At the 2008 SHM Annual Meeting in San Diego, I had the pleasure of serving as moderator for a panel commenting on the opportunities and challenges faced by hospitalists. I’m not sure how well our predictions will withstand the test of time, but two things came up that I’ll discuss here:
1) Nearly every group is recruiting, and many seem to think the hospitalist shortage will last throughout the careers of those in practice today.
2) Nearly all hospitalist groups are looking for more doctors. I asked the approximately 1,600 in attendance how many are recruiting for more hospitalists. Nearly every hand in the room shot up. It was impressive; one friend (Bob Reynolds) told me he was sitting in the back and could feel a breeze in the room from all the hands being raised. Only about three hands went up when I asked how many thought their staffing was adequate.
Bear in mind that based on the show of hands nearly every group in the country is recruiting. Many groups are looking to add three to six hospitalists this year alone. This is on top of the average group growing about 20% to 25% the past two years, based on my study of data from the “Society of Hospital Medicine 2007-08 Survey: The Authoritative Source on the State of the Hospitalist Movement.” The survey showed the number of FTE doctors in the average hospitalist group grew from a median six to eight hospitalists (the average went from eight to 9.7).
Hospital medicine is the fastest-growing field in the history of American medicine, and it looks like the demand for hospitalists may be increasing even faster than the supply.
I was tempted to ask for a show of hands from doctors at the meeting who were looking for a hospitalist position, but feared it could disrupt the whole conference as those seeking new doctors pounced on the potential candidates in a piranha-like feeding frenzy. So there is good news for anyone interested in joining a hospitalist group: You should have a lot of choices. If you’re recruiting, you’d better get to work to make sure you have really good plan. Let me offer a few ideas.
Never stop recruiting. Dr. Greg Mappin, VPMA at Self Regional Hospital in Greenwood, S.C., told me his philosophy is to “recruit forever, and hire when necessary.” I agree.
You should build and maintain a robust candidate pipeline by ensuring your practice maintains a high level of visibility before your best source of new doctors. The best source for most groups is the closest residency training program, though other nearby hospitalist or outpatient practices might be a secondary source of new manpower.
I suggest you engage residents by hosting a dinner near their hospital once or twice a year and inviting all second- and third-year residents to attend regardless of their interest in becoming hospitalists. You might do this even in years you may not need to add hospitalists to ensure your dinner becomes a regular event for them and to ensure they’re very familiar with your program. Some hospitals develop night and weekend moonlighting programs that employ nearby residents, which increases the chance some will join the practice upon completion of their training.
Ensure all hospitalists—especially the group leader—actively participate in recruiting. Your hospital or medical group’s physician recruiter can be a terrific asset. He/she can provide advice regarding how to find candidates, arranging interviews, etc. Yet, it is critical for the hospitalist group leader to actively communicate with every candidate, including responding to every inquiry within a day or so.
Too many group leaders make a big mistake by waiting many days to respond to new inquiries, or letting the recruiter handle all communication in advance of an interview. During the interview, be sure the candidate spends time with many of the current group members and provides contact information for every group member in case the candidate would like to call any who weren’t available on the interview day. Consider providing the candidate with a copy of the group schedule, any orientation documents you have, and other such printed materials to review after the visit.
Recruit specifically for short-term members of your practice. Despite concerns about turnover, I think it is reasonable to actively pursue candidates who may have as little as two years to work in your practice. For example, they may plan to move to another town (e.g., when their spouse finishes training) or start fellowship training. In my experience, at least half of new doctors who plan to be a hospitalist for only a year or two will choose to stay on long term.
If you want your classified ad to stand out, think about writing one that specifically targets short-term hospitalists. It could say something like: “Do you have only two years to work as a hospitalist? Then this is the place for you.” You even could add benefits, such as tuition to attend conferences that would be of value for the doctor regardless of their future specialty or practice setting. If you desperately need additional doctors, get creative in recruiting those who plan to stay with you for only a couple years. I’m confident some will end up staying long term.
Continue “recruiting” the doctors in your practice. For a number of reasons, hospitalist turnover may be higher than most other specialties. So it is particularly important to take steps to minimize it. SHM’s white paper on hospitalist career satisfaction (“A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction”) offers observations and valuable suggestions for any practice. Find it under the “Publications” link on SHM’s Web site, www. hospitalmedicine.org.
No End to Shortage
Now back to that panel discussion at SHM’s Annual Meeting in April. I asked the panelists what things would be like if in 10 years the demand for hospitalists decreased, and the supply finally caught up with and ultimately exceeded demand.
I thought this could be a provocative question that would lead to a discussion about how much of our current situation, such as recent increases in hospital financial support provided per hospitalist, are due to the current hospitalist shortage. Will hospitals decrease their support if there is ever an excess of hospitalists?
No one was buying it. Everyone was convinced that despite the incredible growth in numbers of doctors practicing as hospitalists, the demand for hospitalists will continue to grow even faster than the supply. Panelist Ron Greeno, MD, FCCP, chief medical officer of Cogent Healthcare in Irvine, Calif., thought this hospitalist shortage would continue throughout our lifetime. I’m not sure how long Ron thinks he (or I) will live, but that’s a pretty bold prediction.
It looks like the current intense recruiting environment is here to stay for a long time. Every practice should be thinking about how best to manage it. TH
Dr. Nelson has been a practicing hospitalist since 1988 and is co-founder and past president of SHM. He is a principal in Nelson/Flores Associates, a national hospitalist practice management consulting firm. He is also part of the faculty for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. This column represents his views and is not intended to reflect an official position of SHM.