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The Standard Q3 2015

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Industry Perspectives

Primary Care Demand and the Impact on Specialist Recruitment

By: Travis Farst, Marketing Consultant, Delta Physician Placement

The demand for primary care physicians has continued to top the charts year-over-year, due to a growing population and more individuals receiving access to healthcare through initiatives such as the Affordable Care Act. Family Medicine, Psychiatry, Internal Medicine, and Obstetrics have consistently ranked in the top five most requested positions for recruitment, as noted in the Specialty Demand Comparison of The Standard, in both 2014 and 2015. Consequently, as hiring facilities have adapted their recruitment techniques to stay in front of the swelling demand for primary care physicians, the demand for other specialists has seen an uptick over the last year. 

In areas that have seen success in primary care recruitment, increased patient access has led to a greater amount of specialty referrals, and primary care facilities have benefited from adding these physicians to their staff in order to comprehensively serve their community. Areas that could previously not support certain specialists have now been able to recruit their own specialist because the referral base has grown. Compared to placements over the third quarter of 2014, specialties such as Pulmonary Critical Care, Gastroenterology, Otolaryngology, Urology, and Neurology have emerged in the top 15 most requested searches initiated this quarter. The addition of specialized treatment has allowed facilities and their communities to thrive.

However, many rural counties still struggle to recruit primary care talent, and are now faced with double the burden of attracting permanent physicians to their communities. In fact, Becker’s Hospital Review recently posted an article stating that 73 percent of Texas counties do not have access to psychiatrists (the second highest most requested search of both 2014 and 2015). The article states that this shortage continues into access to other specialties as well; 158 of 254 counties reported having no general surgeons and 147 counties have no Obstetrician or Gynecologist. With an increasing demand for top talent in specialty recruitment, and an ongoing deficit of primary care providers, hiring facilities should consider looking to creative recruitment efforts to improve search initiatives.
One way a facility, particularly in a rural area, can distinguish itself amoung competition is by creating unique recruitment and retention incentives. While good practices, offering signing bonuses, relocation coverage, competitive base pay, and even flexible scheduling have become common recruitment tools, making it difficult for hiring organizations with such packages to stand out among the influx of opportunities presented to qualified candidates. Many facilities have seen success in offering more personalized enticements, such as temporary housing at a reduced cost for the first few months of an assignment, leadership opportunities and/or directorships for candidates, or even just a community tour during the interview process.

In addition, quick decision-making can have a huge impact on recruitment. Because the demand for top talent is so great, most qualified physicians receive multiple offers during their search process. This influx of opportunities has resulted in a limited window of availability before a desired candidate moves on to the next option. A case study published by Delta Physician Placement noted that offers made within a candidate’s pyramid of interest (or the first 72 hours following on onsite interview) showed the greatest amount of success. Being prepared to act on a candidate (whether by choosing to extend an offer or realizing the candidate is not a fit and moving on) illustrates that a facility is serious about their offer and ready to incorporate a new role into their team.
Due to the competitive nature of physician recruitment in today’s market, creative recruitment and speed in the decision process can give any facility a serious advantage. As the physician shortage continues to impact demand for primary care physicians and specialist that benefit from their referral base, being aware of your community’s needs and challenges will allow you to remain 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 Potential Compensation From Interview to Placement Total Placement Fastest Days-to-Fill
Primary Care
Family Medicine $211,962 $44,000  $263,654 51 127 22
Internal Medicine $216,429 $18,750 $267,500 39 111 34
Obstetrics/Gynecology $314,000 $33,333 $440,000 9 103 100
Pediatrics $233,33 $23,333 $291,667 19 195 42
Psychiatry $229,200 $16,500  $278,900 15 156 19
Surgery
Orthopedic Surgery $578,000 $95,000  $830,000 44 151 40
Otolaryngology $466,667 $33,333 $483,333 33 105 49
General Surgery $386,250 $47,500 $406,250 56 141 63
Urology $515,000 $75,000  $625,000 108 173 118
Sub-Specialty
Neurology $275,000 $30,000 $350,000 5 260 260
Pulmonary Critical Care $357,500 $30,000 $375,000 34 174 96
Gastroenterology $252,000 $148,000 $600,000 12 288 288
Hospital-Based
Emergency Medicine  $400,000 $33,333 $466,667 9 129 94
Hospitalist  $264,929 $21,786 $270,214 39 166 1

Data reflects averages from placements and interviews by Delta Physician Placement from October 2014 to September 2015. “Potential 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

Placements by Population

Data indicates sources of candidates for placements and interviews from September 2014 through October 2015.

