Physician recruiting

Is there a doctor in the house?

Of all the questions facing the nation's health care system, this one remains the most critical. After all, without physicians, no model of health care delivery, no matter how well conceived, will accommodate the needs of America's growing and aging population. Despite the growing number and expertise of other health care professionals, it is still physicians who diagnose illness, admit patients to the hospital, order tests, perform procedures and discharge the patient.

As providers of care, they remain indispensable. They also are an essential source of revenue. According to Merritt Hawkins' Physician Inpatient/Outpatient Revenue Survey, a single physician generates an average of $1.5 million per year on behalf of his or her affiliated hospital through admissions, tests, stays and procedures.

Without physicians, the old joke goes, hospitals are simply empty hotels with expensive equipment.

And it is physician recruiters who must supply the physicians on whom hospitals and medical groups depend. Whether working as in-house professionals or with retained or contingent firms, physician recruiters are the "source of the source" from which virtually all patient treatments and revenues flow.

The title "physician recruiter" therefore carries with it a good deal of responsibility and the pressure that often goes with it. That pressure is not likely to lessen any time soon, and will probably increase. Estimates from the Association of American Medical Colleges indicate that by 2025, the United States will be short some 160,000 physicians. This does not take into account the fact that health reform will bring 32 million people into the ranks of the insured by 2019, further driving demand for doctors.

It will take every available resource for hospitals, medical groups, government facilities and other organizations to find the physicians they need. All types of physician recruiters -- in-house, retained and contingent -- will need work together to meet the goals of their employers or clients.

In the past, the relationship between in-house physician recruiting professionals and outside or agency recruiters could at times be characterized as a wary truce. Differences in approach, poor communication and disputes over "turf" have on occasion created conflicts where there should be cooperation.

Moving forward, in-house physician recruiting professionals and outside agencies will have extra motivation to work together. Consolidation throughout the health care industry is creating larger organizations composed of multiple facilities. In-house recruiters at these organizations will have enhanced influence and outside agencies will have to work even harder to earn their trust.

In addition, new delivery models are coming online which depend on physician hospital/integration. Known as accountable care organizations these models will require cooperation between physicians and hospitals on clinical, IT, administrative and other issues. As ACOs proliferate, in-house recruiters will become more influential, serving not only in a recruiting capacity, but also as liaisons between physicians and hospitals, helping to build alignment and communication between the two parties on the front end.

As their duties and responsibilities increase, in-house physician recruiters will, for their part, require the resources and expertise of outside agencies, particularly on high volume, high challenge or temporary search assignments. Agencies will need to understand the dynamics of the new delivery models and bring to bear national candidate sourcing systems and specialty-specific knowledge to be effective. They also will need to create productive partnerships with their in-house peers, finding ways to complement the services in-house personnel provide through value-added consultation.

Health care is changing, but physicians -- and, by extension, physician recruiters -- will remain at the center of the system. Whether in-house or with an agency, it's an exciting time to be a physician recruiter. I am proud to be a member of this vital and dynamic profession and welcome comments or questions from others in the industry.

Mark Smith is president of Merritt Hawkins, a national physician search and consulting firm and a company of AMN Healthcare. Smith can be reached at mark.smith@merritthawkins.com.