2014 Merritt Hawkins Survey

2014 REVI EW
OF PHYSICIAN AND ADVANCED PRACTITIONER

RECRUITING INCENTIVES
An Overview of the Salaries, Bonuses, and Other Incentives Customarily
Used to Recruit Physicians, Physician Assistants and Nurse Practitioners
2014 Merritt Hawkins | 5001 Statesman Drive | Irving, Texas 75063 | (800) 876-0500 | merritthawkins.com
Overview
Key Findings
Merritt Hawkins 2014 Review of Physician and Advanced Practitioner
Recruiting Incentives: Recruiting Assignment Characteristics and Metrics
Trends and Observations
Summary
2
3

5
15
38
For additional information about this survey contact:
Phillip Miller
(800) 876-0500
phil.miller@amnhealthcare.com
5001 Statesman Drive
Irving, Texas 75063
MerrittHawkins.com
2014
REVIEW
OF PHYSICIAN AND
ADVANCED PRACTITIONER
RECRUITING INCENTIVES
1994-2014
2014 Review of Physician and Advanced Practitioner Recruiting Incentives 2
Overview
Merritt Hawkins is a national healthcare
search and consulting rm specializing in
the recruitment of physicians in all medical
specialties and other advanced practice
clinicians. Now celebrating its 27th year of
service to the healthcare industry, Merritt
Hawkins is a company of AMN Healthcare
(NYSE: AHS), the nations largest healthcare
stafng organization and the industry
innovator of healthcare workforce solutions.
This report marks Merritt Hawkins 21st
annual Review of the search and consulting
assignments the rm conducts on behalf
of its clients. Merritt Hawkins Review is the
longest consecutively published and most
comprehensive report on physician recruiting
incentives in the industry. The Review is part of
Merritt Hawkins ongoing thought leadership
efforts, which include surveys and white papers
conducted for Merritt Hawkins proprietary use,
and surveys and white papers Merritt Hawkins
has completed on behalf of prominent third
parties, including The Physicians Foundation,
the Indian Health Service, Trinity University,
Texas Hospital Trustees, and a Subcommittee
of the Congress of the United States.
The 2014 Review is based on the
3,158 permanent physician and advanced
practitioner search assignments that
Merritt Hawkins and AMN Healthcares
sister physician stafng companies (Kendal
& Davis and Staff Care) had ongoing or
were engaged to conduct during the
12-month period from April 1, 2013, to
March 31, 2014.
The intent of the Review is to quantify
nancial and other incentives offered by
our clients to physician and advanced
practitioner candidates during the course of
recruitment. Incentives cited in the Review
are based on formal contracts or incentive
packages used by hospitals, medical groups
and other facilities in real-world recruiting
assignments. Unlike other surveys,
Merritt Hawkins Review of Physician
and Advanced Practitioner Recruiting
Incentives tracks starting salaries and
other perquisites, rather than total
annual compensation. It therefore
reects the incentives physicians and
advanced practitioners are offered in
the recruiting process, rather than total
average compensation.
The range of incentives detailed in the Review
may be used as a benchmark for evaluating
which recruitment incentives are customary
and competitive in todays physician recruiting
market. In addition, the Review is based on
a national sample of search assignments
and provides an indication of which medical
specialties are currently in the greatest
demand and the types of medical settings into
which physicians and advanced practitioners
are being recruited.
3 2014 Review of Physician and Advanced Practitioner Recruiting Incentives
Key Findings
Merritt Hawkins 2014 Review
of Physician and Advanced
Practitioner Recruiting
Incentives reveals a number
of trends within the physician
and advanced practitioner
recruiting market, including:
For the eighth consecutive year,
family physicians were number
one on the list of Merritt Hawkins
most requested recruiting assignments.
General internists were second on the
list, also for the eighth consecutive year,
highlighting the continued nationwide
demand for primary care physicians
Combined, advanced practitioners,
including physician assistants (PAs)
and nurse practitioners (NPs), were
fth on the list of Merritt Hawkins
most requested recruiting assignments,
though neither were in the top 20
three years ago. The number of search
assignments Merritt Hawkins conducted
for PAs and NPs increased 320% over
the last three years, underscoring the
emerging shortage of these professionals.
Demand also remains strong for
physicians providing inpatient care. After
family physicians and general internists,
hospitalists ranked third among Merritt
Hawkins top 20 search assignments.
Lack of resources and diminished interest
in inpatient psychiatry continues to stoke
a stafng crisis in behavioral health.
Psychiatrists were fourth on the list of
Merritt Hawkins most requested search
assignments, highlighting the ongoing
critical shortage of physicians specializing
in behavioral care.
The decline of physician private
practice continues. Fewer than 10%
of Merritt Hawkins search assignments
were for settings featuring private
practice, compared to over 45% in
2004. 64% of Merritt Hawkins search
assignments were for hospital-employed
settings, while solo practice, which
represented 20% of Merritt Hawkins
search assignment settings in 2004,
represented less than 1% of Merritt
Hawkins assignments in the period
covered by this Review.
N
P
s
P
A
s
<10%
45%
Family
Physicians

Concierge practice appears to be
gaining momentum. Though only 1%
of Merritt Hawkins search assignments
were for concierge practice last year,
two to three years ago Merritt Hawkins
received virtually no requests to recruit
into concierge settings.
A proliferating number of sites of
service, including free-standing
emergency departments, community
health centers, retail clinics, and urgent
care centers, are recruiting physicians,
a sign that healthcare providers have
adopted a strategy predicated on
being everywhere, all the time.
Like hospitals, these facilities also are
employing physicians.
The use of quality/value-based
physician incentives took a step
back last year. Only 24% of Merritt
Hawkins recruiting assignments
featured production bonuses in which
at least part of the bonus was based
on quality/value metrics, down from
39% last year, signaling the difculty
many healthcare organizations are
experiencing transitioning from
volume-based incentives to quality/
value-based incentives.
Relative Value Units (RVUs) continue
to be the most frequently utilized
volume-based production incentive
and were featured in 59% of Merritt
Hawkins recruiting assignments in which
a production bonus was part of the
incentive package, up from 57% last year.
Demand for physicians is not conned
to traditionally underserved rural areas.
Merritt Hawkins worked in all 50 states
in 2013/14, and 41% of the rms search
assignments took place in communities
of 100,000 people or more.
1%
39% 24%
2013/14
2012/13
Merritt Hawkins 2014 Review
Practitioner Recruiting Incentives:
Recruiting Assignment Characteristics and Metrics
(All of the following numbers are rounded to the nearest full digit.)
Total Number of Physician/Advanced Practitioner Search Assignments Represented
The Review is based on the 3,158 permanent physician and advanced practitioner search assignments
Merritt Hawkins/AMN Healthcares physician stafng companies had ongoing or were engaged to
conduct during the 12 month period from April 1, 2013 to March 31, 2014.
Practice Settings of Physician and Advanced
Practitioner Search Assignments
1
2
2010/11
Hospital
Group
Solo
Partnership
Association
Community HC/ IHS
Academics
Concierge
Other
(1,495) 56%
(505) 19%
(54) 2%
(344) 13%
(82) 3%
N/A
N/A
N/A
(187) 7%
2011/12
N/A
N/A
Hospital
Group
Solo
Partnership
Association
Community HC/ IHS
Academics
Concierge
Other (135) 5%
(1,710) 63%
(436) 16%
(28) 1%
(220) 8%
(29) 1%
(152) 6%
2012/13
Hospital
Group
Solo
Partnership
Association
Community HC/ IHS
Academics
Concierge
Other
(1,975) 64%
(493) 16%
(29) 1%
(94) 3%
(28) 1%
(305) 10%
(153) 5%
(20) 1%
N/A
(2,006) 64%
If Academic Medicine, what type of position?* (Of 188 Academic searches)
If Partnership, time to partnership eligibility (of 93 searches offering partnership)
50 States Where Search Assignments Were Conducted
AK, AL, AR, AZ, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI,
MO, MN, MS, MT, NC, ND, NE, NH, NJ, NM, NY, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX,
UT, VA, VT, WA, WI, WV, WY
Number of Searches by Community Size
3
4
2013/14 2011/12 2010/11
Immediate / One Year 33 (36%) 74 (34%) 158 (46%)
58 (62%) 117 (53%) 158 (46%) Two Years
0 (0%) 27 (12%) 23 (7%) Three Years
0 (0%) 2 (1%) 0 (0%) Four Years
2 (2%) 0 (0%) 3 (<1%) Five Years
2012/13
29 (32%)
54 (57%)
6 (6%)
4 (4%)
1 (1%)
Research Teaching Clinical
2013/14 38 (20%) 26 (14%) 128 (68%)
Administration/
Leadership
41 (22%)
*Some Academic positions combine teaching, clinical and other roles, so the percentages exceed more than 100.
025,000
25,000100,000
100,000+
(1,044) 33% (819) 26% (1,295) 41%
(804) 26% (775) 25% (1,518) 49%
(1,001) 37% (784) 29% (925) 34%
(588) 22% (906) 34% (1,173) 44%
(730) 26% (901) 32% (1,182) 42%
2013/14
2012/13
2011/12
2010/11
2009/10
Top 20 Most Requested Searches by Medical Specialty

