In a continuing trend, hospitals, medical groups, and other health care facilities are seeking more medical specialists and fewer primary care physicians, according to an annual report tracking physician starting salaries and other recruiting incentives.

Prepared by Merritt Hawkins, a leading physician search firm and a company of AMN Healthcare, the 2019 Review of Physician and Advanced Practitioner Recruiting Incentives tracks a sample of 3,131 physician and advanced practitioner recruiting engagements that the firm conducted from April 1, 2018, to March 31, 2019. Now in its 26th year, the report indicates that in the 12 months covered by the report, Merritt Hawkins has been conducting a growing number of search assignments for medical specialists while conducting fewer searches for primary care physicians relative to recent years.

“While demand remains strong for primary care physicians, specialists are increasingly needed to care for an older and sicker population,” said Travis Singleton, executive vice president of Merritt Hawkins. “In some medical specialties, shortages are emerging that will pose a serious challenge to public health.”

The findings are that 78 percent of Merritt Hawkins’ recruiting assignments in the last year were for medical specialists, up from 67 percent four years ago. By contrast, the number of searches the firm conducted for primary care physicians (family doctors, internists, and pediatricians) declined by 8 percent year-over-year and by 38 percent compared to four years ago.

In its latest report on physician supply and demand, the Association of American Medical Colleges (AAMC) projects a shortage of up to 67,000 specialists by 2032. The report reveals that search engagements are growing in a number of medical specialties where severe shortages are anticipated. For example, a study published in Arthritis Care & Research projects that by 2030 demand for rheumatologists will exceed supply by 100 percent. The number of infectious disease training programs now fill fewer than half their classes, according to Singleton, while deaths due to drug-resistant pathogens are predicted to rise rapidly, resulting in a looming shortage of infectious disease specialists.

There are approximately 7,300 certified geriatricians in the United States today, and the American Geriatrics Society projects 30,000 will be needed by 2030. Merritt Hawkins’ report also shows that for the fourth year in a row, psychiatry was the firm’s second most requested search, highlighting a critical shortage of psychiatrists nationwide. “The shortage of medical specialists flies under the radar, but it is a serious public health concern that deserves more attention,” Singleton said.

Physicians practicing invasive cardiology have the highest average starting salaries tracked in Merritt Hawkins’ report at $648,000, followed by orthopedic surgeons at $536,000, gastroenterologists at $495,000, and urologists at $464,000. Family physicians are at the lower end of the physician pay scale with an average starting salary of $239,000. The average signing bonus offered to physicians during this time period was $32,692, according to the report.

Value-Based Payments Rise Merritt Hawkins’ report suggests that the use of value-based physician payments is gaining momentum. Of those Merritt Hawkins clients offering physicians a production bonus last year, 56 percent were based in whole, or in part, on value-based metrics such as patient satisfaction and outcome measures, up from 43 percent the previous year and 39 percent two years ago.