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Monday Aug 17, 2015

America's Most Wanted: Family Physicians Again Top Search Firm's Wish List

We're No. 1.

Again.

For the ninth straight year, "family physician" was the most highly recruited role in U.S. health care, according to national health care search firm Merritt Hawkins.

© 2015 Tiffany Matson/AAFP
Residency exhibitors talk with medical students during the 2015 National Conference of Family Medicine Residents and Medical Students. The recent event in Kansas City, Mo., attracted record-setting attendance, including more than 1,200 medical students and representatives from hundreds of family medicine residency programs.

Merritt Hawkins publishes a review each year of the more than 3,100 search and consulting assignments it conducts on behalf of its clients. In its 2015 report(www.hcpro.com), the firm noted it sought to fill 734 openings in family medicine from April 1, 2014, to March 31, 2015. Internal medicine was a distant second at 237 openings. It was the ninth consecutive year that general internist ranked second behind family physician, a fact that highlights "the continued nationwide demand for primary care physicians as team-based care and the population health management model continue to proliferate," according to the report.

The report's authors noted that primary care physicians top the list of most-in-demand doctors in part because of the key role we play in patient management and care coordination. Specifically, they likened us to point guards on a basketball team. Patients need to see us first so we can coordinate their care appropriately. We can provide comprehensive care and refer patients to expensive subspecialist care only when needed. Like a point guard, family physicians see the big picture, not merely focusing on a single issue or area.

The report pointed out that primary care physicians are being rewarded for "the savings
they realize, the quality standards they achieve and for their managerial role" in newer models of care.

"That, at least, is the aspiration of these emerging models," said the report.

"In systems where volume/fee-for service still prevails," the report added, "primary care physicians remain the keys to patient referrals and revenue generation." In fact, a 2014 Merritt Hawkins survey found that family physicians generate, on average, more than $2 million a year for their affiliated hospitals.

I don't know about you, but I'd rather be a point guard who is looked to as the leader of a health care team than as a mere referral factory.

"Regardless of which model is in place (or a hybrid of the two) primary care physicians are the drivers of cost, quality and reimbursement and therefore remain in acute demand," the report said.

And that brings us to income.

For the jobs Merritt Hawkins sought to fill, family physicians had an average starting salary of $198,000. Overall, according to the firm, family physician income has increased more than 11 percent since its 2010-11 survey.

Meanwhile, a recent report by the Medical Group Management Association(www.medpagetoday.com) (MGMA) that was based on a survey of nearly 70,000 physicians reported a median salary of $227,883 for family physicians who provide maternity care and $221,419 for family physicians who do not. MGMA reported a median salary of $241,273 for primary care physicians, which was an increase of 3.56 percent compared with the previous year's figure. The same report found that median pay for subspecialists rose 2.39 percent to $411,852.

So although primary care physician income still lags behind that of our subspecialty colleagues, it is increasing at a faster rate. Since 2012, primary care physicians' income increased 9 percent, while subspecialist pay increased 3.9 percent during the same period, according to MGMA.

Part of the reason for the change is the shift to value-based contracts. According to MGMA, 11 percent of primary care payments came from value-based contracts in 2014, up from 3 percent in 2012. Halee Fischer-Wright, M.D., a pediatrician and MGMA’s chief executive officer, said in a recent interview with Forbes(www.forbes.com) that the figure could grow to more than 30 percent within three years.

It's worth noting that Merritt Hawkins reported decreasing incomes for the positions it sought to fill in several subspecialties. Otolaryngology was down 10.2 percent, physiatry dropped 13.8 percent, urology lost 18.3 percent, and noninvasive cardiology declined a whopping 34.2 percent. OB/Gyn (-4.2 percent), general surgery (-4.2 percent), hematology (-7.2 percent) and pulmonology (-7.5 percent) also saw declines.

Our country has a critical need for primary care physicians. To convince more medical students to pick primary care, that payment gap will have to continue to shrink.

Emily Briggs, M.D., M.P.H., is the new physician member of the AAFP Board of Directors.

Posted at 12:43PM Aug 17, 2015 by Emily Briggs, M.D., M.P.H.

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