5
Psychiatry
Hospitalist
2013/14
714
235
231
206
128
92
89
70
61
61
58
58
54
50
32
32
29
20
18
17
2011/12
631
235
155
168
23
70
106
81
22
41
130
105
51
53
40
46
57
12
68
16
2010/11
532
295
160
133
N/A
64
92
80
N/A
79
69
104
32
35
31
26
56
7
32
14
2009/10
375
246
124
179
N/A
84
116
69
N/A
49
61
88
41
21
32
58
44
11
32
18
Family Medicine
(includes FP/OB)
Internal Medicine
Nurse Practitioner
Pediatrics
Emergency Medicine
OB/GYN
Neurology
General Surgery
Orthopedic Surgery
Gastroenterology
Hematology/Oncology
Physician Assistant
Otolaryngology
Urology
Neurosurgery
Pulmonology
Endocrinology
2012/13
624
194
178
168
69
87
111
77
50
71
74
57
37
45
40
38
26
23
24
22
Cardiology
Other Clinical Specialty Recruitment Assignments
Administrative, Academic and Executive Titles Include:
Addiction Medicine
Allergy & Immunology
Anesthesiology
Anesthesiology/Pain Management
Bariatric Surgery
Bone Marrow Transplant
Breast Surgery
Certied Registered Nurse Anesthetist
Chief of Community Medicine
Clinical Genetics
Clinical Lab Scientist
Colon & Rectal Surgery
Facial Plastic Surgery/ENT
Genitourinary
Gynecological Oncology
Gynecology
Hospice-Palliative Medicine
Infectious Disease
Intensivist
Internal Medicine/Pediatrics
Maternal Fetal Medicine
Medical Director
Medical Humanities
MOHS Surgery
Molecular Research
Neonatology
Nephrology
Nuclear Medicine
Obstetrics
Occupational Medicine
Ophthalmology
Oral & Maxiofacial Surgery
Pain Management
Pathology
Pediatric Anesthesiology
Pediatric Cardiology
Pediatric Emergency Medicine
Pediatric Endocrinology
Pediatric Gastroenterology
Pediatric Ophthalmology
Pediatric Physiatry
Pediatric Pulmonology
Pediatric Surgery
Pediatric, Development-Behavioral
Pediatrics
Physiatry
Physicist
Plastic Surgery
Podiatry
Radiation Oncology
Radiology
Radiology, Neuro-interventional
Reproductive Endocrinology
Retina Surgery
Retinal Disorders
Rheumatology
Sleep Medicine
Surgical Oncology
Thoracic Surgery
Transplant Surgery
Urgent Care
Urological Gynecology
Urological Oncology
Vascular & Interventional Radiology
Vascular Surgery
Dean, College of Medicine
Dean, College of Public Health
and Human Professions
Dean, College of Pharmacy
Dean, College of Public Health
Dean, College of Nursing
Dean of Dentistry
Chair, Department of Internal Medicine
Chair, Department of Cardiology
Chair, Department of Anesthesiology
Chair, Department of Family Medicine
Chair, Department of Surgery
Chair, Department of Orthopedic Surgery
Chair, Department of Pediatrics
Chair, Department of PMFR
Chair, Department of Neurology
Chair, Department of
Gastroenterology
Chair, Department of Pediatric Radiology
Chair, Department of Pediatric Surgery

Chair, Department of Pediatric Oncology
Obstetrics/Gynecology
Chair, Department of Pathology
Chair, Department of Psychiatry
and Behavioral Services
Chair, Department of Ophthalmology
Chair, Department of Otolaryngology
Radiation Oncology
Transplant Surgery
Associate Dean, Diversity & Equity
Associate Dean, Admissions
and Student Affairs
Associate Dean, Education and
Health Professionals
Associate Dean for Research
Associate Dean, Graduate
Medical Education

Assistant Professor
Chief Medical Ofcer
Full Professor
Associate Department Chair
Clinical Director
Medical Director
Associate Professor
Executive Residency Director

Chief Executive Ofcer
Division Chair
Vice President, Medical Affairs
Senior Researcher
Director of Community Medicine
Chief Diversity Ofcer
Director of the Center for
Institutional Diversity
Chief Information Ofcer
Vice President, Medical Services
Director of Quality and Accreditation
Chief Nursing Ofcer
Residency Director
6
7
Income Offered to Top 20 Recruited Specialties
(Base salary or guaranteed income only, does not include production bonus or benets)
8
Low
$145,000
$150,000
$160,000
$160,000
$165,000
Average
$229,000
$227,000
$221,000
$217,000
$208,000
High
$350,000
$350,000
$400,000
$305,000
$295,000
Hospitalist
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$220,000
$210,000
$170,000
$160,000
$185,000
Average
$311,000
$288,000
$264,000
$255,000
$247,000
High
$400,000
$450,000
$380,000
$380,000
$380,000
Emergency
Medicine
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$150,000
$165,000
$160,000
$160,000
$150,000
Average
$217,000
$218,000
$224,000
$220,000
$209,000
High
$350,000
$300,000
$300,000
$275,000
$310,000
Psychiatry
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$145,000
$130,000
$150,000
$130,000
$145,000
Average
$198,000
$208,000
$203,000
$205,000
$191,000
High
$360,000
$325,000
$345,000
$285,000
$250,000
Internal
Medicine
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$130,000
$145,000
$130,000
$120,000
$145,000
Average
$188,000
$179,000
$189,000
$183,000
$180,000
High
$240,000
$300,000
$220,000
$250,000
$265,000
Pediatrics
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$140,000
$130,000
$120,000
$130,000
$140,000
Average
$199,000
$185,000
$189,000
$178,000
$175,000
High
$293,000
$325,000
$300,000
$290,000
$255,000
Family
Medicine
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$215,000
$225,000
$180,000
$220,000
$175,000
Average
$288,000
$286,000
$268,000
$282,000
$272,000
High
$380,000
$350,000
$440,000
$360,000
$350,000
OB/GYN
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$70,000
$75,000
$70,000
N/A
N/A
Average
$106,000
$105,000
$95,000
N/A
N/A
High
$150,000
$150,000
$121,000
N/A
N/A
Nurse
Practitioner
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$71,000
$85,000
$75,000
N/A
N/A
Average
$105,000
$118,000
$99,000
N/A
N/A
High
$150,000
$160,000
$130,000
N/A
N/A
Physician
Assistant
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$400,000
$250,000
$275,000
$270,000
$315,000
Average
$442,000
$447,000
$396,000
$420,000
$420,000
High
$500,000
$550,000
$600,000
$525,000
$600,000
Cardiology
(non-invasive)
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$250,000
$300,000
$300,000
$230,000
$230,000
Average
$372,000
$398,000
$412,000
$359,000
$349,000
High
$500,000
$650,000
$530,000
$500,000
$450,000
Otolaryngology
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$240,000
$291,000
$300,000
$300,000
$300,000
Average
$454,000
$441,000
$433,000
$424,000
$411,000
High
$560,000
$600,000
$550,000
$505,000
$600,000
Gastroenterology
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$350,000
$250,000
$400,000
$300,000
$300,000
Average
$488,000
$483,000
$519,000
$521,000
$519,000
High
$700,000
$750,000
$750,000
$700,000
$825,000
Orthopedic
Surgery
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$315,000
$275,000
$210,000
$250,000
$300,000
Average
$377,000
$382,000
$360,000
$369,000
$385,000
High
$450,000
$525,000
$450,000
$550,000
$500,000
Hematology/
Oncology
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$180,000
$180,000
$160,000
$160,000
$180,000
Average
$262,000
$300,000
$280,000
$256,000
$281,000
High
$400,000
$400,000
$420,000
$345,000
$460,000
Neurology
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$430,000
$385,000
$330,000
$320,000
$250,000
Average
$504,000
$424,000
$461,000
$453,000
$400,000
High
$625,000
$650,000
$650,000
$550,000
$550,000
Urology
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$270,000
$240,000
$220,000
$205,000
$175,000
Average
$354,000
$336,000
$343,000
$336,000
$314,000
High
$515,000
$550,000
$450,000
$450,000
$410,000
General
Surgery
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$350,000
$300,000
$400,000
$380,000
$325,000
Average
$454,000
$461,000
$512,000
$532,000
$495,000
High
$550,000
$675,000
$650,000
$650,000
$680,000
Cardiology
(invasive)
2013/14
2012/13
2011/12
2010/11
2009/10

RVU Based Net Collections Gross Billings Patient Encounters Quality Other
2013/14
59%
21%
5%
11%
24%
9%
Salary
633 (20%)
525 (17%)
489 (18%)
428 (16%)
339 (12%)
Salary with
Bonus
2,335 (74%)
2,323 (75%)
1,977 (73%)
1,975 (74%)
2,082 (74%)
Income
Guarantee
127 (4%)
217 (7%)
191 (7%)
239 (9%)
367 (13%)
Other
63 (2%)
32 (1%)
53 (2%)
25 (<1%)
25 (<1%)

