The State of the Healthcare Workforce - AAPPR
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RE CRU I T M E N T, O N B OA R D I N G A N D R ET EN T I ON The State of the Healthcare Workforce Featured Articles: Introducing the Association for Advancing Physician and Provider Recruitment (Page 8) Meeting Recruitment Targets During the Provider Shortage (Page 12) Utilization of the IMG Workforce in U.S. Physician Recruitment (Page 19)
Contents
President’s Corner............................................................................................................................................... 4
Letter from the Chief Executive Officer............................................................................................................... 5
Letter from the Editor........................................................................................................................................... 6
Introducing the Association for Advancing Physician and Provider Recruitment............................................ 8
AAPPR is Embracing the Future!.......................................................................................................................11
Meeting Recruitment Targets During the Provider Shortage..........................................................................12
Not Just One Silver Bullet..................................................................................................................................16
Utilization of the IMG Workforce in U.S. Physician Recruitment.....................................................................19
Physician Visa Information................................................................................................................................24
AAPPR Buyers Guide..........................................................................................................................................26
2019 In-House Physician Recruitment Processes Report..............................................................................36
Affiliate News and Updates................................................................................................................................38
Committee Chairs and Project Leaders............................................................................................................39
Board of Directors..............................................................................................................................................40
The Medicus Firm and Doximity Join AAPPR as Strategic Corporate Partners..............................................43
AAPPR Fellows, Diplomates and Associates....................................................................................................44
Improving Your Locum Tenens Credentialing Process.....................................................................................46
Key Points to Recruit More Physicians Now.....................................................................................................50
Can Move Benefits Impact Recruitment?.........................................................................................................52
Does Your Recruiting Need a Facelift?.............................................................................................................55
How to Find a Top Quality Locum Tenens Provider Every Time.......................................................................57
AAPPR Team Members......................................................................................................................................59
Reprint Policy......................................................................................................................................................59
SPRING 2019 ROAR │ 3
President’s Corner
Frank Gallagher
Director of Provider Recruitment, Christiana Care Health System
Given what all of us do for a living, I suspect none will be terribly minimum wage policies that will pay employees at levels above
surprised to learn that 70 percent of Americans believe health care what is currently mandated by respective state and federal laws.
is in a ”state of crisis,” according to a recent Gallup poll. At the same
time, the health care industry continues to perform as an important, Additionally, the American Association of Medical Colleges continued
primary driver in today’s overall healthy economy. According to the its prediction of the ongoing physician shortage, estimating by 2030
US Bureau of Labor Statistics, the health care industry added 50,200 that demand will exceed supply by a range of 42,600 to 121,300
jobs in December 2018, representing an increase from the 32,100 physicians. A few assumptions in play here include an increase in the
healthcare jobs added during the previous month – and, during 2018, use of Advanced Practice Clinicians, greater use of retail clinics, and
overall healthcare employment increased by 346,000 jobs, up from delays in the retirement plans for older physicians. As we know, this
an increase of 284,000 jobs in 2017. last point is important given 44 percent of active physicians in 2017
were age 55 or older – again, according the AAMC. And while I’m
A quick look at a sampling of recent headlines, however, provides a citing AAMC statistics, let’s not forget the growing female physician
deeper dive into a few of the changes that are underway across the workforce that now represents more than one-third (35.2 percent) of
healthcare industry and its quickly-evolving health care workforce. A active physicians in the US.
few examples:
• Tenet, one of the largest for-profit owners of hospitals nationwide, Predicting any future impact of the above on all of us as recruitment,
announced plans to ”offshore” more than 1,000 healthcare jobs. onboarding, and retention professionals remains to be seen and
• Amazon (yes, THAT Amazon) announced recruitment for a few would certainly require much more insight and physical space for
of their latest health-related job openings. Positions included a inclusion in this brief letter. However, I can say with high certainty that
Learnings Operation Manager to assist with building the learning each of us will continue to be called upon by our own organizations
department for its PillPack Fulfillment Network, and a Machine to solve problems, create solutions, improve processes, while
Learning Engineer to develop machine-learning software for its contributing positively to the bottom line. A large part of these
Web services’ health care-specific machine learning service. contributions will include the recruitment of non-physician health
• Former Cleveland Clinic CEO and current executive advisor care professionals, and the inclusion of meaningful data to help with
to Google, Dr. Toby Cosgrove, predicted 2019 as the “year of C-suite decision-making. These contributions will no doubt increase
telehealth” citing “increased data going to the cloud potentially our value and enhance our image as we advance the capabilities and
improving health info exchange.” outcomes of the recruitment profession. More importantly, doing so
• US News & World Report published its list of the 2019 Ten Best will allow each of us to fulfill our association’s vision of transforming
Healthcare jobs with rankings that included median salary, health care in our communities.
employment rate, and future job prospects. Physician Assistant
was cited as No. 1. Physician did not make the list’s top five. I am excited at what comes next for our industry and our “new”
• Numerous health care systems including the Cleveland Clinic, organization, The Association for Advancing Physician and Provider
Christiana Care, and Ochsner, to name a few, announced new Recruitment. Think about it: more than ever, the name fits…
4 │ ROAR SPRING 2019
Letter from the Chief Executive Officer
Carey Goryl, MSW, CAE
CEO, Association for Advancing Physician and Provider Recruitment
A shortage in the workforce is not unique to physician recruitment. What I have observed:
Low unemployment in many areas means a skills shortage
• Significant changes in leadership and volunteerism at the local
everywhere. With such low unemployment and an existing physician
and national level
shortage, what does this mean for you and by extension, AAPPR?