Candidate Sources

 

Candidate Sources

Data indicates sources of candidates for placements and interviews from October 2014 through September 2015.

Market Demand

Map represents searches initiated by Delta Physician Placement on behalf of healthcare facilities from October 2014 through September 2015.



Specialty Demand Comparison

  3rd Quarter 2015 3rd Quarter 2014
1. Family Medicine Family Medicine
2. Psychiatry Psychiatry
3. Internal Medicine Internal Medicine
4. Emergency Medicine Orthopedic Surgery
5. Family Medicine - Obstetrics Family Medicine - Obstetrics
6. Hospitalist   Hematology/Oncology
7. Pediatrics Hospitalist
8. General Surgery Pediatrics
9. Gastroenterology

Dermatology

10. Urology Meternal Fetal Medicine
11. Pulmonary Critical Care  Medical Oncology
12. Orthopedic Surgery Opthalmology
13.

Otolaryngology

Physical Medicine $ Rehabilitation
14. Dermatology General Surgery 
15. Neurology

Emergency Medicine

Data compares the top 15 most requested searches initiated by Delta Physician Placement, comparing the third quarters of 2014 and 2015.

Nationwide Search Distribution

 

Nationwide Search Distribution



Candidate Placements

  Top 5 States Providers Have
Taken New Opportunities
1. Wisconsin
2. Texas
3. Iowa
4. Nebraska
5. Alaska

Compares all states for the top 5 candidate placements as initiated by Delta Physician Placement from October 2014 through September 2015.

Locum Tenens

Days Requested - Top Specialties

 

Days Requested

Data indicates the top specialties by days requested from October 2014 through September 2015.

Nationwide Physician Distribution

Nationwide

Map represents searches initiated by Delta Physician Placement on behalf of healthcare facilities from October 2014 through September 2015.

3rd Quarter 2015 
October 2014 - September 2015

Industry Perspectives

Hospitals not interested? Work with rehab providers to increase medical referrals: Expert Insight from The Advisory Board Company

By: Julia Burgdorf, Post-Acute Care Collaborative, The Advisory Board Company

Assisted living operators often fixate on hospitals as a primary source of medical referrals; however, ALFs have another partnership option for increasing occupancy and decreasing resident turnover: rehabilitation providers.
Rehab settings such as skilled nursing facilities (SNFs) serve older, recently hospitalized patients whose need for clinical supervision and social support make assisted living an ideal next setting of care. SNFs also benefit from working more closely with ALFs on post-discharge transitions and, in the case of SNFs’ long-term care units, garner referrals from the assisted living setting.

Why focus on rehab providers?
Many older patients require a rehab setting stay upon hospital discharge, and, in 2012, more than 20% of hospitalized Medicare patients required a post-discharge SNF or IRF stay. Since these older adults transfer to a rehab facility directly after their acute care episode, they must make a decision in those settings about whether living independently is still a safe option. 

By working with rehab providers, assisted living facilities can connect with seniors and their caregivers at a crucial decision juncture. Additionally, rehab providers’ patient profiles have several unique aspects that are well-suited to collaborating with assisted living facilities:

1. Rehab patients generally experience greater length of stay.
The longer a patient remains in a given setting, the more opportunities ALFs have to conduct patient assessments and support discharge planners. In 2010, Medicare beneficiaries had an average length of stay (ALOS) of 5.4 days in the acute care setting and 34 days in the skilled nursing setting. Since patients remain in rehab settings much longer than they stay in hospitals, ALF staff have ample time to evaluate a patient’s appropriateness for assisted living and prepare for the transition. Many rehab providers are also happy to have ALF staff come onsite to help conduct assessments to ensure continuity of care.

2. Rehab patients’ needs align with ALF offerings.
Compared to patients in a hospital, a greater proportion of rehab patients have a needs profile that’s appropriate for assisted living. Since rehab settings often care for higher-risk patients who could not return directly home from the hospital, discharged patients are more likely to need daily living assistance, light supervision, and clinical monitoring—a patient profile that mirrors the typical offerings and areas of strength of ALFs.

3. Rehab facilities can benefit from assisted living referrals. 
Medicare referrals from ALFs provide less favorable economics to hospitals determined to manage payer mix, but SNFs rely on referrals from assisted living facilities to populate their long-term care outpatient rehab business. This economic link means that skilled nursing providers may be more interested than acute care hospitals in building a relationship with local assisted living communities.

