Many physicians coming out of residency find themselves in the enviable position of choosing among multiple hospitalist job offers with attractive salaries and benefits. Driven by the rapid proliferation of hospital medicine programs across the country in recent years, competition for good candidates has intensified, and many hospitals—especially in rural areas—are struggling to fill open positions.
“The demand for hospitalists is as high as we've ever seen,” said Travis Singleton, senior vice president of Dallas-based physician search firm Merritt Hawkins. The average salary for hospitalists rose by 7% to $249,000 in 2016 and hospital medicine ranked fourth among the top 20 specialty search assignments, according to the firm's “2016 Review of Physician and Advanced Practitioner Recruiting Incentives.”
While that's good news for hospitalists on the job market, it presents challenges for employers, especially in smaller or remote communities, namely how to stand out in a sea of recruitment ads promising competitive salaries, flexible schedules, and collegial work environments.
Personalization is key, according to experts. Calls and site visits where candidates make individual connections with potential colleagues can tip the scales in favor of one position over another. In addition, employers often must be willing to tailor jobs to specific candidates.
Other factors are important, but the starting point for recruitment is money. Given the high demand for hospitalists, employers that pay below market have a tough time getting noticed, according to Mr. Singleton.
“You have to be in the ballpark in terms of compensation before you can even get to discussing things like scheduling or quality of life,” he said. “On top of that, hospitals usually have to be prepared to offer extras like signing and relocation bonuses.”
A typical compensation model includes a guaranteed base salary plus opportunities to earn additional income through productivity bonuses and quality improvement-based incentives, said Jason Farr, senior vice president with The Medicus Firm, a Dallas-based physician recruitment company. However, while many programs offer these benefits, they often fail to put them into context for potential employees.
“Employers often fail to take that next step of laying out what the candidate could expect in terms of total income,” he said. “Making sure all of the incentives are properly outlined so candidates know their full income potential is often overlooked.”
For example, established programs should compile historical data showing the average number of relative value units (RVUs) physicians generate per patient encounter. That information can be used to develop estimates of productivity bonuses prospective hires could expect when they exceed an established RVU threshold.
Another topic that programs may fail to address during the interview process is quality incentives. Recruiting employers don't want candidates to feel that they will be under pressure to meet a long list of metrics, said Mr. Farr. However, it's an important topic to cover, considering that quality incentive payments can add as much as $15,000 a year to a physician's compensation package.
Focusing on total income is especially important for small rural hospitals that may not have the financial resources to guarantee a high base salary, he noted. Some such employers may also have a lower threshold of work RVUs than a larger center, which could make it easier for physicians to boost their overall compensation through productivity bonuses.
Student loan forgiveness is another perk that appeals specifically to younger physicians, said Mr. Farr. Some hospitals are offering to repay up to $100,000 of physicians' student loan debt in annual installments if they stay for a specified length of time.
Hospitals located in underserved rural areas should check on their eligibility to participate in federal or state loan repayment assistance programs, he added. For example, the Texas Physician Education Loan Repayment Program offers up to $160,000 over four years to physicians who practice in designated shortage areas.
Young physicians are also particularly attracted to jobs that offer a good quality of life, recruiters say. As a result, flexible schedules, manageable workloads, and generous vacation time are important considerations for prospective employers.
“With Gen X, it was all about moving up, making more, and growing their practice, even if it meant working longer hours,” said Mr. Singleton. “But that's not the typical mindset of millennials. They are much more interested in overall quality of life.”
To guard against burnout, Redlands, Calif.-based Beaver Medical Group offers shorter shifts on weekends than weekdays (nine to 10 hours instead of 12) and limits average daily patient load per physician to between 14 and 17 patients, compared with 20 or more at some hospitals, said Sameh Naseib, MD, FACP, inpatient medical director for the 240-physician multispecialty group. Hospitalists can also become eligible for partnership in the company after two years of employment.
Many younger hospitalists like having the flexibility to work part-time or only during certain parts of the year, noted Mr. Singleton. Instead of losing those physicians to locum tenens work, hospitals may be able to attract them by embracing alternative work schedules and job structures.