• Members newer to the profession or the association have been
We have to stay ahead of the health care workforce trends and this asked to “step up” as leadership vacancies must be filled
issue should help you do that. In order for your association to also • A shift in recruitment reporting structures, now more likely
stay ahead, it means good changes are happening now. to reside in HR
• Hospital and system mergers struggling to break down silos,
ASPR is transforming! The Association for Advancing Physician and
often doubling the work without increasing the resources
Provider Recruitment is the association our members have been
asking us to be. Serving as the voice of the profession and raising • Competition and collaboration at their highest levels because
awareness of our members and their work, looking into the future both do co-exist
requires both an alignment of our actions and our brand language.
Assessing and addressing professional skills gaps are what
For the last two years, I have attended the conference and meetings associations are ideally suited to do! Your new association is poised
of nearly all of the regionally based affiliate groups: from the to invest in you and your new staff yet to come, as an essential part
northeast with NEPRA and UNYPR, to the south with SEPRA, to the of a strategic, respected, and competitive group of professionals that
west with NWSPR, to our sister organization in Canada and most has their community at its core. We may have a new name, but our
places between the coasts. All of you have been generous with impact remains the same: health care is transformed in
your time and insights into the challenges you face and how our our communities.
association can address issues such as the physician shortage.
Members have shared with me:
• Excitement and enthusiasm about the future
• A collaborative spirit in providing insights and solutions
• Honesty about the past, candor about the present, and
predictions for the future
SPRING 2019 ROAR │ 5
Letter from the Editor
Cecilia Jerome, MBA
Physician Recruiter, MidMichigan Health
Just as a roar is the voice of a lion or tiger, ROAR is your voice and right report, the specific data, the particular resource that gives you
AAPPR is your voice. These are your vehicles and resources to exactly what you need for a presentation, a defense, or to garner that
discover and develop greater resources and find and implement elusive recruit.
proven best practices.
If you don’t see it with AAPPR: Bring it! Let us know what we’re
As we develop our new voice, we look to you to help us build the roar missing that would enable you to perform better and more efficiently.
into the image of what you want to project in terms of professional Let us know what could potentially make your job easier or more
and personal development and advancement, in addition to the fun. Let us know how we can help you better communicate with your
advancement of provider recruitment and retention. As a group, the C-suite and all those so critical to your success. Who knows? That
board and membership of AAPPR are working very hard to create challenge you face today may be one someone very recently has
a stronger, more relevant presence of provider recruitment and overcome – and he/she is going to tell you how!
retention at all levels within your organizations. Future associates
will include members of your C-suite, those who want to better There are lots of opportunities with AAPPR and many more not yet
understand their own roles in provider recruitment. Those executives identified. When you find what you need, you will find your own roar!
who see themselves as pivotal members of the recruitment team.
Those who more often than not are the ones who can make or break
the process. Those who truly understand and appreciate (in the words
of one of my colleagues) that it “takes a village.”
If you have not invested time in perusing the AAPPR website, please
do so. You will find support and resources that will help you develop
as a recruiter. You will find resources that will enable you to work more
efficiently. Provider recruiters are your rivals, but they are also your
greatest advocates. I have never worked in an industry where so many
are so willing to share experiences, insights and tips and tricks with
their competition! We are truly a unique group.
Your membership is what you make of it. If you never go to a
conference, you can still gain so much from being a part of AAPPR.
If nothing else, you will learn you are not alone. The struggles you
face are not always unique to you. There are people there to get you
through those challenges. It may be as simple as an ear to listen or
shoulder upon which to lean. It could go as deeply as finding just the
6 │ ROAR SPRING 2019
LOCUMS STAFFING
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We’ve streamlined the locum tenens process as much as possible,
while still maintaining our legendary quality. Ready to experience
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weatherbyhealthcare.com
Introducing the Association for Advancing
Physician and Provider Recruitment
“A changing industry requires a changing association:
redefining the recruitment to retention continuum
starts with new members, services, programs and alignment”
After a year-long disciplined and strategic process that included and logo, members will find new services, resources and stronger
input from hundreds of members, partners and other stakeholders, partnerships that will help them in their positions, and help them
the Association for Advancing Physician and Provider Recruitment, have more visibility with every level in their organizations – including
or AAPPR, has been introduced as the new name for ASPR. The the C-Suite.”
announcement was made by AAPPR Board President, Frank Gallagher
to attendees at the annual AAPPR Conference held in Orlando, FL. Membership Expansion
Supporting the new brand, logo and positioning for the association,
“The board started this journey years ago,” said Gallagher. “For years,
Redefining Recruitment to Retention also includes a focus to expand
we heard from membership that the Association for Staff Physician
membership to anyone working in health care who influences the
Recruiters, or ASPR, represented what our members had become but
recruitment to retention activities of physicians and providers.