2013/14
2012/13
2011/12
2010/11
2009/10
2011/12
54%
33%
5% 5%
35%
3%
Low
$230,000
$225,000
$180,000
$200,000
$200,000
Average
$358,000
$351,000
$321,000
$311,000
$305,000
High
$425,000
$500,000
$415,000
$430,000
$430,000
Pulmonology
2013/14
2012/13
2011/12
2010/11
2009/10
2012/13
57%
25%
3%
6%
39%
9%
Low
$450,000
N/A
$450,000
$550,000
$590,000
Average
$591,000
N/A
$701,000
$613,000
$631,000
High
$700,000
N/A
$1,000,000
$700,000
$720,000
Neurosurgery
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$175,000
$170,000
$180,000
$180,000
$200,000
Average
$206,000
$209,000
$248,000
$218,000
$219,000
High
$235,000
$300,000
$380,000
$270,000
$270,000
Endocrinology
2013/14
2012/13
2011/12
2010/11
2009/10
Type of Incentive Offered
If Salary Plus Production Bonus, on Which Types of Metrics Was the Bonus Based?
(of 2,323 searches offering salary plus bonus, multiple categories possible. Note: 2011 is the rst
year this question was asked.)
9
10
14
Searches Offering Relocation Allowance
13
If Income Guarantee, What was the
Term Offered? (of 127 searches offering
income guarantees)
15
Amount of Relocation Allowance
(Physicians only)
12
If Income Guarantee, What Type?
(of 127 searches offering income guarantees)
11
If Quality Factors Were Included in the
Production Bonus, About What Percent
of the Physicians Total Compensation
Determined By Quality?*
1 Year
64 (50%)
105 (49%)
87 (45%)
113 (47%)
202 (55%)
2 Year
47 (38%)
79 (36%)
83 (44%)
776 (32%)
130 36%)
3 Year
16 (12%)
28 (13%)
21 (11%)
49 (21%)
35 (9%)
Other
0 (0%)
5 (2%)
0 (0%)
0 (0%)
0 (0%)

2013/14
2012/13
2011/12
2010/11
2009/10
Yes
2,845 (90%)
2,821 (91%)
2,577 (95%)
2,451 (92%)
2,671 (95%)
No
313 (10%)
276 (9%)
133 (5%)
216 (8%)
142 (5%)
Net Collections Guarantee Gross Collections Guarantee
19 (15%) 108 (85%)
45 (24%) 146 (76%)
8 (3%) 231 (97%)
43 (12%) 324 (88%)
2013/14
2012/13
2011/12
2010/11
2009/10
Low
$1,000
$1,000
$1,000
$1,000
$1,000
Average
$9,849
$9,555
$10,035
$10,454
$10,035
High
$25,000
$25,000
$40,000
$85,000
$30,000

2013/14
2012/13
2011/12
2010/11
2009/10

2013/14
2012/13
2011/12
2010/11
2009/10
72 (33%) 145 (67%)
Determined by Quality
13% 2013/14
Low
$3,500
Average
$6,904
High
$10,000 2013/14
*Question asked for the first time in 2013/14
16
Amount of Relocation Allowance
(NPs and PAs Only)
17
Searches Offering Signing Bonus
19
Amount of Signing Bonus Offered
(NPs and PAs only)
18
Amount of Signing Bonus Offered
(Physicians only)
20
Searches Offering to Pay Continuing
Medical Education (CME)
21
Amount of CME Pay Offered
(Physicians only)
22
Amount of CME Pay Offered
(NPs and PAs only)
Yes
2,212 (70%)
2,199 (71%)
2,170 (80%)
2,025 (76%)
2,135 (76%)
No
946 (30%)
898 (29%)
540 (20%)
642 (24%)
678 (24%)
Low
$1,000
$1,500
$4,000
$5,000
$2,000
Average
$21,773
$22,069
$23,388
$23,790
$22,915
High
$150,000
$200,000
$200,000
$200,000
$100,000

2013/14
2012/13
2011/12
2010/11
2009/10

2013/14
2012/13
2011/12
2010/11
2009/10
Low
$1,000
$1,000
$500
$500
$500
Average
$3,515
$3,444
$3,391
$3,194
$3,335
High
$15,000
$15,000
$12,000
$10,000
$15,000

2013/14
2012/13
2011/12
2010/11
2009/10
Yes
2,865 (91%)
2,789 (90%)
2,658 (98%)
2,559 (96%)
2,618 (93%)
No
293 (9%)
308 (10%)
52 (2%)
108 (4%)
195 (7%)

2013/14
2012/13
2011/12
2010/11
2009/10
Low
$1,000
Average
$8,000
High
$20,000 2013/14
Low
$1,000
Average
$2,450
High
$5,000 2013/14
24
If Educational Loan Forgiveness was
Offered, What Was the Term? (of 820
searches offering educational loan forgiveness)
23
Searches Offering to Pay Additional Benets
25
If Educational Loan Forgiveness Was
Offered, What Was the Amount?
(Physicians only)
Low
$4,000
$1,000
N/A
N/A
N/A
Average
$77,000
$71,733
N/A
N/A
N/A
High
$336,000
$210,000
N/A
N/A
N/A

2013/14
2012/13
2011/12
2010/11
2009/10
1 Year
90 (11%)
48 (7%)
41 (6%)
39 (5%)
N/A
2 Years
173 (21%)
183 (27%)
192 (27%)
208 (27%)
N/A
3 Years
557 (68%)
449 (66%)
474 (67%)
525 (68%)
N/A

2013/14
2012/13
2011/12
2010/11
2009/10
2013/14
97%
99%
94%
86%
26%
4%
<1%
2012/13
94%
96%
87%
83%
22%
6%
2%
2011/12
97%
99%
82%
75%
26%
5%
1%
2010/11
99%
97%
90%
77%
29%
6%
3%
2009/10
98%
99%
90%
84%
38%
N/A
N/A

Health Insurance
Malpractice
Retirement
Disability
Educational Forgiveness
Housing Allowance
Other
Low
$20,000
Average
$40,000
High
$60,000

2013/14
26
If Educational Loan Forgiveness was
Offered, What Was the Amount?
(NPs and PAs only)
Trends and
Observations
Merritt Hawkins annual Review
Practitioner Recruiting Incentives,
now in its 21st year, tracks three
key physician recruiting trends,
as well as various advanced
practitioner recruiting trends.
1. Based on the physician recruiting
assignments Merritt Hawkins is contracted
to conduct, the Review indicates which types
of physicians are in the greatest demand and
which are the most challenging to recruit.
2. The Review also indicates the types of
practice settings into which physicians
are being recruited (hospitals, medical
groups, solo practice etc.) and the types of
communities that are recruiting physicians
based on population size.
3. The Review further indicates the types
of nancial and other incentives that are
being used to recruit physicians.
Each of these trends is discussed below.
WHO IS IN DEMAND?
Merritt Hawkins 2014 Review of Physician
Incentives examines the permanent
physician and advanced practitioner
recruiting assignments Merritt Hawkins
and AMN Healthcares physician stafng
divisions had ongoing or were engaged to
conduct during the 12 month period from
April 1, 2013 to March 31, 2014.
These search assignments reect the
types of physicians hospitals, medical
groups, community health centers,
academic medical centers, government
entities, physician hospital organizations,
integrated medical systems, Accountable
Care Organizations, urgent care centers
and other organizations that are seeking
nationwide. They also reect which types
of physicians may be particularly difcult
to recruit, necessitating the assistance
and additional resources of a physician
recruiting rm.
A CONTEXT OF CHANGE
Physician recruiting trends and practices
must be placed in the overall context of
the nations prevailing healthcare delivery
system. It is not an exaggeration to state
that healthcare delivery in the United States
has undergone more changes in the 12
month period examined in this Review than
in any previous 12 month period Merritt
Hawkins has examined in similar Reviews
conducted over the last 21 years.
Important recent developments in
healthcare delivery include, but are not
limited to, the following:
The enrollment in health insurance plans
of eight million Americans through the
Affordable Care Act (ACA).
The enrollment of an additional ve million
Americans in Medicaid (as of May, 2014).
The continued nancial pressure on
hospitals and other healthcare facilities as
reimbursement cuts take effect prior to
signicant patient or revenue increases
To varying degrees, all of these
developments impact both physicians and
physician recruiting, because physicians
continue to play a pivotal role in the
healthcare delivery system and are inevitably
affected by changes to it.
PHYSICIANS ARE STILL THE
CENTERPIECE
Though the healthcare system is evolving,
and the role of other clinicians is growing,
physicians remain the quarterbacks
of the healthcare delivery team and are
at the center of the healthcare system.
Through patient consultations, hospital
admissions, treatment plans, prescriptions,
tests, and procedures physicians control
the levers to both quality of care and
healthcare economics.
According to the Boston University School
of Public Health, physicians receive or direct
87% of all personal spending on healthcare
in the United States. While the quality of
care contributions physicians make cannot
be measured in dollars, the economic
contribution of physicians recently was
quantied by an AMA-sponsored study
examining national and state-by-state
physician economic output.
expected to result from ACA related
increases in insurance enrollment.
Decreased hospital census caused
by high deductible insurance plans,
continued unemployment, and more
outpatient choices.
The proliferation of Accountable Care
Organizations (ACOs) and the continued
movement toward outcomes/value-
based delivery models.
The continued consolidation of hospitals,
medical groups and other entities.
The growth of outpatient medicine
and the proliferation of multiple sites of
service, including ambulatory surgery
centers, retail clinics, urgent care centers,
free-standing emergency departments
and others.
The adoption of team based care and the
growing use of advanced practitioners
such as nurse practitioners (NPs) and
physician assistants (PAs).
The adoption of electronic health
records (EHR) as Physician Quality
Reporting System (PQRS) physician
participation deadlines near.
The delay of both ICD-10 implementation
and a permanent resolution to pending
Medicare physician payment cuts
mandated by the Sustainable Growth
Rate formula (SGR).
Release by the Center for Medicare
and Medicaid Services (CMS) of
data detailing $77 billion in Medicare
payments to physicians and other
healthcare professionals.
The continued shortage of
physicians nationwide.
The study revealed several physician related
economic output metrics, including:
Total economic output: The combined
economic output of patient care physicians
in the United States is $1.6 trillion.
Per capita economic output: Each
physician supports a per capita economic
output of $2.2 million.
Jobs: On average, each physician supports
approximately 14 jobs.
Wages and benets: On average, each
physician supports a total of $1.1 million in
wages and benets
Tax revenues: On average, each physician
supports $90,449 in local and state
tax revenues.
Source: The National Economic Impact of Physicians.
Prepared for The American Medical Association by IMS
Health. March, 2014.
In addition to the economic output detailed
by the AMA study cited above, physicians on
average generate $1.4 million in net revenue
per year for their afliated hospitals, and
therefore are critical to the economic viability
of virtually every hospital in the United
States (see Merritt Hawkins 2013 Survey of
Physician Inpatient/Outpatient Revenue).
Physician revenue generation today is based
largely on fee-for-service metrics, a standard
likely to change as the health system pivots
from volume-based reimbursement to value-
based reimbursement. However, if and when
value-based payment systems eventually
prevail, it is physicians, through their practice
patterns and choices, who will ensure
that quality of care is maintained within a
structure of managed, nite resources.
Due to their pivotal role, it is the effective
recruitment, compensation, and integration
of physicians that will determine the
direction of the healthcare system,
including the implementation of value-
based reimbursement, the adoption of
team-based care and EHR, increased
patient access to services and the various
other goals commonly grouped under the
heading of healthcare reform.
For this reason physicians continue to be in
high demand while supply remains limited, a
trend examined in more detail below.

