What specialties are hot?
By Richard Kneidel
Senior Vice president
Weatherby Health Care
Norwalk, CT
The evidence is clear within the health care arena that the evolution of managed care has created dramatic changes, one of which includes the increased demand for primary care physicians as the "gatekeepers" of patient care and cost containment. Graduating MDs responding to this shift are flocking to primary care residencies, swelling this year’s graduating class to more than 3,000 family physicians and almost 8,000 internists.
As a result of this migration, one might assume that eventually the market would become saturated creating a physician glut. However, this has not been the case and is not predicted to occur for several years.
There is still a deficit of primary care physicians, especially family physicians, in communities throughout the country, and a growing number of MDs continue to choose primary care specialties. Newly emerging staffing models for primary care physicians continue to make this a very popular and secure medical discipline. We are beginning to see a trend among primary care residents who are showing greater interest in practice opportunities in Urgent Care Centers and in-patient services (hospitalists). (See December Physician Relations Update, p. 135, for more information on the hospitalists trend).
Improved quality of living
Opportunities at Urgent Care Centers allow physicians a more normal schedule, with a steady stream of patients during a given shift. Due to the elimination of admitting and call schedules, many physicians find these settings offer a quality of life not present in more traditional practice settings. The flexibility and freedom provided by this type of staffing model is becoming an attractive feature for many graduating residents.
For the same reasons, in-patient service/hospitalists have become an increasingly popular choice for many internists. A hospitalist provides in-patient care within a hospital facility, either as an employee or on a contractual (independent or group) basis.
Hospitalists, in coordination and communication with admitting primary care physicians, can provide a more comprehensive and focused continuity of care. This is accomplished without subjecting either physician to the demands of a rigorous call schedule.
Another specialty subset of primary care that is gaining in popularity is Med-Ped. The combination of a two year internal medicine residency, coupled with a pediatric residency, produces an internist trained to treat a broader spectrum of patients within a traditional primary care hospital and outpatient setting.
Of course, no discussion of primary care specialties would be complete without the inclusion of OB/GYN and pediatrics.
The current market force creating the biggest impact in obstetrics is the almost universal demand for female OB/GYNs. As we speak to hundreds of single- and multi-specialty groups daily, the common theme from virtually all of them references daily calls from patients with only one question: "Do you have a female physician on staff?" In the majority of cases, when the answer is "no," the next sound on the line is a resounding "click."
Here is true evidence that no matter what the architects of modern health care believe, it is ultimately the patients who will chart the course for the future of medicine. With starting salaries for female OBs hovering between $150,000 to $180,000 (variances based on geography), the graduating female M.D. or D.O. would do well to consider a career in this vastly unbalanced specialty.
Pediatricians in demand
Pediatrics also continues to be a classic example of the effects of the basic laws of supply and demand. With the number of pediatric practice opportunities far outweighing the supply of graduating residents, the average pediatrician, although compensated similarly to family physicians and internists ($125,000 on average), have the luxury of a veritable cornucopia of practices and locations from which to choose.
In the next decade, with the aging baby boomer generation, those specialties relating to illnesses typically found in geriatric patients will become increasingly important disciplines. These include Cardiology, Pulmonolgy, Hematology-Oncology, and Dermatology. Depending on the level of training and competence in a variety of procedures, a freshly trained internist, packing a fellowship in cardiology, can easily command a first year income of $175,000 to $200,000. Similar salaries are offered in other subspecialties of primary care.
The development of these and other contemporary staffing models coupled with a strong market demand for traditional family practice physicians indicates that primary care is still a "hot specialty" and will remain so for many years to come.
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