not what they are becoming. There was hardly a word in the old name
that continued to make sense or reflect the environment that those of
“The idea of being the association for anyone who influences the
us in the industry work in every day.”
recruitment, onboarding, or retention process in a health care setting
is nothing new – it’s been in the association’s mission statement
Lynne Peterson, FASPR, and the incoming President of the Board of
since its inception,” said Carey Goryl, AAPPR CEO. “And it’s evident
Directors, is quick to add that changing the name is just one part of
in our current membership that we’re attracting a wide array of titles
the brand evolution for the organization, “The new brand identity is
and roles from a wide array of health care settings – titles, roles and
just one aspect of creating a more dynamic and relevant brand to
settings that are very different today than those of 30 years ago.”
support our members and the work that they do. Beyond the name
8 │ ROAR SPRING 2019
Goryl noted that the insights from members who participated in focus
groups during last year’s Annual Conference confirmed the diversity of
member titles and roles.
Alignment with Stakeholders
Another key aspect of the new branding efforts is the reshaping
and structure of the regional and affiliate organizations. In the
past, alignment between these groups and the association has
been disjointed. With the new brand efforts, these groups are
now consistently aligned in brand, and structure, with AAPPR. The
regional groups are now AAPPR Affiliates, remaining independent but
supported by AAPPR in a variety of ways including a stronger use of
AAPPR’s brand identity. AIR and OAR are now Shared Interest Groups.
Leadership for both these groups have already begun to transition
their brand identities to align with AAPPR, and will benefit from the
fact that all AAPPR members can choose to become part of AIR and/
or OAR with no additional membership dues.
Raising the Voice of Members
Yet another key element of the new brand features AAPPR’s expanded
strategic communications efforts – efforts that will support current
members, help attract new members, and create a stronger, more
visible and consistent voice for AAPPR with other key stakeholders
inside, and outside, health care settings. AAPPR’s new website was
launched featuring the new branding but also new resources. “We
have aligned every touchpoint the association has with members and
other stakeholders with a consistent brand identity and voice,” said
Goryl. She also mentioned the annual benchmarking report is being To learn more go to:
reworked to become a more meaningful tool for membership.
www.aappr.org
One of the concerns members had that helped fuel the new branding
effort initially was the general feeling that their roles needed to be
elevated among key internal audiences, such as the C-Suite, and
among the many different physicians and providers they recruit. The new AAPPR website establishes a more
AAPPR will elevate the visibility of its members through the ongoing user-friendly and seamless experience for members
implementation of an integrated marketing and communications
campaign that may include targeted advertising, exhibiting at key while navigating between different platforms. The new
partner conferences, social media, public relations and more.
look of the website creates a level of credibility
Redefining Recruitment to Retention that can be viewed as a trusted source for health
“Our members help their organizations succeed in so many ways,” care leaders and its members who are specialists in
said President-Elect Peterson. “While their role is to recruit, onboard
and retain physicians and providers, their efforts accomplish so the field of physician and provider recruitment or
much more – including increasing revenue and helping build their
retention. The website provides members easy access
organization’s brand in the community they serve. The association’s
new brand represents members and other influencers in the health to engage with colleagues and find learning
care sector, both individually and collectively, who are working toward
moving their profession forward – advancing their work, visibility, resources for the purpose of their professional
credibility – in an effort to be the leading voice on behalf of physician development and career enhancement.
and providers and their communities.”
SPRING 2019 ROAR │ 9
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vbensch@acponline.org scorrigan@acponline.org mfitzgerald@acponline.orgAAPPR is Embracing the Future!
With 30 years of history and 2,000 members, today’s Association for the definition of membership with our desired member and customer.
Advancing Physician and Provider Recruitment (AAPPR) is embracing The board, along with workgroups, committees, and staff leadership,
its future role as the leading resource for professionals engaged in all listened to members and the new realities they face on a daily
facets of the recruitment continuum: basis. The diversity of the titles of those who touch the recruitment
to retention process has grown into hundreds of variations, and our
sourcing | recruiting | interviewing members can fully reflect and align with that continuum.
contracting | onboarding | retention
AAPPR’s expanded member profile includes you as defined as
health care professionals who influence the recruitment to retention
The health care industry has changed significantly since the founding
continuum and are committed to the health of their communities.
of AAPPR and will continue to evolve. Our association needs to keep
pace with this rapidly changing environment. To be the leading
It’s no secret, as someone involved in some part of the recruitment
resource for education, certification, and peer-to-peer networking,
process, that your role is changing. It is up to AAPPR to be at the
AAPPR must be the leading voice for those employed in this dynamic,
forefront of these changes and to do so we need to open our doors
and ever-changing field.
to a broader health care community. Please let your colleagues and
leadership within your organizations know that AAPPR’s membership
Three years ago, the AAPPR board of directors began an ambitious
and conference are open to them, too.
