The battle to recruit primary care physicians (PCP) — family practice, internal medicine, and pediatricians – is on. Based on the growing shortages of PCPs, this should prove to be an epic slugfest.

On one side you have health systems, hospitals, group practices and their aggressive recruiters. On the other you have graduating medical residents who lack the time or the experience to navigate the ins and outs of trying to pick a place to practice without making a costly or professionally compromising mistake that could delay or derail a promising career. For many it is a hit or miss crap shoot.

If recent experience is any sign of what could happen, consider this: 54 percent of physicians recruited to new opportunities leave within five years, according to one study reported by Select International, a Pittsburgh-based workforce consultancy. On an annual basis, physician turnover averages 8 percent. If you factor in physician assistants and nurse practitioner, the number rises to slightly more than 11 percent.

With the current physician recruitment business model, the growing shortage of PCPs, estimated to be between 25,000 to 94,000 by 2025, will only intensify problems. In the interest of transparency, my firm recruits physicians for existing clients from our executive search practice.

Make no mistake, the pressure is on health systems, hospitals, group practices and their recruiters to get their fair share of recruits from a shrinking PCP market. Having a robust portfolio of primary care physicians will probably make the difference for health systems and hospitals between winning and losing in the marketplace. With this kind of pressure, and given the financial consequences for failing, there will be those on the recruiting side who will do whatever it takes to triumph, even if it means playing fast and loose with the truth and/or federal law.

If I were a medical resident, based on what I know about the inside game, here are the five questions I would ask a potential employer or partner:

  1. What is the culture of the organization, and tell me how that manifests itself with physicians? This may sound like a 25,000 foot global question but it is critical. Physicians cite culture as a major reason they decided to leave a practice or employment. Of course you are going to be told exactly what you want to hear so you need to vet their response. Ask to have some one-on-one time with a colleague in your specialty who has been there three years or less. Have your spouse have a similar conversation with the spouse of a recently recruited physician(s).
  2. Is this a new position or a replacement search? If this is a replacement search, the next most important question you should ask is why the previous physician left. A follow up question might be: Am I the first replacement, the second, or third? In one-on-one sessions with other physicians, test that answer. Did they tell you the truth?
  3. What is the average income of physicians in my specialty after three years in practice? Inflating income information is a common ruse in physician recruiting. It doesn’t matter whether it was from the recruiter or the employer, if a new recruit realizes they have been duped, it is not a question of if they will leave, but when. Again, talk to other recruits who have been with the organization for three years or less. What was their experience? How many patients a day do they have to see to meet the income that was promised? If there is a guaranteed salary, how long is the guarantee?
  4. Are there any current CMS investigations or an existing Corporate Integrity Agreement (CIA) in place? What precipitated the inquiry? If the violation revolved around physician issues, hit the brakes and begin asking questions which should include: Can I see the CIA agreement?
  5. What is the fair market value for your speciality in the community that is recruiting you? That is important because if they offer an income substantially above fair market value, physicians could find themselves at the center of a very uncomfortable fraud and abuse investigation. For hospitals that are desperate for physicians, this is a tough temptation to overcome. As a physician candidate, you cannot accept a generous gift as manna from heaven if that offer is outside the compensation norms.

If you want to start your own practice and the hospital will offer a net income guarantee, do not get greedy. Some people call net income guarantees as day of reckoning agreements. If you take more than you can reasonably expect to earn in 24 to 36 months you may find yourself in a financial hole from which you cannot climb out. Take what you need, not what will make you financially comfortable because there will be a day of reckoning.

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