Healthcare Reform and
Physician Supply
Access to physician services in the
United States already can be problematic.
Merritt Hawkins 2014 Survey of Physician
Appointment Wait Times indicates that even
in large metro areas with a relatively high per
capita concentration of physicians, physician
appointment wait times can be protracted
(see chart below):
0
5
10
15
20
25
30
35
40
45
50
B
o
s
t
o
n

D
e
n
v
e
r

P
h
i
l
a
d
e
l
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h
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a

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o
r
t
l
a
n
d

M
i
n
n
e
a
p
o
l
i
s

D
e
t
r
o
i
t

W
a
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h
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,

D
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.

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w

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a
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e
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D
a
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l
a
s

Average New Patient
Appointment Wait Times In Days
Source: Merrit Hawkins 2014 Survey of
Physician Appointment Wait Times.
Of particular note is the fact that Boston has
by far the highest average wait times of the
cities examined in the survey, despite having
450 physicians per 100,000 population
(the average ratio for the entire U.S. is
226 physicians per 100,000). In 2006,
Massachusetts implemented a healthcare
reform system very similar to the ACA,
and today 97% of the states residents
have health insurance. Partly as a result,
wait times to see a doctor have become
extended, while emergency room visits
increased rather than decreased.
A similar physician appointment wait time
study conducted by the Massachusetts
Medical Society (MMS) in 2013 shows an
average wait time in Massachusetts of 39
days for a family physician appointment.
The MMS study also shows that only
51% of family physicians and only 45%
of general internists in Massachusetts are
accepting new patients (Massachusetts
Medical Society Patient Access to Care
Study. July, 2013).
Whether the ACA will drive similar trends
nationwide remains to be seen. In the 12
month period examined in this Review
(April 1, 2013 March 31, 2014) Merritt
Hawkins observed some healthcare facilities
ramping up their physician recruiting activity
in preparation for an anticipated increased
demand for services related to insurance
enrollment through the ACA. However,
physician recruiting activity to date has
not largely been driven by ACA related
spikes in demand. Facilities are waiting
to see how insurance enrollment impacts
physician utilization particularly whether
high deductible plans will limit physician
visits and whether utilization will further
be limited by the enrollment of relatively
healthy younger people.
The expansion of Medicaid enrollment
through the ACA also to date has been a
minimal spur to physician recruiting, having
its greatest effect on Federally Qualied
Health Centers (FQHCs) whose mandate is
to provide accessible care for traditionally
underserved and under-insured populations.
Because so many physicians today are not
accepting new Medicaid patients (only
45.7% in the markets examined in Merritt
Hawkins Physician Appointment Wait Time
Survey cited above) expanded Medicaid
enrollment may have the greatest impact
on hospital emergency rooms. Unable to
access ofce-based physicians in a timely
manner, Medicaid patients often rely on the
emergency room for care.
An analysis of California emergency
department visits conrms that adult
Medicaid beneciaries have the highest rate
of ED visits, higher than both uninsured and
privately insured patients. Similarly, a study
of Medicaid expansion in Oregon showed
that adults chosen in a lottery to
receive Medicaid coverage used the ED
about 40% more often than those who
were not selected (Newsatjama.jama.
com/2014/01/02).
Trends other than ACA-related insurance
enrollment, including the ongoing physician
shortage, have had a more immediate
effect on physician recruiting.
A DEARTH OF DOCTORS
Medical schools in the United States
have expanded in recent years and will
be producing 27,000 graduates annually
by the end of this decade, 50% more
than in 2000 (Help Wanted! Journal
of Oncology Practice. Richard Cooper,
M.D. January, 2014). However, Medicare
funding for residency training was capped
by Congress in 1997 and there has been
little corresponding growth in the number
of resident positions since then, though
the U.S. population has grown by 50
million people. More than 60 state medical
societies, specialty societies, and hospital
organizations have called for the cap to be
lifted, but without practical effect.
Compounding the problem, some
10,000 Americans turn 65 every day (at
a rate of one every eight seconds) and
will continue to do so for the next 20
years (AAMC Physician Policy Workforce
Recommendations, September, 2012).
People in this age group see physicians
at three times the rate of those 30 or
younger, according to the CDC, and
account for over 33 percent of all
community hospital stays, though they
comprise only 12 percent of the population
(HealthLeaders December 29, 2010).
An additional factor driving the physician
shortage is the evolution of physician
practice styles. As more physicians choose
employment and opt for controllable
schedules, physician productivity is
decreasing. According to a survey
conducted by Merritt Hawkins for The
Physicians Foundation, physicians worked
6% fewer hours in 2012 than in 2008, a
drop in productivity equivalent to the loss of
46,000 full time equivalent (FTE) physicians
from the workforce.
Source: AAMC Physician Workforce Policy
Recommendations, September, 2012
Projected Physician Shortages
2008
7,400
58,000
2012
91,500
2020
131,000
2025
Physician demographics also are
contributing to the shortage. Because over
40% of active physicians are 55 years old
or older, the shortage will soon be
compounded by a major wave of physician
retirements during the next ve to ten years.
As a result of these and related
factors, ongoing physician shortages are
projected to worsen. The chart on page
19 illustrates the coming gap between the
number of physicians in the United States
and the number needed, as projected
by the Association of American Medical
Colleges (AAMC).
The shortage is compelling many healthcare
facilities nationwide to recruit physicians
to ll current openings on their staffs. The
chart above shows the average hospital
vacancy rate for various clinical professionals
as tracked by AMN Healthcares 2013
Clinical Workforce Survey.
In addition to the physician shortage,
physician recruiting is being driven in part
by increased consolidation within the
healthcare industry and by the emergence
of aligned delivery models such as
Accountable Care Organizations (ACOs)/
primary care medical homes/integrated
delivery systems. As of April, 2014, over
428 provider groups were operating
as ACOs. About four million Medicare
beneciaries are now in an ACO and an
estimated 14% of the U.S. population is
now being served by an ACO (Kaiser Health
News. FAQ on ACOs. April 16, 2014).
The graph below illustrates the accelerating
rate of hospital consolidations nationwide:
In an effort to meet ACO stafng
requirements, to manage the health of large
population groups, and to secure market
share, these large integrated organizations
are recruiting or acquiring physicians en
Number of Announced Hospital
Consolidations, 20022012
57
2
0
0
6
58
2
0
0
2
38
2
0
0
3
59
2
0
0
4
51
2
0
0
5
58
2
0
0
7
60
2
0
0
8
52
2
0
0
9
72
2
0
1
0
90
2
0
1
1
94
2
0
1
2
Source: Irving Levin Associates.
2012 Healthcare Acquisition Report.
Average Hospital Vacancy Rates
for Clinical Professionals
17.6%
17.0%
14.9%
13.3%
Physicians
Nurses
NPs/PAs
Allied Professionals
Source: 2013 Clinical Workforce Survey.
AMN Healthcare.
masse, rather than on an ad hoc basis, as
has been common in the past. Today, a
large healthcare system/ACO may initiate
a search effort for dozens of primary care
physicians at a time, in order to establish
the primary care networks that are the
key to population health management and
team based care.
In part because of their key role as care
coordinators, primary care physicians
(dened as family physicians, general
internists, and pediatricians) remain in
particularly high demand as delivery models
shift. They also are the main targets for
recruitment of expanding Federally Qualied
Health Centers (FQHCs), urgent care centers
and Veterans Administration facilities.
For the eighth consecutive year, family
medicine was Merritt Hawkins most
requested search assignment, with general
internal medicine second (also for the
eighth consecutive year). Third on the list
are hospitalists, who typically are general
internists, while pediatricians are sixth, up
from 9th two years ago (pediatricians were
not in the top 20 as recently as 2005/06).
The supply of primary care physicians has
been inhibited in recent years by a decline
of interest in these areas. In 1950, 50% of
physicians were engaged in primary care
and the remaining 50% were engaged in a
handful of medical specialties
Today, only 32% of physicians are engaged
in primary care while the remaining
68% are engaged in one or more of 200
specialties for which board certication can
be obtained (New York Times, June 23,
2010) a percent lower than most developed
nations. Due to comparatively low pay and
longer work hours, fewer U.S. medical
graduates have displayed an interest in
primary care over much of the last 15
years, ceding over 50% of lled residency
positions in some years to international
medical graduates (IMGs), according
to the National Residency Matching
Program (NRMP). While interest in primary
care residencies among medical school
graduates recently has increased, nearly
one in ve Americans live in a region
designated as underserved for primary care
by the federal government.
Training of primary care physicians, with a
focus on interprofessional cooperation, will
have to be accelerated to meet the demand
created by delivery systems built around
prevention, population health management,
team-based care and quality/volume-based
reimbursement. Three-year rather than four-
year medical school programs may be one
answer. New York University, Texas Tech,
and Columbia University have launched
three-year programs, and about ten other
medical schools are considering doing so
(The Washington Post. January 14, 2014).
Urgent Care and the Retail Boom
An additional spur to the recruitment of
primary care physicians is the growth of
urgent care centers and other proliferating
sites of service (see chart on page 22).
Hospitals, large medical groups and
other entities are repositioning how they
appeal to healthcare consumers, with
a greater emphasis placed on access to
9,300 urgent care centers in the Unites States
40% expect to expand or add a new site
85% expect to see new patient growth
50% are free standing
50% are in retail shopping centers
Growth of Urgent Care
Source: Beckers Hospital Review. August 2013
services. Urgent care centers, free standing
emergency departments, emergency
departments specically for the elderly
(of which there are now 50 in operation
with another 150 on the way
FierceHealthcare, February 20, 2014) and
retail clinics are among the proliferating
sites of service that allow healthcare
providers to offer access to medical services
everywhere, all the time. Urgent care
centers alone now see 160 million patient
visits a year, and studies show that 14%
27% of visits to hospital emergency rooms
could be handled by an urgent care center
(Beckers Hospital Review. August, 2013).
Retail centers are expected to double
from 1,400 in 2012 to 2,800 by 2015 with
projected 25% to 35% growth in coming
years (Advisory Board Daily Brieng, June
13, 2013). Many of these sites are staffed by
primary care physicians or by NPs and PAs
who provide primary care services.
These outpatient settings are increasing
in part because physician practices in the
United States are less accessible after
hours than practices in other nations, as
the chart following indicates.
Increased access is part of a wider trend
in which healthcare facilities are trying
to evolve healthcare delivery away
from a transactional model toward an
experiential one characterized by
customer service, price transparency,
provider ratings, and ease of use. With
the understanding that consumers punish
complexity and reward simplicity, healthcare
is shifting to a retail model with a wider
menu of niche providers to suit varying
customer preferences.

