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SEEKING NEUROLOGISTS

WHY IT'S HARD TO RECRUIT THE RIGHT CANDIDATE

Avitzur, Orly, MD, MBA

IN PRACTICE

Some experts are predicting that we can anticipate a serious shortage of physicians in upcoming years. And for those who are currently searching, it seems that the demand for new hires may already be outpacing the supply of neurologists available to fill such openings.

Michael F. Finkel, MD, who has been a neurologist for 28 years – the last six-and-a-half at the Cleveland Clinic in Jacksonville, FL – has been trying to recruit a new neurologist for the past two years.

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ECONOMIC REALITIES

“Having incurred large amounts of loans, residents and fellows look to amortize their debt as quickly as possible, while seeking a practice style that fits their long-range goals,” he said. “Florida is blessed with beautiful weather, but hampered by occasional hurricanes, a high cost of housing, high malpractice rates for neurology, as well as a high level of litigation – all factors which influence decisions.”

Dr. Finkel observed: “It is difficult to recruit individuals trained in neurology who have not taken fellowships, but the fellowship creates several problems. Fellows tend to want to work mostly or only in their subspecialty, a condition which is impractical to impose in a general practice setting.

“If their training was not procedurally-oriented, there is a lesser demand for its value due to reimbursement issues; or worse yet, they may have lost their procedural skills or have become rusty in terms of general neurology. On the other hand, if they were trained in a procedurally-oriented sub-specialty, their starting salary expectation may be very close to that of an established partner.”

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NOT ENOUGH GRADUATES?

Eric A. Awad, MD, has also been searching for an associate for the past two years. He has been in a general neurology practice in Atlanta for nearly 12 years, the last five in solo practice. “I am fellowship-trained but I practice general neurology,” he said. “I think it is very hard to find associates these days. I doubt that there is any hope for improvement, especially for small or solo practices.”

“There are many reasons why finding an associate is a demanding task that can test one's patience,” he said. Among them, he listed the dearth of residents pursuing neurology, the challenges of being in a big city, too much competition, and too many expectations. Added to that, he said, the new graduates do not want to work as hard as the older generation, and pay the expenses of recruiters or headhunters. “Most importantly,” he said, “there are not enough good grads.”

One neurologist practicing in suburban Chicago for over 20 years, who preferred to be quoted anonymously, said, “Some of the recent candidates appear to have a rather inflated sense of self-worth and corresponding demands for high salaries and benefits.” Nevertheless, his practice has been quite successful in hiring new associates by word-of-mouth (and without recruiters), a factor he attributes to practicing in an attractive suburb of a desirable city.

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LUCK, GEOGRAPHY, AND ATTENTIVE RECRUITERS

Barry H. Bikshorn, MD, another neurologist practicing in the suburbs of Chicago, agrees that geography plays a role in recruitment. “Part of it is luck and we have been fortunate over the years in having local connections that tip us off to ‘somebody really good finishing,’” he said. “We also divide up our work equally and have a good track record of getting associates into the partnership track, factors that help with retention…. I couldn't be happier with our two most recent associates. They bring freshness and enthusiasm to the practice that gives me a bright perspective.” In fact, the new crop of neurologists appears to be a savvier group. Andrew Rogove, MD, PhD, a PGY-4 at the Department of Neurology and Neuroscience at the Weill Medical College of Cornell University, began his search last September by posting a notice on the National Association of Physician Recruiters Web site, www.napr.com. He ultimately chose a recruiting firm that specializes in neurology and neurosurgery placement, MedHIRE, www.emedhire.com. The recruiter set up several interviews for him based on his geographic and practice preferences and Dr. Rogove accepted a position within two months. He is thrilled with his choice and believes that the process was made easier by an attentive recruiter with a regional presence.