How can your assisted living facility attract rehab referrals?
1. Provide value to the rehab organization.
• Contract to have the SNF or IRF provide your facility’s on-campus therapy services
• Have admissions staff available to quicken transitions to assisted living
• Host networking events, CEUs, and training sessions for IRF and SNF staff

2. Tailor your message to SNF setting regulations.
SNFs may soon face financial penalties if their patients are re-admitted to the hospital within 30 days of discharge from the SNF. Use a capabilities document to demonstrate the types of patients your facility can care for to ease discharge planning and serve as a readmissions reduction partner.

3. Help rehab providers appeal to hospitals
Remind skilled nursing providers that assisted living facilities are now considered home settings by CMS, so a discharge to your campus can help the SNF achieve a higher level of discharge to the community. This quality metric is tracked by MedPAC through the MDS and evaluated as a reflection of rehabilitation quality. Because rehab providers are also looking for upstream referrals, the measure serves as a compelling data point to help SNFs and IRFs demonstrate to hospitals their commitment to minimizing the long-term health service costs of patients receiving their rehabilitation services.

While relationships with rehab providers are an excellent starting point, don’t forget about a large source of potential medical referrals: hospitals and health systems. Effectively communicating and partnering with these providers can jumpstart your medical referrals strategy, along with building relationships with and demonstrating your value to rehab providers.

Placements & Interviews

Placement Data by Specialty

This data represents average statistics of placements and interviews by Delta Healthcare Providers 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 Student Loan Repayment Relocation Reimbursement From Interview to Placement Total Placements Fastest Days-to-Fill
Rehabilitation
Physical Therapy $79,553 $8,732 $14,862  $4,093 8 79 2
Occupational Therapy $80,234 $7,472 $53,543  $6,600 4 40 1
Speech Language Pathology $74,120 $4,500 $18,000 $3,500 4 39 14
Extenders
Nurse Practitioner $108,830 $8,700 $40,500 $5,683 9 93 10
Physician Assistant $122,500 $8,833 $49,667 $6,000 12 138 15
Medical Technology $55,546 $5,000 - $3,000 3 28 20
Allied/Other
Dentist  $142,300 $9,111 $47,500 $6,000 6 93 8
Psychologist $97,764 $5,000  $30,000  $6,250 11 130 77
Nursing
Registered Nurse $69,616 $7,958  $34,296  $7,258 6 76 1
Dir. of Nursing  $86,667 $5,000 - $5,000 15 96 61
Dir. of Surgical Services  $85,009 - - $3,000 7 89 89
Home Healthcare Dir. $75,421 $30,000 - $5,000 5 134 85
Nurse Manager of ICU $95,000 $5,000 - $5,000 6 72 72
Nurse Manager of OB/GYN $85,000 $5,000 $5,000 $2,500 11 53 53
Nurse Manager of Surgical Services $79,000 $5,000 - $5,000 29 111 111

This data represents average statistics of placements and interviews by Delta Healthcare Providers over the twelve-month survey period. Data was collected from October 2014 through September 2015. Since these averages only include placements and interviews, the compensation information presented is an indicator of 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.


Placements by Population

Placements by Population

Data indicates the percentage of placements made from October 2014 through September 2015 by the population of the search facility's metropolitan area.

Years of Experience

Years of Experience

Data indicates the average years of experience of candidates for placements and interviews from October 2014 through September 2015.

Market Demand

Nationwide Search Distribution

Nationwide Search Distribution

Map represents searches initiated by Delta Healthcare Providers on behalf of healthcare facilities from October 2014 through September 2015.



 Candidate Placements

  Top 5 States Providers Have
Taken New Opportunities
1. Texas
2. Alaska
3. Minnesota
4. Kansas
5. New Mexico

Data is compiled from assignments placed by Delta Healthcare Providers from October 2014 through September 2015.

Specialty Demand Comparison

  3rd Quarter 2015 3rd Quarter 2014
1. Registered Nurse Physical Therapist
2.  Physical Therapist  Occupational Therapist
3. Nurse Practitioner Registered Nurse
4. Occupational Therapist Nurse Practitioner
5. Dentist Dentist

Map represents searches initiated by Delta Physician Placement on behalf of healthcare facilities from October 2014 through September 2015.


Candidate Sources

 

Candidate Sources

Data indicates sources of candidates for placements and interviews from October 2014 through September 2015.

Staffing

Facility Demographics

Facility Demographics Charts



Years of Experience 

Years of Experience

Data indicates the average years of experience of candidates for placements and interviews from July 2015 through October 2015.