JENNIFER BOULDEN

The math is simple: Arkansas is long on patients and short on physicians. The state ranks 48th nationally in physicians per capita, according to data from the Health Resources and Services Administration. Statewide, recruiters are working overtime to draw physicians to the state and keep those that train here working here.

Several factors contribute to and compound the shortage, most notably the aging and retiring of the Baby Boomer population, which includes a hefty percentage of the current physicians in practice.

Almost 50 percent of physicians in practice are 50 years or older. This is a troubling factoid because a survey by Merritt Hawkins & Associates, a national physician search firm based in Irving, Texas, revealed that in the next three years 48 percent of U.S. physicians over 50 plan to reduce their patient load significantly, either by retiring, seeking non-clinical jobs, discontinuing accepting new patients, working part-time or substantially reducing the number of patients they see. The study showed that 24 percent of those intend to opt out of patient care entirely in that time.

Medical school applications have been down in recent years, though there are some promising signs that trend may be reversing. The Association of Medical Colleges reports that the 2007 medical school entering class is the largest ever, with almost 17,800 enrolled. Moreover, this increase is not at the cost of academic standards, because the entering class also had the highest MCAT and cumulative GPAs on record.

While applications to medical schools have not yet reached the levels of 10 years ago, the 42,300 who applied to U.S. medical schools in 2007 is 8.2 percent more than 2006. Nearly 32,000 of those were first-time applicants, the highest number ever.

Meanwhile, Arkansas healthcare communities are using every means possible — networking, online job boards, recruiters, ads in journals, mailings, broadcasts, e-mail blitzes, telemarketing, professional associations — to get the word out about their needs and their amenities. While networking and online job boards are its most successful tools for recruiting, White County Medical Center (WCMC) in Searcy is working on changes to its website with physician recruitment in mind, said Physician Representative Stacy Bailey. She said WCMC wants candidates to be able to better use the site for information about available positions.

Phillip Wallace, a recruiter for Baptist Health System, has 20 years of experience in healthcare recruiting. He said the ever-changing reimbursement structures have changed the makeup of the graduating physician base. “(The change in reimbursement) appears to have pushed more physicians into specialties rather than primary care because of the higher potential of income,” he explained. “Consequently, there is an ever increasing shortage, such as in family practice.”

Donna Malone, physician recruiter for White River Medical Center agreed, relating her difficulties recruiting a pediatrician for Batesville: “I wouldn’t have thought that would be too difficult; it’s a popular primary care field,” she said. “But the problem is pediatrics has about as many subspecialties they can go into as internal medicine. What we need is a general pediatrician, and that’s just hard to find.”

General neurology is another specialty that is becoming harder to fill, as more neurologists opt for sub-specialties like epilepsy or sleep disorders, Wallace said.

Malone said that since she started as a recruiter in 1992, more physicians are opting to be employed by the health system, rather than remain independent practitioners. “That’s been a big change that took some of the older doctors a while to get used to. It’s not the way things used to be done, but it seems to be a growing trend.” She said psychiatrists led the trend. “Their reimbursement was so poor, it was really necessary. Now more and more are going that way.”

Hospitalists are among the hottest commodities in the state, several recruiters related, because besides helping the existing medical staff manage workflow, their presence is a huge benefit when recruiting other specialists. Malone said that’s because younger physicians have different priorities than previous generations.

“They really want a work and life balance, and having a hospitalist on staff can make a big difference in the demands on a specialist’s time,” she said, explaining that while younger doctors still work incredibly hard, oftentimes they work much less grueling schedules than their predecessors did. That, too, compounds the shortage since there are fewer overall doctors for more overall patients, and those doctors are working reduced hours.

A U.S. Department of Health and Human Services report on physician supply and demand projections to 2020 attributes some of this trend of working fewer hours to the increased numbers of female physicians, who it reports work an average of 15 percent less than their male counterparts.

Communities across the nation will be affected by the physician shortage, Bailey said. “Everyone will be in need of primary care physicians to care for the aging population…by evaluating current and future population projections, and the ages of the physicians in our area, we can project the physician needs for our community and be preparing for that now,” she said.

Wallace said in-state recruiting is vastly easier than out-of-state. “If they are from here it’s not that difficult,” he said. “Out-of-state physicians have to be convinced that we do in fact have world-class medical offerings here along with outstanding educational opportunities.”

“Most of the candidates I have dealt with have been pleasantly surprised,” said Bailey. “If a candidate has never been to Arkansas and is not familiar with the South it is an education process on our part to inform them of everything Arkansas has to offer. The cost of living in Arkansas is great compared to many other states, and Arkansas is a beautiful state that allows us the opportunity for a great quality of life.”

Rural Arkansas has one advantage over big cities where being a physician is no longer necessarily regarded as the pinnacle of professional achievement. “In a small town, the doctor is still very much the Big Fish,” Malone said. “Doctors are so important to small communities and their status here, and welcome by the community, reflects that.”

Targeting people who already have roots in the state is always a good idea. Bailey said she recommends initiating contact with medical school students from the surrounding communities. Wallace urges not to forget about students who have left the state but may be interested in returning: “We all as a healthcare group within Arkansas should work together to make sure that we do everything possible to get our Arkansas grads training out of state to return home,” he said.

Malone said that of all the reasons a doctor may not opt for her health system, compensation is rarely the deciding factor. “Compensation is important, but I don’t think we would lose a physician over it. We can always negotiate, so it would not be the thing that would keep us from getting a doctor,” she said. “If it’s not a good fit, it doesn’t matter how much you offer them, it’s not going to work.”

Getting the right fit with a physician and a community is the biggest challenge. “We want someone that’s going to stay,” Malone said. “When you spend that much time recruiting someone and building up a practice and then they leave, that’s not good.” She said that short-term gains of several international physicians who came to the area for visas largely have not panned out for her health system, as many have left after establishing three years of permanent residency. “I haven’t found a common reason they leave, but I think it just has to do with not having ties here.”

Likewise, she said a single physician may not be the best match for rural areas. “It’s not that we don’t want them. If they like the outdoors, then we’re right there in the middle of what they want to do. But if they’re single and wanting a night life in Batesville, well, we’re in trouble,” she laughed.

“Truly, physician recruiting is like fishing,” said Malone. “You just have to keep casting, keep doing what you’re doing until you catch the big fish. It’s hard not to get discouraged when you’ve gone a while without any good leads or the leads you had didn’t work out, but eventually, the right one will come along.”

Though, she added, for the many small communities that make up the state, “You may have to keep fishing quite a while.”



May 2008