Brace yourself. Demand for primary care physicians is about to skyrocket at a time when there aren't enough to go around. So hospitals need to make themselves as attractive as possible to maintain this vital link to patient referrals and care management.

A number of factors are behind the jump in demand. The health reform law will usher nearly 30 million previously uninsured Americans into the covered market. The aging population is causing an increase in chronic conditions and fueling demand for outpatient services. And, the shift to medical homes and accountable care places a greater emphasis on care coordination, putting primary care physicians at the center.

But the nation already is anticipating a shortage of 35,000 to 44,000 primary care physicians for adults by 2025, according to the American College of Physicians.

"You can empower everyone in the universe to purchase insurance, but without the physicians to provide the care and continuous care, then you've got a severe problem," says James J. Dickson, CEO of Copper Queen Community Hospital in Bisbee, Ariz. The reform law doesn't take enough steps to boost the number of primary care physicians, he and others say.

The shortage is forcing hospitals interested in hiring primary care physicians to compete. They're doing it by offering good salaries, little or no call duty, regular work hours and, in some cases, signing bonuses.

Copper Queen Community Hospital, a 14-bed critical access hospital, uses these and a variety of other strategies. The hospital employs its doctors through Copper Queen Medical Associates and offers a competitive salary, starting at $175,000 a year. In addition, physicians who exceed a productivity target receive a bonus.

The primary care doctors work regular hours, are on call only every seven weeks, are covered under the hospital's medical malpractice policy, and are plugged into the facility's electronic health record system. Copper Queen also has a telemedicine arrangement with a Tucson hospital so that its physicians can get their continuing medical education. "We've taken away the major inertia to physicians practicing in rural areas by having a good support system," Dickson says.

As the new set of forces renews interest in the purchase of primary care practices though, hospitals also should be careful who they hire, says Jillian Addy, director at Sg2, a Chicago-area health information company. Having rigorous physician-selection criteria, based on productivity and the quality of care, is crucial.

Hospitals also should be prepared to see some red ink, says Steve Messinger, managing director of health care consulting firm ECG. It's difficult for a hospital to generate any kind of margin on employing primary care physicians. Relative to their revenue base, primary care physicians have the highest expense base of just about any physician because of the overhead associated with office-based practice.

"You're doing it to stabilize the medical community or to make sure there are enough primary care physicians who are going to refer to the specialists in the community," Messinger says.

Once a hospital fills out its physician roster, the trick is keeping the doctors at a time when competition is fierce, Addy says. Hospitals should have an on-boarding team that provides physicians with mentors and helps them understand the organizational culture, expectations and core values. The goal is to make the physician's transition as smooth as possible.

Other steps include providing social engagements, introducing the new physician to the community, arranging meetings with high-level management personnel, and having a team that serves as a liaison between physicians and the hospital.