Demand for Medical Specialists Increases, Surpassing Primary Care

Recruiting assignments for medical specialists increased to 78 percent in 2019 as demand for primary care physicians declined, Merritt Hawkins reported.

Hospitals, medical groups, and other healthcare organizations increased their demand for medical specialists from 2018 to 2019 despite the industry-wide push for more primary care, according to Merritt Hawkins’ annual report on physician recruiting and incentives.

The report, 2019 Review of Physician and Advanced Practitioner Recruiting Incentives, showed that 78 percent of Merritt Hawkins’ recruiting assignments from April 1, 2018, to March 31, 2019 were for medical specialists, including psychiatrists, OB/GYNs, and radiologists.

The number of recruiting assignments for medical specialists is up from 67 percent four years ago, and most notably, higher compared to the number of requests for primary care doctors.

In contrast, the number of searches for primary care physicians (i.e., family doctors, internists, and pediatricians) decreased by 8 percent year-over-year and by 38 percent compared to four years ago, the report showed.

“While demand remains strong for primary care physicians, specialists are increasingly needed to care for an older and sicker population,” Travis Singleton, executive vice president of Merritt Hawkins, stated in a press release. “In some medical specialties, shortages are emerging that will pose a serious challenge to public health.”

The healthcare industry is facing a significant physician shortage problem, particularly in terms of medical specialists. In April 2019, the Association of American Medical Colleges (AAMC) projected a shortage of up to nearly 122,000 physicians by 2032, an increase from the previous year’s projected shortfall of 121,300 physicians by 2030.

The updated projection included significant shortages of primary care physicians and medical specialists alike. However, medical specialties are slated to take a greater hit by 2032, with a projected shortage of approximately 67,000 specialists versus up to 55,200 primary care physicians.

With a significant specialist shortage occurring, hospitals, medical groups, and other healthcare organizations are actively seeking physicians to fill their specialist roles, Merritt Hawkins found.

In particular, organizations are increasingly demanding psychiatrists. 2019 is the fourth consecutive year that psychiatry was the second most requested search behind family medicine. The specialty notably rose from the 13th spot in 2000.

Other medical specialties making the list of top ten most requested searches in 2019 included OB/GYN, radiology, neurology, and gastroenterology.

While searches for medical specialists dominated in 2019, family medicine remained the most requested search assignment, marking its 13th consecutive year in the top spot, Merritt Hawkins reported.

Demand for primary care is driven by rising healthcare costs, an aging population, and most importantly, emerging value-based payment models. Alternative payment models place primary care physicians at the center of care delivery to coordinate care, manage chronic conditions, and prevent costly conditions and events from progressing or occurring.

Hospitals and other provider organizations are increasingly engaging in value-based payment and population health models. One recent study from the Health Care Payment Learning & Action Network (LAN) showed that about one-third of healthcare payments made in 2017 were tied to alternative payment models and an additional 25 percent were linked to quality and value.

Healthcare organizations are still looking to bolster their primary care workforce to succeed in alternative and value-based payment models. In fact, Merritt Hawkins found that larger hospitals and health systems are recruiting primary care providers en masse, with some systems seeking 200 or more physicians at a time.

However, demand for primary care physicians continues to decline compared to previous periods. In 2014 and 2015, Merritt Hawkins saw a record-high number of family medicine searches (734). That number decreased by 38 percent in 2019.

The report explained that the decrease in primary care physician demand may be natural. Healthcare organizations recruited a large number of primary care physicians in the recent past and are now addressing other priority areas, such as behavioral health and radiology.

But the decline in demand could also indicate a value-based care shortfall considering the significant uptick in recruiting assignments for medical specialists.

“What also is notable about this trend is that emerging integrated, value-driven delivery systems are designed to emphasize prevention and to address the social determinants of health, reducing the need for costly specialist interventions. The accelerated recruitment of specialists indicates that demand for surgical and diagnostic specialists, driven largely by patient aging, is outpacing efforts to manage care and reduce specialty utilization,” the report stated.

Merritt Hawkins added that, “It may be the case that the healthcare system cannot manage its way out of our collective demographic destiny, which will be characterized by a growing number of older patients with a growing number of healthcare needs. Organs, bones, skin and psyches eventually reach the point of obsolescence, and an increasing number of medical specialists are being recruited to address the physical and mental consequences of aging.”

Furthermore, specialists generate greater revenue volumes compared to primary care physicians. With operating income falling for two-thirds of health systems from 2015 to 2017, organizations may be looking to boost their bottom line through revenue-generating specialists.