strategic planning process that prioritized the importance of aligning
SPRING 2019 ROAR │ 11Meeting Recruitment Targets During
the Provider Shortage
By: Maggie Van Dyke
“We have not hit the eye of the storm yet,” says Bruce Guyant, FASPR, These challenges will only increase over the next decade as Baby
about the provider shortage that is making it difficult for in-house Boomers age, increasing demand for medical care at the same
recruiters to fill open positions. time one-third of current physicians reach retirement age. A 2018
report from the Association of American Medical Colleges projects
“The shortage – not just of physicians but of nurse practitioners and a shortage of 42,600 to 121,300 physicians by 2030. The greatest
physician assistants as well—has affected my organization’s ability to recruitment searches tend to be for family and internal medicine
meet our strategic growth plans as quickly as we would have liked,” providers, as well as psychiatry, according to AAPPR’s 2018
says Guyant, systems director of provider recruitment and onboarding, Benchmarking Report. Other specialties heavily sought in 2017-
Covenant Health, Tewksbury, Mass. “There’s also the patient care 18 include radiologists, obstetricians/gynecologists, hospitalists,
perspective: When time to fill increases, patients have longer waiting gastroenterologists, and urgent care physicians.
times to see a provider.”
12 │ ROAR SPRING 2019“The pool of candidates continues to diminish,” says Christy Ricks, Like many health care organizations, LifePoint Health offers student
MHA, FASPR, senior director, physician recruitment, LifePoint Health, loan repayment assistance to physician recruits as well as a monthly
Brentwood, Tenn. “Geographically, if it isn’t an attractive place to live, stipend (capped at 18 months) to residents who sign on to work at
that shortage-related challenge is even more pronounced.” the health system once their residency training is completed.
What strategies and tactics can in-house physician recruiters adopt “The financial piece is important,” Guyant says. “You need to be
to help address shortage-related challenges? Three AAPPR members competitive, but it’s not everything. You need to understand a
share what their organizations are doing. provider’s hot points so you can show him or her how you can help
with those things. It might be a flexible schedule, like a four-day work
Begin with Sound Recruitment Practices week. Or it might be an opportunity to work with a specific provider
who has a good reputation.”
Innovative, creative recruitment tactics can help health care
organizations gain the attention of would-be candidates. But window
dressing won’t make up for a cracked foundation, Guyant stresses. Track the Stats
“More often than not, a lack of recruitment success is not due to lack Understanding how the shortage is playing out — both nationally and
of innovation or creativity, but to the lack of a well-thought-out plan in specific geographic regions — can help in-house recruiters with
and subsequent poor execution of that plan,” he says. long-term recruitment planning. Data resources on the provider supply
and demand include:
Successful recruitment, particularly during a shortage, needs to
reflect well-established practices, including: • The American Medical Association’s book Physician
Characteristics and Distribution in 2015
• Establishing clear recruitment objectives for the search (e.g., • State hospital associations and medical societies
positions to be filled, date for position to be filled).
• The Fellowship and Residency Electronic Interactive
• Developing a recruitment strategy for each specific search, Database (FRIEDA)
which will vary depending on the specialty, position, geographic
• National Rural Health Association
location, and other factors.
• Various consultants and private companies
• Identifying and carrying out specific activities that reflect the
recruitment strategy for the search.
In-house recruiters can also use national and regional statistics to
• Evaluating results. help educate senior leaders in their organizations about the extent of
the shortage. “A lot of senior leaders don’t understand and appreciate
Build One-on-One Relationships the level of just how acute the problem is. So you have to arm yourself
with the proper information and show them the trends,” Guyant says.
Finding potential candidates is easier in today’s digital world than it
used to be. But getting candidates to consider available positions is
It’s also important to track internal recruitment metrics, such as
challenging, particularly since providers are often being recruited by
time to fill, and benchmark performance against other organizations
multiple organizations.
through the AAPPR benchmarking survey. “It gives you an opportunity
to step back and say, ‘This is what our numbers look like today. I know
Old-fashioned relationship building is key, Guyant believes. “A lot of
we can do better,’” says Lynne Peterson, FASPR, director, physician,
people miss this boat in this day of tech. It’s becoming increasingly
advanced provider and executive recruitment, Fairview Health
easier to differentiate yourself if you still know how to use the
Services in St. Paul, Minn.
human touch.”
Benchmark data can also help recruiters engage leaders and
Recruiters trained in the art of conversation can uncover what’s most
physicians in the recruitment process. “The days to fill metric is
important to candidates (e.g., job location, hours worked). “Talent
sometimes tied to physicians not following up with candidates in
acquisition to a large extent is match making,” Guyant says. “A good
a timely manner,” Peterson says. “If you show leaders inside your
recruiter will put on his or her consultant hat and think in terms of
organization that it is taking X many days for physicians to connect
what is in the best interest of the prospective candidate and his or her
with candidates, then leaders may provide additional support.”
family or significant other.”
