placement from January 2011 through December 2011. “Total Annual Compensation” data reflects average yearly compensation at full production excluding benefits. “Average Days” data does not include off-contract placements. “Average Days Total Placement” data is calculated from profile to placement.


Placements by Population

Data indicates the percentage of placements made from January 2011 through December 2011 by the population of the search facility’s metropolitan area.

Candidate Sources

Data indicates sources of candidates for placements and interviews from January 2011 through December 2011.

Market Demand

Nationwide Search Distribution

Map represents searches initiated by Delta Physician Placement on behalf of healthcare facilities from January 2011 through December 2011.



Specialty Demand Comparison

4th Quarter 2011 4th Quarter 2010
1. Family Medicine
Family Medicine
2. Internal Medicine Emergency Medicine
3. Psychiatry General Surgery
4. Emergency Medicine Internal Medicine
5. Hospitalist Orthopedic Surgery
6. General Surgery Otolaryngology
7. Gastroenterology
Psychiatry
8. Neurology
Pediatrics
9. Urology Urology
10. Orthopedic Surgery Obstetrics/Gynecology
11. Obstetrics/Gynecology Hospitalist
12. Pediatrics Gastroenterology
13. Cardiology Cardiology
14. PM&R Neurology
15. Otolaryngology Pulmonary Critical Care

Data compares the top 15 most requested searches initiated by Delta Physician Placement, comparing the 4th quarters of 2010 and 2011.

Search Specialty Distribution

Data indicates the percentage of searches initiated by specialty grouping between January 2011 through December 2011.



Candidate Placements

Top 5 States Providers Have
Taken New Opportunities
1. Alaska
2. Nebraska
3. North Carolina
4. North Dakota
5. Texas

Compares all states for the top 5 candidate placements as initiated by Delta Physician Placement from January 2011 through December 2011.

Locum Tenens

Days Requested

Specialty Number of Days
1. Hospitalist 44,766
2. Family Medicine 15,415
3. Emergency Medicine 14,748
4. Psychiatry 6,633
5. Nurse Practitioner 6,632

Data indicates the top five specialties by days requested from January 2011 through December 2011.

Nationwide Physician Distribution

Map represents the percentage of licensed physicians by region working with Delta Locum Tenens.

Privileging

Lowest Average
to Close Credentialing
Number of Days Highest Average
to Close Credentialing
Number of Days
1. Utah 18 1. Wisconsin 75
2. Massachusetts 18 2. Connecticut 71
3. Nebraska 21 3. North Dakota 66
4. Louisiana 23 4. Oklahoma 59
5. Arizona 23 5. West Virginia 56

Total Privileging
files Completed

626

Average days
to complete a file

40

Data indicates total number of days - highest and lowest for a state to close credentialling from January 2011 through December 2011. This data represents all states Delta Locum Tenens has done business in during the past 12 months.

4th Quarter 2011
January 2011 - December 2011

Industry Perspectives

Flexible Work Schedules for Therapists

Marc Froehle, Senior Director of Marketing, Delta Flex Providers

The unemployment rate for the U.S. population as a whole is now hovering in the high single digits. By contrast, only about 2% of physical therapists are unemployed. Great news for them, but bad news for hospitals, health systems, nursing homes, and home health agencies looking to add PTs to their staff this year. Occupational therapists and speech language pathologists are in similarly high demand. Projected job growth in all of these specialty areas is robust.

Recruiting and retaining top notch therapists is a high priority for human resources professionals around the country. One relatively easy way to make your organization more attractive to the best candidates is to allow for flexible work schedules. Increasingly, therapists are being offered four-day work weeks and, in some facilities, the option to work fewer than 40 hours a week while retaining many of the benefits associated with full-time employment.

Therapists appreciate flexible schedules for the same reasons that nurses and physicians have been enjoying working “four tens” and “three twelves” for years. Some of the benefits that therapists report include improved work-home balance, long weekends for recreation and travel, and less time spent commuting.

Flexible work schedules have become important to a sub-set of therapists in recent years who have found themselves in the position of wanting to accept a job in a new location, but being unable to sell their homes and relocate. Some are finding that it makes career and economic sense to rent a room or apartment near a new job, put in three or four long days in a row, and then return to their permanent home until it’s time to work again.

Because of the shortage of rehabilitation therapists, more hospitals are tapping the temporary workforce to meet patient care needs. Physical and occupational therapists and speech language pathologists who travel for their careers typically take assignments for 13 weeks at time. Those opting for this peripatetic lifestyle often do so because they want to see and enjoy different parts of the country. Three- and four-day weekends allow travelers to venture further from their home base while they’re in an area working. This is appealing to individuals who are trying to experience as much as possible in a short period of time. Travelers who accept engagements relatively close to their primary residence have the option to return home on their long weekends, which may also be attractive.

