A March 2015 report by the Association of American Medical Colleges projects that the United States will face a shortfall of 46,000 to 90,000 physicians by 2025. The physician shortage remains especially problematic in rural areas, where more than 20 percent of the U.S. population resides but only 10 percent of physicians practice, according to a position paper by the American Academy of Family Physicians (AAFP).
For a number of reasons, many rural hospitals and clinics struggle to recruit and retain primary care and emergency physicians, internal medicine subspecialists such as oncologists and interventional cardiologists, and surgeons in various specialties.
More and more traditional country doctors are retiring or leaving private practice for other opportunities, overwhelmed by new government regulations in the wake of the Affordable Care Act, performance-based reimbursement policies and increasingly stringent requirements for maintaining board certification and licensure.
At the same time, most physicians attend medical school and serve residencies in comparatively urban locales, where they become accustomed to city conveniences, a selection of restaurants and retail stores, and various cultural attractions and sporting events, according to an August 2015 article in The Atlantic titled “Why Are There So Few Doctors in Rural America?“ As a result, most new medical graduates prefer to live in larger communities.
How then can rural communities attract and retain physicians? Because doctors who grow up in or train in small country towns are more likely than other physicians to practice in such communities, medical schools have embraced a number of strategies that attempt to leverage these trends. For example, several new colleges of medicine, including osteopathic medical schools, prioritize recruiting students from health professional shortage areas. And some established medical schools have rural medicine tracks that include preceptorships, clerkships and graduate medical education positions or rotations in medically underserved communities.
But the long-range solutions championed by academic medicine do not address rural hospitals’ immediate needs or take into account the practice inclinations of today’s physicians, says Bob Johnson, MD, the CEO of Remedy Medical Services, a multispecialty group practice based in Eau Claire, Wisconsin, that deploys its physicians to hospitals and clinics in the Midwest.
During his 10 years running Remedy Medical Services, Johnson discovered that while most physicians may not want to plant roots in remote rural towns, many will enthusiastically do shift work in such communities for a defined period of time. “I have doctors who commute from as far as California and Florida because they love this kind of work,” he says. “They work for four days on and eight days off.” Under contract with hospitals, the group practice pays doctors’ travel expenses and provides housing in rented homes.
“What we’ve tried to solve with Remedy Medical Services is how to get doctors to go where no one wants to live,” says Johnson, a board-certified family physician.
Allure of adaptability
The demand by physicians, especially the young or semi-retired, for flexible, variable-length assignments also explains the rapid rise of locum tenens staffing agencies. Citing a survey by Staff Care, a locum tenens firm in the Dallas area, the October issue of Family Practice News reports that 87 percent of residents were open to “test driving various practice styles and geographic locations by working temporary assignments post residency.” In addition, 15 percent of the survey participants said they wanted their first job after residency to be part time, defined as 30 hours per week or less.
The problem with locum tenens agencies, however, is that they charge hospitals and other health care organizations high fees for their services, contends Johnson. He experienced this firsthand when Remedy Medical Services turned to such an agency to find a doctor in a pinch to replace one who got sick. “I went to a locum tenens agency, which charged me more than I could bill the hospital for my services,” he recalls.
Alternative to employment
In the current high-pressure regulatory compliance environment, hospitals increasingly employ physicians. The number of hospital-employed primary care physicians doubled from 10 percent in 2013 to 20 percent in 2014, according to a survey by Jackson Healthcare, a staffing agency based in Alpharetta, Georgia. And nearly 40 percent of the AAFP’s members are hospital employed.
Still, studies indicate that the vast majority of medical graduates do not want to be employees, Johnson contends.While they may not want to assume the risks of starting a private practice, many doctors would like to be independent contractors, working when and where they want to, he says.
This realization led Johnson to start a new venture, Remedy Direct, a membership-based online service that helps physicians become independent contractors and connects them with hospitals needing their services. By eliminating the need for an intermediary locum tenens agency, hospitals can slash their costs while physicians can make more money, he says.
“The beauty of this [approach] is that hospitals can save a significant amount of money,” Johnson insists. “And doctors will be directed to the places they want to work.”
Physicians pay a $79 monthly membership fee to join Remedy Direct, while hospitals pay a one-time $1,500 fee. Member hospitals can post as many positions as they want on the website. Besides access to these listings, physicians receive the resources they need to become and remain sole proprietors—for example, information and selected vendors that will help the doctor set up as an S corporation or LLC, acquire medical liability insurance, and obtain banking services and lines of credit.
Using Remedy Direct, physicians can establish short-term or long-term relationships with hospitals anywhere in the country.
“There is a rebellion going on in medicine,” observes Johnson. “[Doctors] desire flexibility when it comes to where, when and how much they work. Remedy Direct is a win-win model that enables independent physicians to take charge of their destinies while reducing health care costs.”