Know Where You Stand with Recruits
Offer a Competitive Package
Peterson was curious how Fairview Health Services was viewed by
In the current shortage, “physicians have the buying power,” Ricks
potential candidates, particularly medical residents who lived in the
says. “It pushes the market to be extremely competitive in terms of
health system’s geographic area. Even though the health system
compensation and other incentives.”
had grown to be the fourth largest company in Minnesota, Peterson
cont’d on page 14 →
SPRING 2019 ROAR │ 13← cont’d from page 13
struggled to sign in-state residents. “I wondered why I wasn’t getting Influence Care Model Changes
people from my own backyard,” she says.
To help address primary care shortages, many health care
organizations are adopting a team-based care model that diverts
To find out, Peterson contracted with an outside company to survey
some patient care responsibilities to nurse practitioners and/or
Minnesota-based residents about their preferred employers in the
physician assistants. While in-house recruiters cannot change care
state. On the first survey, Fairview Health ranked in the middle of a
models on their own, they can help drive these changes during
list of 14 health care employers. “I was like, ‘Holy cow, how is that
conversations with operational and clinical leaders.
possible when we’re one of the largest organizations in the state?’”
“If you supply them with enough information, then they can make an
As she dug more into the data, Peterson discovered that residents
informed decision,” Peterson says. “You can use data to help support
tend to rank employers based on familiarity. She suspected that
the argument, saying something like I could get an APP [advanced
Fairview Health suffered from a branding issue. Some hospitals and
practice provider] here in three months, but a physician is going to
other organizations owned by Fairview Health, such as the University
take nine months.”
of Minnesota Medical Center, were not branded with the Fairview
Health name and, thus, unfamiliar to residents.
Engage Key Stakeholders
At first Peterson was overwhelmed by the findings. “I thought, ‘How Ricks’ last piece of advice is to engage and overly communicate with
am I going to overcome this?’” She decided to pursue one specialty all the key stakeholders involved in provider recruitment, from the
at a time, beginning with outreach programs to family medicine legal team involved in bringing foreign applicants on-board to the
physicians. The emphasis was on physician-to-physician outreach. For operational leader driving the recruitment plan or the physicians who
instance, Fairview Health primary care physicians gave slide shows at have agreed to talk with candidates. “We have to move very quickly
specific residency programs and interacted with residents at special with candidates in the current environment,” she says. “So make sure
evening lectures on clinical topics. Then Fairview Health physicians that you’re all on the same page and that you all know what you’re
followed up with the residents with a thank you note. recruiting for and what your priorities are.”
In the latest survey of residents on their preferred employers,
Fairview Health’s ranking had improved to number two among family
medicine residents.
Retain Current Residents
Eight of the 89 hospitals in the LifePoint Health system have
residency programs. Recognizing the value of this internal pipeline of
recruits, the health system named a director of residency outreach in
2018 and charged him with engaging and retaining residents.
“This is more than a job board for residents,” Ricks says. “We want to
connect residents to others in the health system and also learn from
them, such as what made them choose the residency and how can we
retain their wisdom.”
Outreach and support services have included lunch-and-learns for
residents with the health system’s chief medical officer, football
tailgates, and a bowling outing. In addition, subcommittees made
up of residents or faculty members are exploring specific goals.
For instance, a social media subcommittee is setting up a closed
Facebook page that will allow residents to connect to other residents
across all 89 LifePoint Health hospitals.
LifePoint Health is also considering building additional internal
pipelines of needed providers. One idea is to establish a
rural graduate education track at some of its rural hospitals
aimed at developing primary care physicians to serve those
smaller communities.
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or email us at sales@physiciancareer.com. visit aaos.org/careercenterNot Just One Silver Bullet
By: Char Plotycia, FASPR, MAOL
Physician Recruiter, Physician and Provider Talent Selection, Mercy Clinic
Experienced health care recruiters accept the ebb and flow of talent SOM announced in 2017 that all medical students will have free
pipelines as standard business; however, few candidate pipeline tuition. Case Western Reserve University SOM will pay the tuition and
deficits have as much impact as a physician workforce gap. fees of students who will complete a fifth research focused year. The
Estimates predict the shortage to be anywhere between 42,600 University of California Riverside provides full scholarship to medical
and 121,300. Blame it on the aging generation of Baby Boomers or students in exchange for a commitment to stay in the region for
on the institution of national health care coverage. The resulting limit practice. One-fifth of UCR’s graduates go into primary care.
to medical care access is a real threat to our nation’s health
and economy. The AMA has been driving innovations in medical school curriculum
having formed the Accelerate Change in Medical Education
This is not fresh news to physician recruiters who have progressively Consortium. The goal is to create and implement changes in
experienced the impact of physician workforce disparities for several medical school curriculum and methods to meet the dynamics of
years now. What may be fresh news is that there are new strategies modern health systems and to prepare more physicians to meet the
in play to build the number of physicians in the workforce targeting rising demand. These innovations include accelerating educational
the barriers to a robust physician talent pipeline. New, innovative timelines by eliminating seasonal breaks and using competency-
strategies target medical school enrollment and Graduate Medical based assessments to advance students.