FQHCS AND SPECIALTY SERVICES
As referenced above, FQHCs have an
expanded mandate to provide access to
traditionally underserved populations
through funding provided by the federal
stimulus bill and the ACA, and many have
ramped up their recruiting efforts.
In addition, numerous hospitals and larger
medical groups have invested in high-end
2013
95%
90%
87%
81%
78%
47%
40%
Nations
Netherlands
New Zealand
United Kingdom
Australia
Germany
Canada
United States
Medical Practices That Can
Arrange For Patients to See a
Doctor or Nurse After Hours
Source: Commonwealth Fund International Policy Survey of
Primary Care Physicians
specialty services in recent years, and the
last decade has seen a building boom of
sleep centers, heart centers, neuroscience
centers, orthopedic centers and other
specialty care facilities that require primary
care doctors to ensure they have a requisite
number of patients.
ONLINE RESOURCES
AND TELEHEALTH
Despite this proliferation of service sites,
consumer access to physicians remains
a challenge, which innovators and
entrepreneurs are rushing to meet. New
services promoting access are arising in
markets nationwide, such as ZocDoc,
an online service that allows consumers
to access physician schedules in their
cities to determine which physicians have
openings. Zipnosis, pioneered by Park
Nicollet in Minnesota, is an online program
that for $25 a visit provides diagnosis
of minor problems such as colds, u,
bladder infections, allergies and acne.
Since 2010 it has expanded to Alaska,
Colorado, Connecticut, Kentucky, Maryland,
Massachusetts, New York, Rhode Island,
Washington and Wisconsin.
Phone and web-based telehealth services
are exploding with more employers and
insurance companies willing to pay for
these services. The share of large employers
with more than 5,000 employees that offer
telehealth services increased to 17% in
2013, from 12% the year before, and the
percent of companies considering doing so
grew to 43% from 33% in the same time
frame (Wall Street Journal/MarketWatch,
March 3, 2014).
Even though physicians can be made
more efcient and accessible through the
use of technology, the existing physician
workforce is insufcient to meet demand
and is being supplemented by other
clinicians, such as NPs and PAs, a trend
underlined by the 2014 Review.
IS THERE AN ADVANCED
PRACTITIONER IN THE HOUSE?
Prior to 2011, Merritt Hawkins received
few requests to recruit advanced
practitioners, including NPs and PAs. In
2013, NPs and PAs made the list of our
top 20 most requested search assignments
for the rst time. In the 2014 Review, NPs
and PAs combined rank as our fth most
requested search. The number of search
for NPs and PAs grew 320% collectively
from 2011/12 to 2013/14.
There are over 115,000 NPs practicing
in the U.S., with 88% focusing on primary
care, and 18% practicing in rural areas,
according to the American Academy of
Nurse Practitioners (AANP). They hold
prescriptive authority in all 50 states and
96% of them are female.
Over 83,000 PAs practice in the U.S., about
one-third in primary care and two-thirds
in specialty areas, according to the
American Academy of Physician Assistants
(AAPA), and 62% are female. They have
prescriptive authority in all 50 states and
their numbers have increased by 100% over
the last ten years.
While NP and PA professional groups are
seeking a wider scope of practice in many
states, they and most other observers
agree that NPs and PAs are intended to
supplement physicians, not to replace
them. In the emerging era of health
professional shortages, physicians, NPs, PAs
and other clinicians will need to practice
to the limits of their training, so that work
is redistributed as appropriate across the
spectrum of healthcare providers. Facilities
using NPs and PAs will need to understand
their role and ensure they are truly
supplementing physician services rather
than duplicating them.
This team-based model of care ultimately
may only be achieved through programs
stressing interprofessional education, when
succeeding generations of clinicians trained
in the team-based approach are integrated
into the workforce. Nevertheless, many
facilities aspire to this model today and are
moving toward it.
THE ROLE OF LARGE RETAILERS
While there are still disputes about scope
of practice issues between physician and
advanced practitioner professional groups,

