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What is going on in family medicine? Demand is up, say surveys, but compensation may be down. Productivity is up. Bewildering as they seem, economic and workforce data do portend growth for family medicine, at least in the long term, say many health care observers. They point to physician workforce analyses and to income and recruiting surveys to support their forecasts.
Demand for family physicians
Among the signs of growth: 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. Forty-five percent of all hospitals were actively recruiting family physicians. Moreover, only recruitment for orthopedic surgeons, radiologists and cardiologists topped the search for family physicians, said Curt Mosely, vice president for business development at Merritt, Hawkins.
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HELOISE POVEY: |
The 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, recruiting classifieds for family physicians jumped nearly 13 percent 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 subspecialists -- particularly hospital-based, procedure-focused specialists -- rely on primary care physicians for referrals.
"Now that the hospitals are getting these subspecialists in place, they're asking, Where are our referrals?'" said Mosely. "They need family physicians for referrals."
Ironically, demand for FPs exceeds that for other primary care physicians because of the perceived shortage of subspecialists, he added. Internal medicine residents increasingly have gone 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 percent 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 FP compensation remains mixed. Some surveys show that FP incomes dropped slightly recently, while others indicate an impressive increase.
Merritt, Hawkins reported that, despite a 35 percent increase in FP recruitment contracts, the average offer for FPs in 2004 was $144,000, down about $2,000 from last year. Likewise, the AAFP 2004 Practice Profile Survey reported FPs' average income in 2003 was $140,000, down $2,000 from 2002.
The Medical Group Management Association's 2004 Physician Compensation and Production Survey offered a better compensation picture, noting salary offers for FPs without obstetrics ranged from $125,907 to $234,961, with a median offer of $150,267.
However, MGMA noted, all primary care specialties continued to grapple with mediocre income.
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 U.S. 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, they say.
Others -- such as Merritt, Hawkins analysts -- say sluggish compensation reflects a good balance between supply and demand for FPs.
"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 notable exception is rural and some inner-city areas, many of which have a long-standing shortage of primary care physicians and specialists," says the report.
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
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Copyright © 2004 by American Academy of Family Physicians.