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ADVICE FOR RESIDENTS

In a noon conference on the subject for neurology residents, he advised that it is never too early to start setting goals and thinking about options. He suggested that they will do better if they have an idea of where they want to practice, what kind of practice they are willing to join – for example, single specialty, multi-specialty, hospital-based – and their financial expectations. He also advised them to hire an attorney who specializes in physician-employer contracts, as he did, in order to review and help negotiate terms for employment.

Laura Roberts, a neurology recruiting specialist for MedHIRE, said candidates often want to work near the geographic region in which they trained, making placements more difficult to secure.

“The more popular the region, or the more glutted it is with physicians, the lower the salary,” she said. “The areas with greatest needs for neurologists are in the South and in the Midwest.”

The job search should begin nearly one year before completing a fellowship on residency. For example, she said, residents and fellows completing their programs in 2006, for example, should have begun their search by April 2005, submitted their CVs by early fall (2005), and have completed their site visits before the end of the year. “You need to have a signed contract by January 2006 because in some states the licensure process may take up to six months!”

Tony Schnapp, Vice President of Recruiting for the Upper Midwest region for Merritt, Hawkins & Associates – www.mhagroup.com – a national physician search and consulting firm based in Dallas, said, “Neurology has been a very difficult specialty to place. The demand is great, but there is not a sufficient surplus of candidates.”

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INCREASE IN CLASSIFIED ADVERTISING

Although solid statistics regarding recruitment efforts in the field of neurology are unavailable and many practices are reluctant to disclose their search efforts, Dendrite, the AAN classified advertising service boasts a 20 percent increase over the past year in practices seeking to fill positions.

Available since 2003 in both print and searchable online forms, the service averages 60 new ads per month, a number that clearly outstrips the number of new graduates. One possible explanation is that physicians appear to be changing jobs more often, a trend estimated to affect more than 10 percent of the physician workforce per year. In fact, Ms. Roberts noted that 50 percent of her clients are employed neurologists looking to make a change.

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REASONS FOR HIGH TURNOVER

Why is there such a high job turnover? Some experts speculate that professional dissatisfaction is at an all-time high and that there is a misalignment of expectations between established physicians hiring young doctors into practices they have built with long hours and at great personal sacrifice and newer trainees reluctant to compromise on lifestyle and family values.

Others believe that inflated first-year packages targeted to lure physicians in this highly competitive market fall short in subsequent years when productivity expectations kick in and fail to be met, resulting in a radical income drop. Anecdotes abound about neurologists hired by a hospital or university system seeking to edge out existing medical groups, only to find that productivity was less than projected and that they were abruptly cut loose after setting roots in a new community.

“Neurology in general is not a ‘hot’ field or not one that medical students, especially those from good US medical schools, find attractive any longer,” said Dr. Awad. “We have to take care of chronic and difficult patients in return for little reimbursement from Medicare and other insurance companies. In addition, the few procedures we do as neurologists are being threatened by other health care workers, some of who are not even physicians. Furthermore, if we try to do procedures that we played a major role in developing but are practiced by other specialists, we are attacked.”

Dr. Awad added: “My situation will become more critical soon when my part-time associate, who joined me less than a year ago, leaves to join a bigger practice. I believe that solo practice has a lot of advantages and I wish that I could keep my practice that way. But it is not easy these days with one physician having to cover the overhead and call alone.”

Dr. Awad plans to hire a recruiter in the near future. But typically, small practices are unable to afford the search initiation fees and hourly billings of large recruitment firms and prefer to work with local firms who are willing to work on a contingency basis.

Dr. Awad summed up the shortage crisis, “I know that almost every neurology practice in the Southeast is looking for an associate!”

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SUCCESSFUL RECRUITMENT STRATEGIES: LET'S HEAR THEM

Do you have some successful recruitment or retention strategies to share with fellow neurologists? If so, we'd like to hear from you – for publication. Send your ideas in 200 words or less to neurotoday@lwwny.com. Include your name, full title, and contact information.

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ARTICLE IN BRIEF

  • ✓ Neurologists and physician recruiters discuss the challenges and opportunities for recruiting for new neurology positions.
©2005 American Academy of Neurology