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“It is now widely accepted that there is a shortage of dermatologists,” says Alexa Boer Kimball, MD, an assistant professor of dermatology at Stanford University, who conducts research on workforce issues in dermatology. “And one of the problems with the workforce shortage is the geographic imbalance — we see a shortage everywhere, but it’s more acute in remote areas.”
To demonstrate the scope of the problem: the mean wait time for new-patient appointments is now 36 calendar days, and in some areas it’s up to 120 days, according to survey data reported by Kimball in a recent article in the Journal of the American Academy of Dermatology.
Practices in desperate need of dermatologists face an unprecedented recruiting challenge, says Tony Schnapp, regional vice president of recruiting for Merritt Hawkins Associates, a national physician search firm in Irving, Texas.
“If we picked up the phone and called any one of our hospital — system or large-practice clients, in some shape or fashion they would be looking for a dermatologist,” Schnapp says. “It’s simply an underserved field at the moment.”
What that means is practices that wish to attract new dermatologists must be willing to pull out all the stops: “Compensation packages are a lot more attractive than they were five years ago. We are advising our clients to ensure they are offering a [compensation] package that’s in the top 5 percent for the specialty,” Schnapp says.
Brent Stanley, chief executive officer of Action Medical Search in St. Joseph, Mo., says that while competitive compensation is key, other factors — such as partnership opportunities — also figure prominently into a candidate’s choice of a practice opportunity in today’s market. “Today, it’s like a free-agent nation, so the days of the five-year partnership track are no longer. We recommend that practices consider offering a partnership opportunity after the first year,” Stanley says, adding that a few practices he has worked with have even offered a previously unheard-of six-month partnership track to attract top candidates.
Hobart Collins, a principal with the Medical Group Management Association’s Health Care Consulting Group in Englewood, Colo., who advises practices on hiring and compensation strategies, urges practices looking to hire in today’s difficult market not to lose sight of what is feasible for and important to the practice — bringing in a skilled clinician who will be an asset.
“All you can really do is offer the most competitive and attractive package situation that’s reasonable for you in terms of compensation,” says Collins.
Practices can sweeten their offer by providing not only fast-track partnership but also the opportunity to participate in decision making for the group. “I think it’s helpful, when you’re trying to attract candidates, to create a situation in which they will be treated like a partner and stockholder, even though they aren’t,” Collins says.
Collins also recommends ensuring the buy-in amount is “extremely moderate” to make ownership financially feasible for the candidate. “There was a time years ago when buy-ins were fairly significant. That’s been changing,” Collins says. “Now those buy-ins are pretty modest.” While it was once common to see a significant good-will component in the buy-in formula, that is no longer the case. The trend in recent years has been toward calculating the buy-in simply based on hard assets — plant, property, equipment, furnishings, and accounts receivable.
When practices are dealing with a limited pool of candidates, Collins suggests they allocate resources prudently and efficiently by focusing recruiting efforts on dermatologists who “are drawn to you for logical reasons.” That means focusing on physicians who are either from the area or who trained there, and/or doctors who are known to the practice. Fully 75 percent of opportunity decisions are made on those grounds, Collins notes.
Anne Wolff, CMPE, clinical administrator for Dermatology Associates in Richmond, Va., has experienced the current undersupply situation firsthand. The practice has hired three new dermatologists in the last year and expects to hire another before this year is out. In the case of the nine-physician Richmond practice, rolling out the welcome mat involved not only offering competitive compensation packages — including a 15-month partnership track — but also enhancing and expanding facilities to ensure an appealing work environment.
For practices with a pressing need for additional dermatologists, Wolff recommends a two-part strategy: using a good recruiting firm with demonstrated dermatology-search expertise, and maximizing the resources of local or regional teaching institutions. For example, one of Dermatology Associates’ physicians teaches part time at the nearby Medical College of Virginia, which proves helpful in establishing relationships with residents. Because those residents also attend the local dermatology society’s monthly meetings, having the practices’ partners frequent those gatherings offers another avenue for conversing with potential candidates.
Collins says practices should be prepared to invest a significant amount of time in the recruiting process. “It is really a communication activity — people have to become aware of the opportunity you have,” he says. With time, money, and focus, practices can get the word out about themselves.
Wolff thinks it is also important to follow up even on casual inquiries from dermatology residents or potential candidates. “If they look like good candidates and appear interested, we call them a few times and then bring them here to visit,” she says. “The well-staffed, well-equipped practice is a draw.” It also allows potential physicians to see the practice in operation.
Collins imparts final advice to recruiting practices: Even though the recruiting environment is challenging, practices should avoid bringing in a physician who isn’t an ideal candidate just to fill a slot.
“Don’t compromise your standards just to get someone, and don’t bring someone in who isn’t a good fit,” Collins says. The outcome in such an event is likely to be poor. Working relationships between physicians may become strained, or the newly hired physician will leave for the next opportunity that is a good fit — an expensive conclusion for the practice that has expended considerable time and resources to retain the less-than-ideal candidate.
Wolff agrees. “We do a lot of phone work before the doctor gets here because we want to make sure the candidate would be a good fit. Dermatology Associates is a general-dermatology practice, so if the candidate has a strong interest in doing cosmetic procedures, we say it’s probably not the best fit because we’re philosophically geared toward general dermatology,” she says.
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Disclaimer: The material above has been prepared by Physicians Practice. It has not been reviewed by the DermQuest Editorial Board for its accuracy or reliability. Reference to any products, service, or other information does not constitute or imply endorsement, sponsorship, or recommendation by members of the Editorial Board.