“Ask yourself what you can do to be more flexible for the physician who wants to work six months out of the year because they have a growing family or want to travel,” he said. “That person may not fit into your traditional scheduling model but they can still be a great addition to the staff.”
Potential for career advancement is another key topic to cover with younger physicians, he added. Make sure to discuss any educational or leadership opportunities in your hospital that may help potential hires bolster their credentials or gain experience in specific areas of interest.
Honesty still best policy
While recruiters naturally want to highlight the benefits of a position, it's also important to clearly convey the challenges of the job to candidates before any offer is made, said Dr. Naseib. That way, you are more likely to end up with someone who fits with the culture and remains happy in his or her job.
“We are very transparent about our expectations,” he said. “Every physician in our program is required to participate in at least one or two committees focused on improving quality and safety. We want to make sure they are on board with that before they walk in the door.”
One of the biggest challenges in small or rural hospitals is lack of subspecialty support, said Mr. Farr. Some hospitalists are deterred by the prospect of a heavier workload in a setting where they do not have support from cardiologists, pulmonologists, and other subspecialists.
“Often hospitalists have to take on additional responsibilities that involve higher acuity of care with no specialty backup,” he said. “In addition, rural hospitals often do not have additional support for night call or backup coverage, which could mean a quicker path to burnout for hospitalists.”
At Hannibal Regional Healthcare System in Hannibal, Mo., for example, hospitalists sometimes have to manage stroke patients and take night call. That can be concerning for younger physicians fresh out of residency who have been used to working in larger groups with a full range of subspecialty support, said Rexanne Griffeth, the hospital's recruitment specialist.
However, the program, which has been growing since it launched almost three years ago, has had some recent success with filling positions. It recently hired two new hospitalists and is in the midst of negotiations with a third.
“We have to keep a very flexible and open mindset here to be competitive in recruiting,” said Ms. Griffeth. “We are always open to candidates' suggestions about how to handle scheduling, patient flow, and night call and will consider part-time schedules.”
Appealing to a candidate's specific interests is another way to stand out, she said. For example, Hannibal created a position for a new hospitalist who is board-certified in sleep medicine, allowing him to direct the sleep medicine program on alternate weeks.
Hannibal uses a variety of tactics to attract potential candidates, working with professional recruiting firms and talking with foreign as well as U.S. medical graduates, said Ms. Griffeth. The hospital recently hired one foreign graduate who is slated to start work in July, pending approval of her H1B visa extension.
“It's somewhat risky because we'll be stuck if the immigration paperwork doesn't go through,” Ms. Griffeth conceded. “But it's a chance we have to take in the middle of a shortage when our program is taking off and we've been forced to use locums.”
Screening and networking
At the University of Nebraska Medical Center in Omaha, significant time is spent in screening potential hires, according to Rachel Thompson, MD, FACP, chief of hospital medicine.
She has 30-minute calls with anyone who submits a resume, which sometimes reveal interests or strengths that aren't immediately apparent on paper, she said. Promising candidates are then invited to spend a day on site meeting with administrators and physicians and participating in rounds with the care team.
Dr. Thompson also recruits heavily from residency programs in the region in the hope of attracting physicians who are familiar with the area and interested in staying.
“We have a lot of physicians who grew up here and want to come back,” she said. “Omaha attracts people from the Dakotas and all over Nebraska who want to be in a city and work in an academic environment while staying close to home.”
Although time-consuming, the intensive process has been successful so far, she said. Eight new physicians were hired over the summer, and the hospital has plans to fill several more positions over the next year.
Personal connections made through phone calls, site visits, and conferences can be deciding factors for candidates weighing multiple job offers, noted Ms. Griffeth. Ultimately, your own staff is your most effective recruitment tool.
“Physicians are your best recruiters,” she said. “Professional firms can help beat the bushes for candidates and market positions, but physicians recruit other physicians, and help retain them once they're here.”
Remember that hiring someone is only the first step in a successful recruitment, added Dr. Thompson.
“If we hire someone who isn't a perfect match, we may end up trying to fill that same position the next year,” she said. “I try to identify each candidate's particular interests and strengths and how they fit in with our priorities over the next five years. . . . When we find that person, we do everything we can to craft a job that supports their career growth so that they are encouraged to stick around for the long term.”