Physician offices projected to see a decade of significant job growth
■ Concern is high that work force shortages will persist and that paying for additional staff will be challenging.
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The number of physicians, administrators and allied health professionals employed by medical practices is expected to increase substantially from 2008 to 2018. Hospital employment will grow more slowly, according to Bureau of Labor Statistics projections.
What's unclear is where the physicians will come from to fill those positions, and how practices, given current payment trends, will be able to hire the number of staff the bureau projects will be required.
"The population is aging and growing, and, no matter how you're going to slice it, we're going to need more folks," said Mark Doescher, MD, MSPH, director of the WWAMI Rural Health Research Center at the University of Washington. "More and more care that used to be done on an acute short-stay hospitalization is now outpatient."
Experts are concerned that these projections will mean that current shortages of doctors and nurses will get worse.
"We have coming work force issues that are very real and that we are going to have to grapple with," said Dr. Doescher.
The situation for physician offices might be further complicated by the fact that registered nurses in this setting tend to be older than those who work in hospitals, so they may be retiring at a faster rate, experts said.
"I don't know how physicians are going to do it," said Peter Buerhaus, PhD, RN, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University in Nashville, Tenn.
The American Medical Association recognizes the existing shortage of physicians in many specialties and regions. The Association also supports basic nursing education opportunities, work force incentives and other efforts to increase the supply of registered nurses.
The Bureau of Labor Statistics, a division of the U.S. Dept. of Labor, projected on Dec. 10, 2009, that from 2008 to 2018 the civilian labor force will grow by 12.6 million and total employment will increase by approximately 15.3 million jobs. Health care and social assistance will add approximately 4 million positions, with 772,200 of these in physician offices. About 109,300 of these new jobs will be for physicians, and 106,500 for registered nurses. In addition, 107,600 additional medical assistants will be needed, along with 248,700 office and administrative support positions.
The Bureau of Labor Statistics does not break down these numbers by type of physicians or practices. But experts suspect that much of the growth of physician jobs will be in primary care specialties, which are already seeing work force shortages.
"There's not a financial incentive to go into primary care. Unless primary care doctors are compensated, there won't be the physicians to coordinate the level of care," said Brian McCartie, vice president of business development for Cejka Search, a health care executive and physician search firm based in St. Louis. "A lot of our clients are very worried about primary care."
High demand is also expected in geriatrics and other specialties, such as orthopedic surgery, that provide treatment for age-related conditions.
Many of the administrative positions are expected to be added to larger practices or health systems.
The only position in a physician's office not expected to increase is file clerk, primarily because electronic medical records are becoming more common.
"This is the story of increasing complexity in health care, and why solo practices and small practices are having such difficulties with the business of medicine," said David N. Gans, vice president of innovation and research for the Medical Group Management Assn. "Existing practices are getting larger and adding sophistication. They are reducing their transcription staff and the number of medical records clerks. They are adding IT staff and technicians."
Hospital job growth is expected to continue, but on a more modest scale. Hospitals will add 571,000 staff over the next decade, including 274,200 registered nurses, but only 9,600 physicians and surgeons, the Bureau of Labor Statistics projects.
Some experts say the bureau's numbers run counter to their own experiences. For instance, physician search firms report an increase in the proportion of requests from hospitals, and a decrease from medical practices.
"The trend we're seeing is a shift back to hospital employment of physicians, and I don't see that changing any time soon," said Jim Stone, managing partner of a physician search company, the Medicus Firm.
Physicians can also expect employment opportunities in the offices of other health care professionals, such as optometrists, audiologists, mental health professionals, and physical, occupational and speech therapists. According to bureau projections, approximately 2,200 physician jobs will be added in those settings. Another 9,800 physician jobs will be added at outpatient care centers. The federal government is expected to hire an additional 2,100 physicians. State and local governments will hire another 1,200.
Although projections indicate more jobs will be created than people added to the labor pool, the Bureau of Labor Statistics says this does not necessarily mean a worker shortage, since individuals might hold more than one job. But other surveys have found that health care institutions are already having work force concerns.
One survey, released Nov. 16, 2009, by AMN Healthcare Services Inc., in partnership with the National Council on Physician and Nurse Supply, found that nearly all hospital CEOs believed there was a shortage of physicians, nurses and allied health professionals. In addition, the vacancy rate for physician jobs was 11%. About 6% of nursing jobs went unfilled, as did 5% of jobs for allied health professionals.