Redefining Recruitment to Retention

How to Maximize Your Chances of Successful Neurology Recruitment in the Face of Short Supply

Article provided by RosmanSearch, Inc.
By: Judy Rosman, President


Whatever your neurology recruitment need, you can maximize your chances of success by understanding the neurology recruiting landscape and adapting your practice opportunity to current market trends.

Factors Driving Supply and Demand in Neurology—the Shortage is Bigger than You Think

Studies point to an aging population and a limited candidate pool as the reasons for the neurology shortage. A 2013 study published by the AAN found, by looking at the number of neurologists, retirement probability, the number of new graduates, and the number of hours worked, that demand outstripped supply by 11%, and estimated that the demand would outstrip supply by 19% by 2025. Dall, Timothy M et al. “Supply and demand analysis of the current and future US neurology workforce.” Neurology vol. 81,5 (2013). However, this estimate may be a gross underestimate of the shortage because it doesn’t take into account more recent factors increasing the demand for neurology services and constraining supply, including:

1. increased sub-specialization,
2. the evolution of the inpatient/outpatient split practice,
3. the increase in the value candidates place on work-life balance, and
4. the high percentage of candidates requiring visa support.

Sub-specialization and the Evolution of the Inpatient/Outpatient Split Practice

For patients suffering from neurological problems, the treatment options have dramatically increased in recent years. This increase in therapeutic options has increased the patient demand for subspecialized neurology care, and is accompanied by a sharp increase in sub-specialization among neurologists. Based on the latest data from the American Academy of Neurology, 90% of residents report plans to pursue a fellowship following residency. Neurology residency training in 2017 Mahajan, Abhimanyu et al Neurology Jan 2019, 92 (2) 76-83. The AMA puts this number at 89%, and our own data also show that 88-90% of new graduates go on to do fellowships.

Accompanying this steep trend towards sub-specialization, neurology practices have tended to split inpatient from outpatient responsibilities. In many practices, neurohospitalists have taken the hospital call burden away from the outpatient neurologists. Neurohospitalists usually prefer working 7on/7 off, ideally in 10-12-hour shifts requiring no more than 12-15 patient encounters per day. Conversely, neurologists who are fellowship trained in an outpatient-focused sub-specialty generally prefer jobs that are purely outpatient which will allow them to focus 50% -80% or more on their subspecialty.

What is the Impact of Sub-specialization on Neurology Recruitment?

To replace a do-it-all neurologist, you may need to hire 2-3 neurologists to replace that one individual. If you do find a general neurologist who is willing and able to do it all, we advise you to enthusiastically incorporate that neurologist into your practice!

Work-Life Balance

While modern healthcare encourages physicians to work as many hours as they will give, candidates often express a desire for work-life balance. Burnout is common, but neurologists who are unhappy with their work hours can easily find new employment with fewer hours. Neurologists seeking to juggle work and family life may seek part-time positions, further constraining supply in a fixed pool of neurologists.

International Candidates

According to our data, over 30% -40% of U.S. neurology trainees in recent years are foreign medical graduates. They have done their residencies in the US which makes them US Board Eligible (or board certified if they have already taken and passed the board exam) but will need some type of visa sponsorship (primarily J-1 or H-1B). These candidates often prefer jobs in locations which offer a community of individuals from similar ethnic and/or religious backgrounds.

How do you use these trends to your advantage?

1. Adapt your job to the candidate pool: Sub-specialization in neurology is now the rule, and general neurology is the exception. Encourage your administrators to figure out which neurology sub-specialties could be well-supported by your facility and your patient population. While the need for general neurology is often paramount, especially in smaller communities, half of a good neurologist’s time doing general neurology is better than nothing. Advertise for the sub-specialists you can legitimately support, and make 50% general neurology a part of the job. Making your job attractive to sub-specialists who will each do 50% general neurology may be a path to meeting your general neurology need; it will just take more than one hire to replace a retiring neurologist.

2. Use APPs to help meet your general neurology need: Some hospitals are training APPs to run a neurology access clinic (which may have 3-4 APPs supervised by a neurologist) in order to reduce patient wait times. Additionally, NPs and PAs can often relieve much of the burden of the general neurologist by doing pre-screening and follow-ups.

3. Get creative to adapt to candidate’s desires for fully inpatient or fully outpatient work: We have seen a smaller hospital team up with a slightly larger hospital nearby to hire a neurohospitalist who covered both hospitals. Hospitals that do not have the volume or budget to support two 7 on/7 off neurohospitalists may hire one neurohospitalist who works M-F, 9am-5pm.

4. Provide Visa Support: Since 30-40% of new graduates in any given year are foreign medical graduates, if you can provide an H-1B or J-1 visa waiver, you should.

5. Offer Work-Life Balance: While you may want a more-than-full-time neurologist to meet the demands of your practice, a .5% or .8% FTE is better than none! Practices that can proudly advertise part-time positions or limited working hours are at an advantage in this hiring market.

6. Keep Compensation Competitive: There is no room for wishful thinking when it comes to compensation for neurologists. Your most senior neurologists may never have made as much money as it will take to recruit a new neurologist. MGMA 2019 Median reported compensation for neurology (based on 2018 data) was up almost 7% to $323,190. Source: 2019 MGMA DataDive Provider Compensation, based on 2018 data. Used with permission from MGMA, 104 Inverness Terrace East, Englewood, Colorado 80112. 877.275.6462. Copyright 2019.

7. In our experience, guaranteed compensation for certain sub-specialties and in less popular locations may need to be significantly more.

8. Rural Communities: If you are in a rural community and desperately need a general neurologist, find every neurologist in private practice within a 90-minute drive from your facility. Offer them a comfy guaranteed salary, no administrative burden and a quality lifestyle.

Sharing these strategies with your key stakeholders can help you win in an incredibly tight neurology hiring market!

Questions? Comments?

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