Recruiting physicians and long-term viability: perspectives of physicians and practice managers.(Statistical Data Included)

As outcome measures become more informative, staffing by high quality physicians becomes more important to the competitive position of care providers. Success in physician recruiting is, therefore, a key to the long-term success and viability of care providers. Perceived problems in recruiting physicians led the Cincinnati Academy of Medicine to sponsor a study in the agreement between physician recruiters and physicians on the relative priority of factors affecting physicians' choices of practice location. The study found general agreement on most of the 15 factors considered. Disagreement existed, however, on the importance of salary and benefits and the importance of physicians' ability to make management decisions.

Key words: physician recruiting, staffing, practice location, physician income, physician management.

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A CARE delivery organization that cannot attract high quality physicians suffers the long-term risk of losing clients and revenue. A geographic region that is unable to attract qualified physicians is at risk of lowering the access of its citizens to quality medical care. To effectively recruit high quality physicians, health care providers must understand the array of factors that physicians consider when making their practice location choices and the relative importance of these factors in their decision process. Group practice and hospital managers in the greater Cincinnati area have reported difficulty in recruiting physicians. (1) A 1999 national survey of physician compensation put the Cincinnati area in the 25th percentile with regard to physicians' total compensation. (2)

Recruiting difficulties in the Cincinnati area raise two questions. The first is whether or not the problem is caused largely by relatively low average incomes for physicians. The second is, if incomes are not the primary problem, what other factors could be improved to increase recruiting success. An approach to the answers is to find the priorities physicians put on factors they consider in making practice location decisions. If physicians' priorities are found to be different from those that recruiting managers believe them to be, recruiting problems could be rooted in recruiting efforts not being focused on the factors with which physicians are primarily concerned.

Previous research, although sparse, indicates that factors affecting practice location fall into two broad categories--personal and professional--as shown in Figure 1. (3) Ernst found that personal factors were at least as important as the professional factors. (4)

The Academy of Medicine of Cincinnati, a nonprofit medical society of Hamilton County, OH, sponsored this study. The data collection was done with the assistance of the Greater Cincinnati Residency Programs (GCRP) and the Ohio State Medical Association (OSMA). The general intent was to assist recruiters in identifying priority factors that physicians consider in selecting their practice location so that these factors can be emphasized during recruiting. The specific objectives were to: (1) understand the priorities of factors from both the physician and practice manager perspectives, and (2) compare physicians' priorities to those practice managers believe physicians hold.

Methodology

Focus interviews with members of the Cincinnati Healthcare Roundtable were held to isolate factors affecting the choice of practice location and to set a strategy for collecting data. The members consisted primarily of physician practice managers. Two self-report surveys were designed, one for physicians and the other for medical group practice managers. A letter stating their purpose, the approximate time it would take to respond, and the confidentiality of responses accompanied the surveys, along with stamped return envelopes.

The Sample

The physician population selected for study was physicians completing residencies in Cincinnati between 1990 and 2000. A letter explaining the Academy of Medicine's intent was sent to 25 residency programs identified by GCRP. Data were received from 16 programs, providing a list of 1,019 graduates of which 875 could still be reached. The response rate from these physicians was 38.2 percent.

The OSMA was asked to provide the names and addresses of all group practices within Hamilton County. A list of 124 groups was received. The criterion used by OSMA to be considered a group practice is that the practice has more than three physicians. The response rate was 37.4 percent.

The Surveys

Figure 2 is the instrument sent to physicians. Figure 3 is the instrument sent to practice managers. The first section requested demographic data. The second section of each survey allowed respondents to rank the importance of each of a pre-selected list of factors affecting the choice of practice location. The factors were chosen from the output of the focus interviews, literature review, and the judgment of the researchers. An objective was to make the surveys comprehensive yet brief enough to be put on one …