Higher Demand for Family Physicians Bodes Growth Despite Sluggish Pay Increases

DEMAND FOR FAMILY PHYSICIANS

Demand for family physicians has risen. Family medicine was the fourth most heavily recruited specialty, according to the 2003 Survey of Hospital Physician Recruitment Trends, published by Merritt, Hawkins & Associates. Only recruitment searches for orthopedic surgeons, radiologists, and cardiologists topped those for family physicians, said Curt Mosely, vice president for business development at Merritt, Hawkins.

Of the 85% of hospitals recruiting physicians in the 2003 Merritt, Hawkins hospital survey, 45% were actively seeking family physicians. By comparison, 32% were recruiting internists, 21% obstetrician-gynecologists, 20% anesthesiologists, 13% radiologists, and 7% dermatologists.

Moreover, 43% of hospitals with 100 beds or fewer were recruiting family physicians, as were 48% of hospitals with 101 to 200 beds, and 47% of hospitals with 201 or more beds.

These data ring true for Heloise Povey, executive vice president at Russell Johns Associates, which places recruitment advertisements for the medical community. Between January and August 2004, recruiting classifieds for family physicians jumped nearly 13% over the same period in 2003, according to Povey.

“Everyone is recruiting,” she said.

IRONIC TWIST IN DEMAND

Mosely thinks hospitals’ revived interest in family medicine stems from recognition that specialists—particularly hospital-based, procedure-focused specialists—rely on primary care physicians for referrals.

“Now that the hospitals are getting these specialists in place, they need family physicians” said Mosely.

Ironically, demand for family physicians exceeds that for other primary care physicians because of the perceived shortage of subspecialists that has driven internal medicine residents into subspecialty fellowships, strangling the influx of new primary care internists. The result, Mosely surmises: more demand for family physicians.

“There’s more need for family physicians because of the subspecialty shortage,” he said. “Internists are doing cardiology work, pulmonology work. We used to see internists do 50% primary care work. But now we’re seeing internists so tied up (with subspecialty work) that people are going back to family physicians so they can have a primary care doctor.”

MIXED COMPENSATION PICTURE

The picture for compensation for family physicians remains mixed. Some surveys show that incomes have plateaued this year, while others indicate a slight drop, and still others an impressive increase. Merritt, Hawkins reported that, despite a 35% increase in recruitment contracts, the average offer for family physicians in 2004 was $144,000, down about $2,000 from the previous year. Likewise, the AAFP 2004 Practice Profile Survey reported FPs’ average income in 2003 was $140,000, down $2,000 from 2002.

However, the Medical Group Management Association’s 2004 Physician Compensation and Production Survey reported an average income of $163,000 for family physicians who did not provide obstetrics.

The disparities may reflect the current distribution of primary care physicians, say analysts. Some point to a primary care shortage that continues to plague more than one third of US counties in rural and inner-city areas and drives up demand for family doctors. Those high-demand areas, generally populated with lower income residents, cannot afford to sweeten recruitment efforts with higher pay, observers say.

Others, such as Merritt, Hawkins analysts, say sluggish compensation reflects a good balance between supply and demand for family doctors.

“We do not anticipate that demand for family physicians will accelerate rapidly and believe that the current supply of family physicians generally is adequate to meet demand in most areas,” the Merritt, Hawkins report says. Though the overall supply of family physicians is in balance with demand, the report says, “The notable exception is rural and some inner-city areas, many of which have a long-standing shortage of both primary care physicians and specialists. The general market has yet to perceive an increase in demand for family practitioners, which is reflected in average income offers to recruit them.”

AAFP WORKFORCE STUDY

In general, data collected for AAFP’s most recent work-force study agree that, on a national scale, the supply of family physicians currently is in balance with patient demand. However, the report—The Physician Work-force of the United States: A Family Medicine Perspective, which will be published this year—says the current balance could shift as American patients age and develop chronic conditions and as more immigrants demand culturally competent services. It suggests that the specialty should prepare for steady growth in demand.

The report underscores the Future of Family Medicine recommendations regarding residency training. Meeting future demand depends on graduating residents who are competent in providing family medicine’s basket of services and implementing a model of care that emphasizes evidence-based care, information technology and consumer service, the report says.

AAFP is developing and will publish an updated Academy position on the physician workforce in spring 2005.