Education training slots, medical school debt, medical school
curriculum, and residency training. Competency-based assessment at Oregon Health & Science
University SOM allowed 25 percent of the 2018 medical student class
In 2002, the AAMC called for a 30 percent increase in medical to graduate. UC Davis School of Medicine and Kaiser Permanente
school enrollment and a commensurate increase in GME training of Northern California have developed a six-year primary care
positions. The increases have been slow but crucial. The American training program — three years of medical school and three years of
Medical Association reports 25,440 U.S. medical school graduates residency. This model’s first class of residents was placed in June
in 2017, a 10.8 percent increase since 2013. In the same timeframe 2017. Competency-based advancement can have a double impact: to
the National Resident Matching Program reported a 10.15 percent reduce student debt and to allow early workforce entry.
increase in residency slots. In spite of this, there are real concerns
that future medical school graduates will be met with limited On the horizon, the AMA has announced a five-year grant program —
residency opportunities. In May 2017, The Resident Physician “Reimagining Residency.” The goal is to transform residency training,
Shortage Reduction Act of 2017 - HR 2267 was introduced to the continuing efforts to build the physician workforce to meet the needs
115th Congress, to increase the current GME cap to support 15,000 in our nation. “The times-they-are-a-changin’,” they may say, and they
additional residency positions. would be correct.
Educational debt is often a deterrent to students’ entry to medical It was more than 100 years ago that Abraham Flexner turned medical
school and can also influence post-graduate medical training. education upside down. Today our leaders again rise to meet the
Innovations that target the burden of educational debt have been need for radical transition. Flexner would have surely wished to be
made available through the medical schools. New York University here for it.
16 │ ROAR SPRING 2019Our
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www.inline.groupThe Association of Staff Physican Recruiters
2018 In-House Physician Benchmarking
Survey Participation
2019 Physician and Provider
Recruitment Benchmarking Survey
The Association for Advancing Physician and
Provider Recruitment invites anyone
directly involved, or anyone who influences
the recruitment, onboarding or retention
Fill continuum as a member of that
* percentage represents the amount filled by year end
organization’s staff to share their
candidate search statistics from the
previous year. Membership is not required to
participate. The collection period for 2019
is currently underway until May.
Searches The infographic on the
Filled, 60.2%
Open, 32%
left-hand side of the page
represents data collected
from the 2018 survey.
On Hold, 2%
Cancelled, 5.8%
This is not the year to miss participating!
We are rolling out a new Time to Fill
staff members is the
average size of a
recruitment department
calculator allowing you to account for differing
factors in a specific search. This will help you
better predict time to fill that is suited to the
search criteria at hand. We are developing
Turnover
other calculators that we will be beta
testing with this year’s data.
Take the survey at:
www.aappr.org/benchmarking
Disclaimer: The benchmarks reported in this report are intended to provide a point of reference for the purposes of education and process
refinement. There are innumerable variables that should be taken into consideration when comparing your organization’s data to national
medians, any one of which can have a significant impact on recruitment outcomes. It is recommended that a more detailed examination be
conducted with regard to the specific geographic region, population, specialty and organizational demographics of the market in question.
© Association of Staff Physician Recruiters (ASPR)Utilization of the IMG Workforce
in U.S. Physician Recruitment
By: Steven Jacobs, MA, FASPR
The U.S. physician workforce includes allopathic physicians, Medical Graduates (ECFMG). This body was established by six major
osteopathic physicians, and international medical graduates (IMGs), regulatory, medical, and educational entities dealing with physician
which are grouped based on their medical education. International workforce issues: the American Board of Medical Specialties, the
medical graduates are physicians who received their medical school American Medical Association, the Association of American Medical
education outside the United States or Canada. They comprise both Colleges (AAMC), the Association for Hospital Medical Education,
U.S. citizens (U.S. IMGs) and citizens of foreign countries (non-U.S. the Federation of State Medical Boards, and the National Medical
IMGs) who have trained abroad, and they are important segments of Association. Certification has been issued from the ECFMG since
the physician population. Today, one in four physicians practicing in 1958 and is the standard for establishing the equivalence of
the United States is trained at a foreign medical school; consequently, qualifications of IMGs. Accordingly, all lMGs must obtain ECFMG
IMGs play a crucial role in our health care system. The United States’ certification before they qualify to enter a graduate medical education
need for overseas medical schools to train physicians is likely to (GME) program in the United States. Certification from the ECFMG
continue. [1] The purpose of this article is to summarize available is also a requirement for medical licensing, as it is a prerequisite for
data regarding IMGs in training and in practice as it related to taking the United States Medical Licensing Examination Step 3. [2,3,4]
physician recruitment.
ECFMG’s program of certification assesses whether international
The Physician Recruitment industry in the United States faces a medical graduates are ready to enter U.S. graduate medical education
dilemma of unimaginable proportions in trying to staff the needs of programs that are accredited by the Accreditation Council for Gradu-
many communities based solely on a workforce of American Medical ate Medical Education (ACGME). ACGME requires ECFMG Certification
Graduates (AMGs). Simply put, there are just not enough of them for international medical graduates who enter such programs. ECFMG
being produced to meet the need. As a result, many recruitment Certification assures directors of accredited residency and fellowship
professionals find themselves looking at a vast array of IMGs to fill programs, and the people of the United States, that international
their open spots. However, many recruiters struggle with the concept medical graduates have met minimum standards of eligibility to enter
of the IMG. Questions arise as to their training, their qualifications, such programs. [2,3,4]
their immigration standing, etc.