the ways in which PAs/NPs are being used
now are often being dictated by state
governments, by large health systems,
major employers and retailers.
For example, Wallgreens announced
in April of 2013 that it will become the
rst retail chain to expand its health care
services to include diagnosing and treating
patients for chronic conditions such as
asthma, diabetes, and high cholesterol,
using PAs and NPs. (Walgreens Becomes
1st Retail Chain to Diagnose, Treat Chronic
Conditions, Kaiser Health News, April 4,
2013). The use of PAs/NPs in a diagnostic
role is a signicant step that may be
imitated by other retail chains and sites of
service. Whereas in the past, hundreds of
independent physicians in a region may
have decided if and how PAs and NPs were
employed, today those decisions are being
made at a more corporate level.
In 18 states, NPs have full authority
to evaluate and diagnose patients, order
diagnostic tests and prescribe drugs,
enabling them to open a practice or
work in a retail clinic with no doctor on
site. Law makers in numerous other
states are considering legislation that
would allow nurse practitioners to
practice independently.
Enhanced scope of practice laws for NPs
and PAs and recognition of their expanded
duties by third party payers are likely to
further drive demand for these clinicians.
A LOOMING SHORTAGE
OF NPS AND PAS
The shortage of healthcare professionals
is so acute that some experts believe that
even the enhanced use of NPs and PAs
will not be enough to ll the gaps. Like
physicians, many NPs and PAs today are
gravitating to specialty areas and to larger
communities. Data generated by noted
physician workforce analyst Richard Buz
Cooper, M.D. show that while the number
of NPs and PAs per capita is growing, the
number in primary care per capita peaked
several years ago and is declining.
These numbers suggest there may not be
enough PAs and NPs to ride to the rescue
and alleviate primary care shortages, and
that some of the same trends that have led
to physician shortages may be duplicated
in the PA and NP workforce. Though the
number of NP and PA education programs
is projected to grow by 3% to 5% annually,
Dr. Cooper projects a 20% decit of these
clinicians by 2025 (Physician Shortage Isnt
the Only Looming One, Advance for NPs and
PAs, July 28, 2011).
Though many hospitals and medical groups
have become better at assimilating NPs
and PAs onto their clinical teams, more
interprofessional cooperation will be
needed as primary care physicians focus on
directing team-based care and managing
chronically ill patients.
THE CRISIS IN PSYCHIATRY
Federal rules that go into effect in 2014
give Americans more access to behavioral
health coverage, but as in primary care
and other areas, coverage may not always
lead to access.
The shortage of psychiatrists and
behavioral health resources has become
acute nationwide, a fact highlighted by
the difculty many psychiatric patients in
emergency departments have accessing an
inpatient bed. In California, the average time
is 10 hours. In central Ohio, it is 19 (Access to
Mental Health Services Strained as Benets
Expand. HealthLeaders, February 27, 2014).
In 2014, psychiatry was Merritt Hawkins
fourth most requested specialty. As Merritt
Hawkins has reported in this Review and
elsewhere, the shortage of psychiatrists
continues unabated while failing to receive
the attention focused on the shortage of
primary care physicians.
The silent shortage will continue as
psychiatrists are essentially aging out of
the workforce, a trend illustrated by the
chart below:
70
%
55
%
10
%
40 or Younger
20
%
41-50
31
%
50-60
39
%
61 or Older
All active psychiatrists
are 50 or older
All active physicians
are 50 or older
Psychiatrists by Age
Source: AMA Physician Master File
Many psychiatrists today are seeking
outpatient practice settings, so that it is
increasingly difcult for inpatient facilities
to recruit the physicians they need. This
is particularly true of federally funded
psychiatric facilities and correctional facilities,
where the need is greatest.
In the future, demand for psychiatric services
will have to be addressed by primary care
physicians, who today are prescribing a
growing volume of psychopharmacologic
drugs, and by non-physician behavioral
health professionals such as psychologists.
Psychologists now are able to prescribe
medications in the military and in the Indian
Health Service, and in two states, New
Mexico and Louisiana. At least six states
(Arizona, Hawaii, Montana, New Jersey,
Oregon, and Tennessee) have or
are considering giving psychologists
prescriptive authority.
WHAT ROLE WILL THE ED PLAY?
While requests for emergency physicians
were down relative to last year, emergency
medicine nevertheless ranked as Merritt
Hawkins seventh most requested search.
The number of hospital emergency room
visits continues to grow and hit an all-time
high of about 130 million in 2010, the last
year for which numbers are available, up
from 124 million in 2008, according to the
CDCs National Hospital Ambulatory Medical
Care Survey. Emergency departments
now account for about half of all hospital
admissions in the U.S. according to a RAND
Corporation study (www.rand.org.news/
preess/2013/05/20.html).
While the number of hospital-based
emergency departments has decreased in
recent years, the number of freestanding
emergency departments has increased,
doubling in the last decade and now up to
284 in 45 states (Freestanding Emergency
Department Growth Creates Backlash,
American Medical News, April 29, 2013).
Opened by hospitals and physicians,
sometimes in alliance and sometimes
separately, they are able to take more
complex cases than urgent care centers.
Freestanding EDs are subject to the
Emergency Medical Treatment and Active
Labor Act (EMTALA) if they accept Medicare
or Medicaid, and must see all patients who
present to the department. The proliferation
of free-standing EDs is part of the shift
in philosophy referenced above in which
healthcare organizations are placing a
premium on making services more accessible
to patients by expanding hours and creating
multiple service sites.
Despite popular perceptions, emergency
department visits are not largely driven
by the uninsured, but by those with
insurance. According to the Center for
Health System Change (CHSC) Testimony
before the Senate (Nonurgent Use of
Hospital Emergency Departments, May 11,
2011) the uninsureds use of emergency
departments is considerably less than
privately insured people.
Tellingly, the rate of hospital room visits
increased in Massachusetts after healthcare
reform expanded access to health insurance
in the state in 2006 (Emergency Room Visits
Grow in Massachusetts, Boston Globe,
July 4, 2010). What the CHSC testimony
and other sources underline is that insured
patients come to the ED for problems when
they cannot obtain reasonable access to a
primary care physician or other providers.
The conclusion is that EDs are not serving
as the primary care source for uninsured
patients as much as they are serving as a
source of convenient care for the insured.
As more patients obtain health coverage
through the ACA, and as the shortage of
primary care physicians persists, emergency
room visits can be expected to increase,
further driving demand for physicians
stafng the emergency department.
Demand will be particularly strong for
ABEMs (physicians board-certied in
emergency medicine), as trauma centers
require EDs that are ABEM staffed. Even
though ABEMs command salaries up to
50% greater than primary care physicians
who may moonlight in the ED (particularly
in rural areas), they are in great demand,
and these searches are among Merritt
Hawkins most difcult assignments to ll.
WHICH SPECIALISTS ARE IN
DEMAND?
Healthcare reform, dened as both the
ACA and ongoing market changes, is
driving the pivot from a volume and
procedurally-based system in which
specialists predominate to a quality and
preventive-based system more generally
directed by primary care physicians.
Part of this trend includes ongoing Medicare
and other third party reimbursement cuts
to specialists coupled with Medicare and
other reimbursement increases to primary
care physicians. Both these trends have
diminished to some extent demand for
certain medical specialists.
For example, in 2001, 2002 and 2003,
radiology was Merritt Hawkins most
requested specialty. This year, radiology is
not in the top 20. Similarly, anesthesiology,
once a top search assignment, also is
not in the top 20. Inhibiting demand for
anesthesiologists is the use of certied
registered nurses anesthetists (CRNAs),
who now administer 65% of all anesthetics
nationwide, according to the American
Association of Nurse Anesthetists (AANA)
and are particularly prevalent in smaller,
rural communities.
However, demand for particular specialists
cannot be measured only by number of
search assignments requested, since more
populous specialties such as family medicine
and general internal medicine can be
expected to generate more requests than
less populous specialties. The chart below
ranks demand for specialists based on Merritt
Hawkins 2013/14 search assignments as a
percent of all physicians in each specialty.
Considered this way, demand for such non-
primary care areas as psychiatry, neurology,
gastroenterology, otolaryngology, urology,
hematology/oncology, general surgery and
others remains strong.
Over 20 medical specialty societies have
released studies projecting shortages in
their elds, and as patients age and require
more specialty services, demand for specialty
physicians should remain strong.
WHERE ARE THEY RECRUITING?
INTO WHICH SETTINGS?
Merritt Hawkins annual Review tracks
the types of practice settings into which
physicians and advanced practitioners are
being recruited. These can include hospital
employed settings, group practice settings,
solo practice settings, physician partnerships
or associations, Federally Qualied Health
Centers (FQHCs), academic medical centers,
Indian Health facilities and other settings.
The 2014 Review signals the continuation of
a trend that Merritt Hawkins has observed
for almost a decade. From 2004 to 2013, the
percent of search assignments we represented
Hospitalists
Family Medicine
Psychiatry
Neurology
Gastroenterology
Otolaryngology
Pulmonology
Urology
Emergency Medicine
General Surgery
Hematology/Oncology
Internal Medicine
OB/GYN
Pediatrics
Merritt Hawkins Top Physician Search Assignments as a Percent
of All Physicians Per Specialty (patient care only)
.019%
. 0082%
. 0069%
0055%
. 0045
0038%
.0036%
. 0031%
0028%
.0027%
.0026%
. 0025%
.002%
.0018%
in hospital employed settings increased (see
chart below) each year, peaking at 64%
where it remained in 2014.
These numbers underscore the rapid decline
of physician private practice ownership
and the growing predominance of hospital
employment of physicians and employment
of physicians in other practice settings.
The 2014 Review indicates that less than
ten percent of Merritt Hawkins recruitment
assignments now are for settings in which
physicians are likely to be independent
and self-employed. These settings include
partnerships (3% of Merritt Hawkins search
assignments) solo settings (less than 1%
of Merritt Hawkins search assignments)
concierge settings (1% of Merritt Hawkins
search assignments) and a number of
medical group settings featuring ownership
arrangements (approximately 4%5% of
Merrit Hawkins search assignments).
CONCIERGE GROWING
The 2014 Review marks the rst time
Merritt Hawkins has tracked concierge
practices as a separate practice setting. We
anticipate that this style of practice will
grow in response to widespread physician
dissatisfaction with the prevailing medical
practice environment and the desire of
many doctors to embrace alternatives to
traditional practice models. The concierge
model, which typically eliminates third party
payers, represents one of the few nancially
viable ways in which physicians may be able
to maintain independence in the future. The
chart on page 30 illustrates the percentage
of physicians in various specialties who
remain in independent private practice.
The trend toward physician employment
is being driven by a variety of factors,
including a growing reluctance among
Merritt Hawkins Hospital Employed Search Assignments
510 (19%)
285 (11%)
654 (23%)
1,297 (43%)
1,416 (45%)
1,579 (45%)
1,430 (51%)
1,975 (64%)
1,495 (56%)
1,710 (63%)
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2006 (64%)
physicians to assume the nancial risks and
administrative responsibilities of private
practice ownership in todays problematic
medical practice environment. Hospital and
medical group consolidation, emerging
practice models such as ACOs that require
large physician panels, and proliferating sites
of service such as free standing emergency
departments, urgent care centers, and
retail clinics, all of which typically employ
doctors, also are contributing toward
the move to employment and away
from private practice.
One of the repercussions of physician
employment is declining productivity.
Employed physicians see 17%
fewer patients per day than independent
physicians according to a survey
conducted by Merritt Hawkins for The
Physicians Foundation.
FQHCS AND
ACADEMIC SETTINGS
Among the proliferating sites of service are
FQHCs, which are expanding and adding
new sites of service to meet anticipated
demand. Funding for these safety net health
centers, charged with providing affordable,
quality patient care to traditionally
underserved populations, was signicantly
increased by the federal stimulus bill and
the ACA. By 2015, FQHCs are projected to
increase patients seen from 20 million a year
to 30 million. Merritt Hawkins is conducting
an increasing number of search assignments
for FQHCs. In 2014, FQHCs and Indian
Health facilities accounted for 12% of all
Merritt Hawkins search assignments, up
from about six percent in 2012.
The 2014 Review also indicates that
academic medical centers are recruiting
37%
Pediatrics
Emergency Medicine
Family Practice
Psychiatry
General Surgery
Internal Medicine
Internal Medicine Subspecialties
Surgical Subspecialties
Physician Practice Owners by Specialty
38%
40%
41%
46%
46%
62%
72%
Source: Policy Research Perspectives: New Data on Physician Practice
Arrangements. American Medical Association. 2013
physicians in greater numbers. The
Association of American Medical Colleges
has committed to growing medical school
enrollment by 30 percent by 2015 and is
on target to reach that goal. Academic
medical centers are becoming more
involved in the delivery of care and are
expanding their clinical networks.
In an era of physician shortages, many
physician faculty members are being
lured to private practice by comparatively
high income offers. Further, leaders at
academic institutions, including Chairs,
Department Heads, and others, frequently
are targeted for leadership positions by
pharmaceutical companies, integrated
systems, and other organizations, leading
to a brain drain that also has been
observed among faculty at nurse training
programs. These trends, combined with
the need to replace an aging academic
workforce, are likely to spur recruitment at
hundreds of teaching facilities nationwide.
The 2014 Review marks the second time
Merritt Hawkins has tracked academic
searches as a separate category. Such
searches accounted for six percent of all
Merritt Hawkins search assignments in the
2014 Review period, up from ve percent
the previous year.
SEARCHES BY COMMUNITY SIZE
The 2014 Review indicates that Merritt
Hawkins conducted physician search
assignments in all 50 states during the
12-month period from April 1, 2013 to
March 31, 2014. Hospitals, medical groups
and other organizations in every state
found it necessary or desirable to retain the
services of a physician search rm such as
Merritt Hawkins, suggesting that physician
recruitment challenges are wide spread.
Forty-two percent of Merritt Hawkins
2013/14 search assignments took place in
communities of 100,000 people or more,
suggesting that it is not only traditionally
underserved smaller communities that
face challenges in physician recruiting.
Facilities in large urban centers and even
resort areas are recruiting physicians and
sometimes nd it necessary to enlist the
help of recruiting rms to do so. In many
cases, urban recruiting is being driven by
large, integrated systems such ACOs and
academic centers with multiple physician
recruiting needs.
WHAT ARE THEY OFFERING?
Merritt Hawkins Review of Physician
Incentives tracks the starting salaries or
income guarantees being offered to recruit
physicians, as well as other recruiting
incentives typically offered to doctors and
advanced practitioners.
Average salary and income guarantee
numbers represent the base only and are
not inclusive of production bonuses or other
incentives. This is in contrast to physician
compensation numbers compiled by the
Medical Group Management Association
(MGMA) and other organizations, which
track average physician incomes, including
production bonuses. Merritt Hawkins salary
and income guarantee ranges are therefore
indicators of what is required to attract
physicians already established in a practice
or those coming out of residency training to
particular practice opportunities, rather than
indicators of physician average incomes.
Comparisons between Merritt Hawkins
average salary numbers and MGMA overall
compensation numbers in several specialties
are listed below.
SALARIES IN PRIMARY CARE
The 2014 Review indicates that demand for
family physicians continues strong, exerting
upward pressure on salary offers which
increased to an average of $199,000 this
year, up from $185,000 the previous year.
Higher salaries may reect the growing
responsibility and value of family physicians
in team-based and value-driven delivery
models, such as the patient-centered
medical home, in which primary care
doctors can be rewarded for reaching
quality and cost effectiveness goals. In
general, however, we see across the board
demand for family physicians in a growing
number of practice settings as the impetus
for higher family medicine average salaries.
Pediatricians also saw a year over year
increase in salary offers, from $178,602
in 2012/13 to $188,000 in 2013/14. One
reason for the increase is that the type of
organizations recruiting pediatricians is
changing, from smaller, single-specialty
practices to hospitals and hospital systems
that have the resources to offer more.
By contrast, average salary offers for general
internal medicine physicians decreased year
over year, from $208,313 in 2012/13 to
$198,000 in 2013/14. This trend may be
driven by the types of organizations that
are recruiting general internists, including a
growing number of FQHCs, Indian Health
and Veterans Administration facilities, all
of which typically pay less than private
sector settings.
Merritt Hawkins
$199,000
$198,000
$354,000
$488,000
MGMA
$225,701
$244,689
$402,409
$586,311