Hospitals and other healthcare facilities have recognized how positively received flexible work schedules are on the part of staff, and we’re seeing a definite upward trend in organizations offering this benefit. In doing so, they are enjoying improved staff retention and easier, faster recruiting.

As you might imagine, therapists who are satisfied with their current jobs and feel as though they have a degree of control over their work schedules are less likely to look for positions elsewhere. Recruiting managers are keenly aware that it is much more cost effective to keep the staff they have than it is to hire new staff. This is particularly true in specialty areas where the demand is high, supply is limited, and identifying and hiring new employees can take months.

In the current environment in which therapists have so many choices about where to work, it’s up to hiring organizations to make themselves as attractive as possible if they want to land the best candidates. You can only go so far with pay and standard benefits, so offering flexible scheduling is an easy way to make your institution a candidate’s first choice.

If you’re already offering flexible scheduling for nursing and other clinical staff but haven’t yet ventured into your rehabilitation departments with this benefit, 2012 might be a good time to put that plan into motion. The demand for PTs, OTs, and speech language pathologists isn’t likely to decrease any time soon, so why not get ahead of the curve.

Placements & Interviews

Placement Data by Specialty

This data represents average statistics of placements and interviews by Delta Physician Placement over the twelve-month survey period. Since these averages only include placements and interviews, the compensation information presented indicates the rate at which candidates are choosing to interview or sign. Average days information can be used to forecast a probable timeline for a recruitment effort in a particular specialty.

Average Compensation Average Days
Starting Compensation Sign-on Bonus Total Annual Compensation From Interview to Placement Total Placements Fastest Days-to-Fill
Rehabilitation
Physical Therapy $70,056 $8,809 $85,816 17 79 1
Occupational Therapy $77,826 $7,923 $83,433 9 32 13
Speech Language Pathology $70,597 $10,710 $78,992 7 39 34
Extenders
Nurse Practitioner $96,500 $7,000 $100,740 22 102 8
Physician Assistant $96,334 $8,750 $117,850 12 80 12
Allied/Other
Registered Nurse $71,523 $4,800 $74,937 7 68 28
Pharmacy $126,750 $5,000 $132,880 10 82 46
Medical Technology $59,203 $2,000 $60,658 23 72 36

Data reflects averages from placements and interviews by Delta Healthcare Placement from January 2011 through December 2011. “Total Annual Compensation” data reflects average yearly compensation at full production excluding benefits. “Average Days” data does not include off-contract placements. “Average Days Total Placement” data is calculated from profile to placement.


Placements by Population

Data indicates the percentage of placements made from January 2011 through December 2011 by the population of the search facility’s metropolitan area.

Years of Experience

Data indicates the average years experience of candidates for placements and interviews from January 2011 through December 2011.

Market Demand

Nationwide Search Distribution

Map represents searches initiated by Delta Healthcare Placement on behalf of healthcare facilities from January 2011 through December 2011.



Candidate Placements

Top 5 States Providers Have
Taken New Opportunities
1. Alaska
2. Texas
3. Iowa
4. Oklahoma
5. South Carolina

Compares all states for the top 5 candidate placements as initiated by Delta Healthcare Placement from January 2011 through December 2011.

Specialty Demand Comparison

4th Quarter 2011 4th Quarter 2010
1. Physical Therapy Physical Therapy
2. Occupational Therapy Occupational Therapy
3. Nurse Practitioner Nurse Practitioner
4. Registered Nurse
Director/Executive
5. Physician Assistant Physician Assistant 

Data compares the top 5 most requested searches initiated by Delta Healthcare Placement in the 4th quarters of 2010 and 2011.

Travelers

Assignments by Specialty

Specialty Average Length Contract
to Start Date
Average Length
of Assignment
Physical Therapy 4.5 weeks 11.8 weeks
Physical Therapy Assistant 3.6 weeks 12.1 weeks
Occupational Therapy 3.2 weeks 12 weeks
COTA 4.2 weeks 13.1 weeks
Speech Language Pathology 3.8 weeks 14.9 weeks

Data is compiled from assignments placed by Delta Flex Travelers from January 2011 through December 2011.



Facility Demographics



Years of Experience

Data is compiled from assignments placed by Delta Flex Travelers from January 2011 through December 2011.

Top Licensure States

Map represents top licensure states by Delta Flex Travelers on behalf of healthcare facilities from July 2011 through December 2011.



Licenses Per Quarter

Data is compiled from by Delta Flex Travelers from July 2011 through December 2011.



Licensure Cost

Specialty Average Cost of License
Physical Therapy $276.17
Occupational Therapy $236.75
Physical Therapy Assistant $257.42
Speech Language Pathology $181.50
COTA $164.00

Data is compiled from assignments over 2 years placed by Delta Flex Travelers from October 2009 through December 2011.