Currently, international medical schools are not required to follow a
IMG graduates represent 26 percent of physicians in practice in the standardized system of accreditation, though they may already follow
US and 24 percent of all residents in specialty training. [2,3] For an local or international guidelines as part of their operation. This setup
IMG physician to enter the US workforce, several requirements need is likely to change, as the ECFMG has announced that by 2023,
to be satisfied. He or she must go through a systematic process of students who are seeking ECFMG certification should graduate from
evaluation and credentialing to ensure that all physicians have the a properly accredited medical school. Such an accreditation process
same level of training regardless of the place of origin of training. At should include criteria similar to those used by the Liaison Committee
the core of this process is the Educational Commission for Foreign
cont’d on page 20 →
SPRING 2019 ROAR │ 19← cont’d from page 19
on Medical Education in the United States or criteria accepted by the Research has also shown that international medical graduates
World Federation for Medical Education. [2,3,4] deliver high-quality care — in some cases, higher-quality care
than doctors educated in the States. One recent study found that
The quality of international medical schools does indeed vary widely. Medicare patients admitted to a hospital were less likely to die
But that’s equally true of schools in the United States. And the within 30 days if treated by an internationally trained doctor rather
data show that the best international schools are on par with top than one educated in the United States.
American programs.
Finally, international medical graduates tend to practice in locales
At first glance, U.S. medical schools seem to do a better job and disciplines where the need is greatest. For example, in areas
preparing their graduates for careers in medicine. Ninety-six percent where per capita income is below $15,000 per year, international
of students from U.S. or Canadian medical schools passed the U.S. graduates account for 42 percent of doctors.
Medical Licensing Examination on the first try in 2016. Just 78
percent of students from schools outside the United States or Or take primary care. By 2030, the United States could be short
Canada did so on their first go-round. 43,000 primary care physicians. International medical graduates
will be the ones who fill that shortage.
But the data from specific international schools tell a different story.
In 2015, 97 percent of students at the University of Queensland’s More than half of medical students educated in the Caribbean
Ochsner Clinical School in Australia choose primary care, compared to one-
passed step one of the exam on the first third of U.S.-educated students. At some
try. At St. George’s University in Grenada, international schools, that share is even
96 percent passed in 2016. higher — about three-quarters of grads
The figures on residencies for interna-
“By 2030, from St. George’s and almost 60 percent
from the American University of the
the United States
tional students look scary, too. In 2016, Caribbean head into primary care.
94 percent of U.S. students matched for
residencies. Just over half of students In other words, Caribbean medical
trained internationally did.
could be short schools are doing a better job addressing
America’s doctor shortage than their
43,000
But again, there was wide variation counterparts in the States.
among international schools. Some post- The region’s best medical schools provide
ed numbers on par with their U.S.-based the personalized training and support
counterparts. This year, all of the grad-
uates of the Medical School for Interna- primary care needed to turn promising students into
top-notch physicians. And American
tional Health at Ben-Gurion University of patients benefit immensely. [9]
the Negev, in Israel, who entered the
U.S. National Resident Matching Program
physicians.” Although IMGs have been playing an
secured residencies. Last year, 93 active role in the full spectrum of health
percent of American graduates of St. care in the United States, 41 percent
George’s who applied for residencies in of practicing active IMGs are in primary
the United States got them. care disciplines as defined by the AAMC, including internal medicine,
family medicine/general practice, pediatrics, internal medicine/
In some ways, these international medical schools’ stats are even pediatrics and geriatrics. [7,8]
more impressive because their students typically enter with lower
grades or MCAT scores than their U.S.-educated peers. Many Distribution of active IMGs by discipline shows that internal
students attend international schools only because they were turned medicine has the highest number of lMGs (42,141 [21 percent])
down stateside. followed by family medicine/general practice (22,965 [11 percent]),
pediatrics (14,509 [7 percent]), psychiatry (11,250 [6 percent]), and
So international medical schools tend to invest in support services anesthesiology (9,640 [5 percent]). Active IMG representation varies
that help students succeed academically and personally. The School in each discipline, with the highest percentage in geriatrics followed
of Medicine at University College Cork in Ireland, for example, by nephrology, interventional cardiology, and critical care. [1, 5, 6]
assigns each international student a senior faculty mentor to provide
advice and support. According to the AAMC, the demand for physicians is projected
to grow 26.3 percent between 2006 and 2025, from 680,500 to
20 │ ROAR SPRING 2019859,300 FTEs. Most of this projected demand increase is attributable of that key interface declining or being eliminated is remote. Practices,
to the projected growth and aging of the population, especially the hospitals, and groups will have to face the inevitability that IMGs are
former. In fact, only about one-third of the projected rise in demand a segment of the work force that must be considered as the Baby
will be attributable to the aging of the population. Most of the increase Boomer generation develops a voracious appetite for health services.
in demand from the older population will come from the increase in As physician recruitment professionals, we are charged with the
their sheer numbers, rather than the shift in the age structure of the responsibility to avail our employers of all remedies present in
population - at least between now and 2025. [1] today’s market.
