Doctors looking for work or a change of scenery are increasingly gaining the upper hand, and hospitals that don't have a game plan on how to make themselves stand out might get left out in the cold.

You're probably already familiar with all the ingredients that are coming together to create the stew that is the current doctor market. With the economy steadily improving, physicians who have put off retirement or switching jobs are starting to make moves. Some 44,250 full-time doctors could be lost in the next four years, equaling about 91 million fewer patient encounters each year, one survey found. Plus, millions of new patients are expected to grab health insurance from insurance exchanges and flood the health care system come 2014, further worsening the doc shortage.

Smart hospitals are investing dollars into their recruitment infrastructure and devising a plan to both attract new physicians and keep the old ones, says Gilbert Drozdow, M.D., an anesthesiologist and executive vice president for physician services firm Sheridan Healthcare, Sunrise, Fla.

"If you're a hospital that has given lip service to recruitment, you're going to be in trouble," he says. "You need to build out an infrastructure for recruitment, whether in-service or outsourced. But one way or another, you're going to be paying for it. The doctors are not going to come knocking on your door; you have to go out there and find them."

Nowadays, providing the red carpet treatment for potential doctor hires almost isn't enough, says Lori Schutte, president of recruiting firm Cejka Search. Employers are being forced to get "uber" creative while trying to seal the deal with potential new hires. To stay competitive, hospitals should try to avoid behaviors that might dissuade doctors from landing elsewhere — drawn-out hiring processes, unwieldy contract negotiations or completely excluding the ever-important spouse from the entire affair.

A recent survey of medical residents and fellows by Cejka found that students — who are starting job searches earlier than ever — put a key emphasis on family. Some 76 percent said that proximity to their loved ones is a factor in picking their next employer, and 67 percent said their spouse or significant other played into the final decision. Hospitals would be wise to carefully screen doctors to figure out motivations and see if the hire is a good fit, according to the survey. Turnover rates peak in physicians' first year of practice, and another study by the recruiting firm found that physician turnover hit its highest rate in eight years of tracking those numbers.

There's no master list of questions to ask, really, Schutte says, and each hospital or health system should look inward as it figures out the process. If it's a team-oriented environment, for example, does the doctor work well with others?

"The first thing to know about cultural fit is: 'what's your culture?' You have to know something about yourself and the organization you work for to find the person (who's) going to fit best for your organization," she says.

Another key piece to the recruitment and retention puzzle is putting physicians in key leadership roles. Docs are sometimes wary of leaders from business backgrounds, and physician leadership can be the "secret sauce" not just to leading clinical integration and value-focused efforts, but also making your hospital a more appealing landing spot for candidates, Drozdow says.

"Certainly having physicians in leadership positions can make the organization sensitive to the needs of physicians, but it really is about the design of the care model and the interest you have in hearing the physician's voice within the organization," says John Combes, M.D., senior vice president of the American Hospital Association and president of its Center for Healthcare Governance. "I think those two things will help physician recruitment and retention. They need to know that they're an important part of the organization, and that their opinion helps shape the focus of the institution going forward."