Family Medicine
Internal Medicine
General Surgery
Orthopedic Surgery
Merritt Hawkins vs. MGMA Compensation Averages
SALARIES IN SPECIALTY CARE
As referenced above, the ACA, market-
based reforms, and targeted Medicare cuts
all tend to enhance the nancial prospects
of primary care physicians and may inhibit
the prospects of specialists. In some cases,
the 2014 Review indicates at least a year
over year decrease in salary offers in some
specialty areas (see chart below).
Reimbursement cuts for ofce-based
oncology services have impacted salary
offers in the specialty, while salaries for
2014
$227,419
$229,000
$288,000
$311,000
$285,581
$288,000
$336,375
$354,000
$441,421
$454,000
2013
+0.7%
$464,500
$488,000
+5.1%
$424,091
$504,000
+18.8%
$351,125
$358,000
+2%
+8%
+0.8%
+5.2%
+2.8%
Specialties Seeing Year Over Year Salary Increases
Hospitalist
Emergency Medicine
OB/GYN
General Surgery
Gastroenterology
Orthopedic Surgery
Urology
Pulmonology
2014
$300,000
$262,000
Neurology
Hematology/oncology
Otolaryngology
Endocrinology
Psychiatry
$382,000
$377,000
$398,000
$372,000
$209,000
$206,000
2013
-12.7%
-1.3%
-7.9%
-1.4%
-0.5%
Specialties Seeing Year Over Year Salary Decreases
$218,113
$217,000
psychiatrists may have plateaued
due to the limited resources available
to the state supported facilities that
frequently recruit psychiatrists. The
decrease in neurology shows a step
back after two years of increases that
may be a temporary adjustment.
Surgical specialty areas such as ob/
gyn, general surgery, gastroenterology,
orthopedic surgery and urology continue
to entail complex procedures which
generate revenue for physicians and
hospitals, even though the ACA and market
forces generally enhance reimbursement
for primary care services and inhibit
reimbursement to specialists. Incomes
in some specialty areas therefore
continue to increase, as they did for high-
demand hospital-based specialists such
as emergency medicine physicians
and hospitalists (see chart on page 33).
PHYSICIAN ASSISTANTS AND
NURSE PRACTITIONERS
Average salaries for NPs increased year
over year, from $105,000 in 2012/13 to
$106,000 in 2013/14. This was to be
expected as demand for NPs grows, and NP
salaries are likely to increase next year.
Average salaries for PAs declined, from
$118,000 in 2012/13 to $105,000 in
2013/14. This decline can largely be
attributed to the fact that Merritt Hawkins
recruited a higher percent of primary care
PAs in the period covered by the 2014
Review than it did the previous year. As with
physicians, primary care PAs are not as well
paid as PAs who have chosen to specialize.
THE USE OF QUALITY/VALUE-
BASED INCENTIVES STALLS
In todays recruiting market, the average
salary offered to recruit physicians may be
secondary in some cases to how overall
compensation is structured and to how
physicians will be rewarded.
Reecting the growing number of
employed physicians, most income
packages offered to physicians today
are structured as salaries or salaries with
production bonuses. Income guarantees,
which typically are offered to independent,
private practice physicians, have become
progressively less utilized in recent years.
Ninety-four percent of the search
in 2013/14 featured either straight salaries
or salaries with production bonuses, while
only four percent offered private practice
income guarantees. Seventy-four percent of
all search assignments offered a salary with
some type of production bonus.
Of these, the majority (59%) featured a
production bonus calculated on Relative
Value Units (RVUs). RVUs are a metric for
determining physician productivity based
on work units performed by a physician,
rather than the number of patients seen.
For example, a physician may be assigned
a larger number of RVUs for examining
a patient with acute diabetes than for
examining a patient with a cold. RVUs are
one of several volume-based metrics that
help ensure physicians remain productive.
Additional volume based metrics used in
production bonuses include net collections,
gross billings, or number of patients seen.
However, the trend in health care today
is to reward physicians for meeting
certain quality/value-based standards
or other standards that are not purely
based on volume. These quality metrics
could include patient satisfaction scores,
outcome measures, low readmission rates,
timely submission of charts, adherence to
treatment protocols and others.
A growing number of physician
compensation models include a quality
component as well as a volume-based
component. In 2012/13, 39% of searches
conducted by Merritt Hawkins that
offered a production bonus included a
quality component in the bonus structure,
up from 35% in 2012 and up from less
than seven percent in 2011 (Note: in the
2011 Review, quality-based metrics were
included in the Other category).
However, in the 2014 Review, the number
of production bonuses featuring a quality
component dipped to 24%. This decline
reects the continued difculty hospitals,
medical groups and other employers are
having in creating value/quality based
physician compensation models. Metrics
that are essentially fee-for-service in nature,
such as RVUs, are easier to calculate and to
explain to physicians than are value-based
metrics, which can be more subjective.
After a period in which many facilities were
determined to move toward quality-based
payments, some facilities have hit a wall and
have put off struggling with their physicians
over this issue until the denition of quality
and how to reward it becomes clearer.
In addition, a growing percent of Merritt
Hawkins clients are composed of urgent
care centers and other facilities that do
not typically include quality metrics in their
physician compensation formulas.
While the end-game (a value-based system)
is clear to most healthcare leaders, the path
to reach this goal is not. The ACA provided
an impetus to this tectonic shift which may
be inevitable, but there will be starts and
stops along the way before the realization
of this transformative change.
WILL INCENTIVES CHANGE
BEHAVIORS?
An additional concern is that value-based
compensation metrics to date have had little
impact on overall physician compensation
and therefore may not be signicant
enough to affect physician behaviors.
However, the 2014 Review indicates
that value-based metrics (in those bonus
structures in which they are included)
determine 13% of the physicians overall
compensation, a number that likely is high
enough to inuence physician behaviors.
Creating a physician compensation model
in the Goldilocks zone (with enough
volume-based metrics to ensure productivity
and enough value-based metrics to
promote desired behaviors) remains a core
challenge for many healthcare facilities.
SIGNING BONUSES AND
HOUSING ALLOWANCES