AAMC further posits the following implications in the workforce planning References:
of physician utilization in the US.
1. Dill MJ, Slasberg ES; Center for Workforce Studies. The Complexities of
Physician Supply and Demand: Projections Through 2025. Washington,
1. If US MDs continue to select other specialties, the future of primary
DC; Association of American Medical Colleges; 2008. http://www.
care practice is likely to rely increasingly on foreign medical school innovationlabs.com/pa_future/1/background_docs/AAMC%20
graduates, osteopaths and non-physician clinicians. [5] Complexities%20of%20physician%20demand,%202008.pdf. Accessed
2. The demand projections are likely a conservative estimate. All signs October 16, 2018.
suggest that Baby Boomers – and most following generations – will 2. .About ECFMG: overview. Educational Commission for Foreign Medical
be aggressive about seeking care that will allow them to remain Graduates website. http://www.ecfmg.org/about/index.html. Accessed
active, and that they will be more likely to seek medical care than October 12, 2018.
previous generations. 3. About ECFMG: history. Educational Commission for Foreign Medical
Graduates website. http://www.ecfmg.org/about/history.html. Accessed
3. Over the next several years, there are several factors that could October 13, 2018.
worsen the shortage significantly. For example, if the nation does 4. About ECFMG: initiatives—medical school accreditation requirement
not implement significant delivery system reforms and/or improve for ECFMG certification. Educational Commission for Foreign Medical
efficiency and effectiveness, or if the nation moves rapidly towards Graduates website. http://www.ecfmg.org/about/initiatives-accreditation-
universal health coverage, or if the flow of IMGs slows significantly, requirement.html. Accessed October 13, 2018.
then any shortages that develop may be even more severe than 5. Center for Workforce Studies. 2014 Physician specialty Data Book.
those described in this report. Washington, DC; Association of American Medical Colleges; November
4. Given the evidence that IMG physicians are more likely to provide 2014. https://members.aamc.org/eweb/upload/14-086%20Specialty%20
Databook%202014_711.pdf. Accessed September 12, 2018.
care for poor and underserved communities, increasing the
6. Center for Workforce Studies. 2013 State Physician Workforce
diversity of the physician workforce should continue to be a priority
Data Book. Washington, DC: American Association of Medical
of the medical education community (and physician recruitment
Colleges; 2013. https://www.aamc.org/download/362168/
across the country).
data/2013statephysicianworkforcedatabook.pdf. Accessed September 8,
2018.
Whether you’re a new physician recruiter or a seasoned veteran, IMGs,
7. Fordyce MA, Doescher MP, Chen FM, Hart LG. Osteopathic physicians
visas and immigration laws are topics you may need to acquaint yourself
and international medical graduates in the rural primary care physician
with going forward.
workforce. Fam Med. 2012;44(6):396-403. [PubMed]
8. Accreditation Council for Graduate Medical Education (ACGME). Data
Understanding and strategizing about IMGs in your workplace will, Resource Book: Academic Year 2013-2014. Chicago, IL: ACGME;
at some point, become part of your everyday physician recruitment 2014. http://www.acgme.org/acgmeweb/tabid/259/Publications/
activities. Here are a few things to remember when considering IMGs for GraduateMedicalEducationDataResourceBook.aspx. Accessed August 8,
practice settings in the US. 2018.
9. Olds, G. Richard. June 2018. International medical schools have a bad
To practice in the U.S., IMGs must: reputation. That needs to change, for the good of U.S. patients. [Blog post].
Retrieved from https://www.washingtonpost.com/news/grade-point/
1. Pass Steps One & Two of the United States Medical Licensing Exam wp/2018/06/26/international-medical-schools-have-a-bad-reputation-
that-needs-to-change-for-the-good-of-u-s-patients/?noredirect=on&utm_
2. Get certified by the Educational Commission for Foreign
term=.4d468b46c407.
Medical Graduates
10. Mullaney, Amber. June 2016. Immigration, IMGs, Visas, Sponsorships and
3. Complete a residency or fellowship(s) program in the U.S. Physician Recruitment [Blog post]¬. Retrieved from https://info.practicelink.
(regardless of whether or not they have already completed one in com/blog/immigration-international-medical-graduates-visas-sponsorships-
their own home country- with the exception of Canada where most and-physician-recruitment.
residency programs are recognized in the U.S.) [10] 11. Carroll, Aaron. October 2017. Why America Needs Foreign Medical
Graduates. [Blog post]. Retrieved from https://www.nytimes.
In summary, the IMG population of physicians play a vital role in the com/2017/10/06/upshot/america-is-surprisingly-reliant-on-foreign-
momentum and stability of the U.S. health care system. The likelihood medical-graduates.html.
SPRING 2019 ROAR │ 21ROSMANSEARCH, INC.
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