Trend in Florida is toward hiring more advanced practice providers, fewer primary care physicians; specialty shortage prominent

By P.L. JETER

The healthcare industry may have found a way to minimize the demand for primary care physicians by hiring more physician assistants, nurse practitioners and now assistant physicians.

According to Merritt Hawkins' Annual Review of Physician and Advanced Practitioner Recruiting Incentives, the number of searches for primary care physicians dropped 19 percent last year, down 32 percent over the last three years.

"Average compensation for family medicine is $240,000, compared to $129,000 for nurse practitioners," said Mark Conley, vice president of Merritt Hawkins' eastern regional office, noting that busy advanced practice providers earn more via enticing production plans. "Because healthcare organizations are having such a difficult time finding family medicine physicians, they're replacing them with advanced practice providers."

Controversial Measures

After a few stumbles, Missouri lawmakers found a unique way to fill its severe statewide primary care physician shortage via assistant physicians, not to be confused with physician assistants.

State representative Keith Frederick, DO, an orthopedic surgeon who has championed difficult healthcare issues such as ways to address the alarmingly rising rate of medical student suicides, worked with colleagues on legislation to ease qualifications standards for medical school graduates unable to practice medicine until completing their residency.

"We've been trying for years to address our maldistribution of physicians in the country," Frederick told the St. Louis Post-Dispatch. "We have all sorts of incentive programs and all sorts of ways to try to get them to go out to Podunk, but a lot of them just don't want to go to Podunk."

Under the new law, all legal U.S. residents who have graduated from medical school within three years and have passed their medical licensing exams within two years may apply for an assistant physician license in Missouri. The catch: assistant physicians practice alongside a licensed physician -- 10 percent of the time -- in a healthcare shortage area. In Missouri, that accounts for 98 of 101 rural counties with significant physician shortages, according to data from the U.S. Department of Health and Human Services.

Even though medical school enrollment nationwide has increased 25 percent since 2002, per the Association of American Medical Colleges (AAMC), the National Resident Matching Program reported that 11,122 of 41,334 applicants in 2015 were denied residency slots.

"They're sitting there idle," St. Louis plastic surgeon Edmond Cabbabe shared with a Nebraska media group, after Nebraska lawmakers began mulling the option. "They cannot earn a living. They cannot gain any experience, and there was no solution available to them."

National Reception

The controversial new medical classification of assistant physicians, which won the approval of the Missouri State Medical Association but not the American Medical Association, has caught the eye of healthcare organizations seeking ways to minimize overhead costs while also seeing more patients. Some healthcare executives view the approach with cautious optimism. Others question the new solution.

"(We're) concerned by efforts that would bypass the experiences necessary for physicians to provide safe and effective patient care independently," said Matthew Shick, AAMC director of government relations and regulatory affairs. "They're going to have to be trained a little bit before they can get into the system."

The new trend of more advanced practice providers and fewer primary care physicians may be short-lived if demand outpaces salary boosts.

"We're seeing advanced practice providers' salaries increasing quite a bit because the need is driven by a demand for experienced providers," explained Conley. "Oftentimes, they're looking for someone who can really step into the breach and see patients at a fairly high level from day one."

Because "Florida tends to be a trailblazing state ... trying different models in healthcare delivery," noted Conley, sunshine state lawmakers may consider a similar measure.

Other White Paper Findings

Merritt Hawkins (NYSE: AMN), that has produced the annual survey for 25 years and is one of the nation's largest recruiting firms, highlighted other surprising trends. Last year, three of four recruiting requests involved specialists. By 2030, the specialist shortage could top 70,000 nationwide, according to the report.

"The notion that we should be training more primary care physicians while maintaining or reducing the supply of specialists is a grave miscalculation," said Merritt Hawkins president Mark Smith. "We should be training more of both types of physicians."

According to the survey, 80 percent of specialists are overextended or at capacity, leaving only 20 percent to see more patients or take on additional duties.

With invasive cardiologists garnering the highest starting salaries at nearly $600,000 annually, followed by orthopedic surgeons at $533,000, gastroenterologists at $487,000, dermatologists at $425,000, and pulmonologists at $418,000, "hospitals will have to take a hard look at their budgets and margins to see where room can be made for more labor spending if they're to keep care delivery quality and access high, allowing them to remain competitive with other systems," wrote Healthcare Finance.

Sunny Baby Boomers

With Florida's aging population, demand remains strong for psychiatrists, cardiologists, rheumatologists, gastroenterologists, radiologists and dermatologists.

"Florida represents a number of unique markets," said Conley. "Orlando is different from Miami and the panhandle. Because there's an older population throughout the state, demand in Florida will always be robust."

Radiology and dermatology specialties have noteworthy characteristics that might skew the numbers at first glance, Conley pointed out.

"Because radiology is a fairly stable practice, often, radiologists stay a while," he said. "We're seeing a core of radiologists starting to get into that 55 and older (category) and starting to slow down, maybe working just three or four days, maybe not taking calls. Because of that scenario, we're seeing demand increase dramatically for nighthawk radiologists."

Dermatologists in Florida are trending to a "three- or four-day pace," Conley said. "They still earn a very robust income, and it allows them to not necessarily be a full-time employee. Therefore, we're finding people to fill that gap."

Psychiatry remains a specialty in crisis as healthcare organizations continue to prioritize physical health above mental health, in part because cash-strapped community-based organizations postpone hiring psychiatrists while hospitals weigh cost benefits.

Compared to hefty specialist salaries, primary care physicians making $240,000 a year may seem like a bargain.