Signing bonuses were offered in 70% of
the recruiting assignments Merritt Hawkins
conducted in 2013/14, down from 71%
last year. This drop may be a result of an
increasing number of instances in which
physicians are changing employers within
the same community and do not need the
extra inducement of a bonus. Some facilities
also may be hesitant to offer signing
bonuses in light of renewed attention
to Stark-related recruiting regulations,
while others are using pay for emergency
department call as a type of bonus.

The graph on this page illustrates the
use of signing bonuses over the last
several years. Signing bonuses offered to
physicians in 2013/14 averaged $21,773
down marginally from $22,069 the previous
year. Signing bonuses offered to NPs and
PAs averaged $7,786.
Certain other incentives, such as paid
relocation, paid CME, health insurance
and malpractice insurance are standard in
the majority of Merritt Hawkins physician
search assignments. The average relocation
allowance offered to physicians in 2013/14
was $9,849, up from $9,555 the previous
year, while the average CME allowance
offered to physicians in 2013/14 was $3,515,
up from $3,444 the previous year.
The average relocation allowance offered
to NPs and PAs was $6,904 while the
average CME allowance was $2,450.
Searches Offering Signing Bonuses
2
0
0
4
/
0
5
46%
58%
2
0
0
5
/
0
6
72%
2
0
0
6
/
0
7
74%
2
0
0
7
/
0
8
85%
2
0
0
8
/
0
9
76%
2
0
0
9
/
1
0
76%
2
0
1
0
/
1
1
80%
2
0
1
1
/
1
2
71%
2
0
1
2
/
1
3
70%
2
0
1
3
/
1
4
This is the rst year Merritt Hawkins has
tracked relocation and CME allowances for
advanced practitioners.
Twenty-six percent of Merritt Hawkins
2013/14 search assignments featured
medical education loan forgiveness, up
from 22% the previous year. Educational
loan forgiveness entails payment by the
recruiting hospital or other facility of the
physicians medical school loans in exchange
for a commitment to stay in the community
for a given period of time. The term of
forgiveness in 68% of searches Merritt
Hawkins conducted in 2013/14 featuring
educational loan forgiveness was three
years; 21% of searches offered a two-year
term, and 11% offered a one year term. The
average amount of loan forgiveness offered
to physicians was $71,000. The average
amount of loan forgiveness offered to NPs
and PAs was $40,000.
The 2014 Review tracks a relatively new
physician recruiting incentive: housing
allowances. Given the current volatile real
estate market, some physician candidates
are unable to leave their current homes
in order to relocate. Housing allowances
help pay for their housing in their new
location, allowing them the exibility to
relocate. Such allowances may be rolled into
the overall signing bonus. Some facilities,
however, emphasize housing bonuses
by identifying them as a separate, clearly
delineated incentive. Housing allowances as
a stand-alone benet were offered in four
percent of the search assignments Merritt
Hawkins conducted in 2013/14, down from
six percent the previous year.
Summary
Merritt Hawkins 2014 Review of Physician
Incentives indicates that demand for
primary care physicians remains particularly
strong, as they are seen as the keys to
achieving quality and cost objectives
necessary under emerging delivery models.
Recognizing that other types of clinicians
will have to help address primary care
physician shortages, demand is rising
for advanced practitioners such as nurse
practitioners and physician assistants.
The 2014 Review further suggests
that the independent, private practice
model is becoming an anachronism.
Hospital employment of physicians, and
employment of physicians in other settings,
such as community health centers, urgent
care centers and freestanding emergency
departments, continues to displace the
independent model.
While reimbursement in healthcare is
moving toward value-based metrics,
the 2014 Review indicates that many
healthcare facilities are still struggling
with the challenge of rewarding physicians
for both volume-based productivity and
value-based behaviors.
The 2014 Review also suggests that
recruiting physicians remains a national
challenge, as Merritt Hawkins conducted
search assignments in all 50 states in
2013/14. This challenge is not conned to
traditionally underserved rural areas but is
prevalent in communities of all sizes. The
enrollment of eight million people in health
insurance plans through the Affordable Care
Act is not yet a major driver of physician
recruiting activity, but is likely to spur
demand for physicians in the near future.
Merritt Hawkins Additional Discussion
Groups/Surveys/White Papers
Merritt Hawkins hosts a professional Discussion Group on LinkedIn to review and discuss
matters pertaining to physician recruiting, compensation, workforce solutions and related
healthcare trends. To join, visit http://linked.in/AB6mOC.
Merritt Hawkins is an AMN Healthcare company. AMN Healthcare, the largest healthcare
stafng organization in the United States, is the industry innovator of healthcare
workforce solutions. Surveys and white papers completed by Merritt Hawkins or other
AMN companies include:
Survey of Physician Appointment Wait Times
Survey: A Survey of Americas Physicians: Practice Patterns and Perspectives
(With The Physicians Foundation)
Physician Inpatient/Outpatient Revenue Survey
Survey of Final Year Medical Residents
White Paper: Incentive-Based Physician Compensation
Hospital-Specic Physician Requirements Model
(In conjunction with Richard Buz Cooper, M.D., University of Pennsylvania)
White Paper: Ten Keys to Physician Retention
White Paper: The Cost of A Physician Vacancy
White Paper: RVU-Based Physician Compensation
White Paper: The Economic Impact of Physicians
Curriculum: Physician Recruiting, The University of Florida
Review of Temporary Healthcare Stafng Trends & Incentives
Review of Temporary Healthcare Stafng Trends & Incentives (Mid-level Providers)
Survey of Chief Nursing Ofcers
Survey Registered Nurses
Survey of Travel Nurses

BOOKS WRITTEN BY MERRITT HAWKINS:
Will the Last Physician in America Please Turn Off the Lights?
A Look at Americas Looming Physician Shortage, Fourth Edition
Merritt Hawkins Guide to Physician Recruiting
In Their Own Words: 12,000 Physicians Reveal Their Thoughts
on Medical Practice in America. (With The Physicians Foundation)
For additional information about this survey or other information generated by Merritt Hawkins or AMN Healthcare, please contact:
Merritt Hawkins / Corporate Merritt Hawkins / Atlanta Merritt Hawkins / Irvine
5001 Statesman Dr 7000 Central Parkway, NE, Ste 850 19200 Von Karman Ave, Ste 400
Irving, Texas 75063 Atlanta, GA 30328 Irvine, CA 92612
(800) 876-0500 (800) 306-1330 (800) 288-1210
Speaking Presentations from
Merritt Hawkins and AMN Healthcare
An Educational Resource
Merritt Hawkins and AMN Healthcare are committed
to providing survey data and other information of use
to healthcare executives, physicians, policy makers and
members of the media.
AMN Healthcare offers speakers to address
healthcare industry trends in stafng, recruiting
and nance. Topics include:
A History of Medical Practice in America
Clinical Workforce Solutions
Evolving Physician Staffing Models
Physician and Nurse Shortage Issues and Trends
How to Make Your Hospital or Group a Physician Magnet
New Strategies for Healthcare Staffing
Healthcare Reform and Workforce Issues
Economic Forecasting for Clinical Stafng
Allied Stafng Shortages
Vendor Management
Recruitment Process Outsourcing
Other topics Upon Request
For more information or to schedule a speaking
engagement, please contact:
Phillip Miller
Phil.Miller@amnhealthcare.com
(800) 876-0500
5001 Statesman Drive
Irving, Texas 75063
(800) 876-0500
www.merritthawkins.com
2014 Merritt Hawkins | 5001 Statesman Drive | Irving, Texas 75063 | (800) 876-0500 | merritthawkins.com

2014 Merritt Hawkins Survey

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2014 Merritt Hawkins Survey

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2014 REVI EW

OF PHYSICIAN AND ADVANCED PRACTITIONER

2014 Review of Physician and Advanced Practitioner Recruiting Incentives 4

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