Physiatry Practice Management Resources

Having been in the staffing industry as a recruiter of NPs and PAs since 1992 (when the NP and PA job markets were among the hottest in health care), I have experienced the roller-coaster effect in the niche. In the early years, it wasn't unusual to have 50 job openings for PAs and NPs, and employers paid us nearly as much for NP and PA placements as they did for physician placements.

Most hospitals in rural America offered whatever it took to lure PAs and NPs. While most older physicians in private practices didn't yet have an interest or realize what NPs and PAs could do for them, many younger physicians were easily convinced that the providers would be an asset to their growing practices. Surgical practices were hiring without regard to compensation. It was not uncommon for them to pay six-figure incomes to candidates with less than 5 years' experience.

Now, less than a decade later, the job market for PAs and NPs is tighter than ever. My firm has only a few openings for these practitioners, and many recruiting firms have reduced their efforts in the niches or no longer offer such services for candidates or employer clients. We have more unemployed candidates than ever. The fees paid to recruiters for NP and PA placements have dropped dramatically.

The majority of our client hospitals in rural America have fewer vacancies for PAs and NPs. Most of our private-practice clients are now a small part of a larger "provider organization," and many employ NPs or PAs in some capacity; but there is little effort necessary to find candidates when openings arise.

An informal poll leads me, my associates, candidates, and many attendees at the recent American Academy of Physician Assistants (AAPA) Conference in Atlanta, Ga, to believe that supply-and-demand economics dictates an oversupply in many geographic and specialty markets. The larger recruiting firms have admitted a slow in client demand for permanent placements and locum tenens services. Thus, many do not have recruiters dedicated in the niches. According to a recent nationally broadcast television news report, the primary shortage in the health care workforce is in staff nursing. Most of the firms that I spoke with agreed that staff nursing is the hottest market in health care recruiting today.

 So What Happened?

Recruiters also tend to trace the job market changes to the proliferation of new programs. That's not surprising given that in 1992, there were approximately 60 PA programs and 119 NP programs (253 tracks). Today, there are 116 accredited PA programs, according to Kevin Bayes, assistant director of information services for the AAPA, and there are over 320 NP programs with nearly 1,000 tracks, according to Kitty Werner of the National Organization of Nurse Practitioner Faculties.

But the job market problem isn't that simple. In the early 1990s, 50% of my NP and PA placements were new graduates, as compared with 20% today. One reason often cited by experienced NPs and PAs is that the new graduates are not as well prepared academically and clinically as students once were. I don't agree with this view. In fact, I think that today's graduates are better trained because of the constant learning process offered by more experienced PA, NPs, and physicians who are involved in student training. Furthermore, based upon my business relationship with training programs, I believe that there is better organization of faculties and faculty training, especially in training programs in such specialties as primary care, acute care, and surgical subspecialties.

Another often-cited contributing factor to the tight job market is that fewer employers have fewer vacancies. Managed care certainly has reduced the numbers of employers through mergers, acquisitions, consolidation, discouraging of referrals, and the streamlining of services. The positions available are often filled by in-house recruiters and by employers "growing their own" NPs and PAs (meaning that employers hire the NPs and PAs who are completing rotations and/or preceptorships at their locations).

Also, "The best jobs are not usually advertised," according to Zo DeMarchi, director of association services for the American Academy of Nurse Practitioners (AANP). She stated that word of mouth and networking is how many NPs are landing positions. Having placed employees in dozens of industries at all salary levels, I submit that this is the leading way to find employment -- in any field.

Contradicting the general consensus, I think that there actually are more jobs for PAs and NPs today than there were in 1992. After all, there are more NPs and PAs than ever, and they eventually find positions. I believe that the principal reason for the apparent scarcity of jobs for NPs and PAs is the difficulty in finding suitable employment in a specific geographic area or specialty. I refer to these candidates as geographically or specialty prohibited. Nancy Hughes, vice president of communications and information services for the AAPA, agreed and mentioned that the Academy has recognized "regional differences" when it comes to the lack of opportunities.

The average position is no longer advertised in conventional places, and sometimes it is not advertised at all. In addition to word-of-mouth and internal referrals, many employers and recruiters rely on the Internet to locate job candidates. As a result, there are fewer print job advertisements.

Thanks to the Internet, in less than 5 minutes a recruiter or employer can E-mail hundreds of candidates about a position, a task that would have taken 2 weeks when the telephone was the standard communication tool. The recruiter or employer can interview interested candidates via E-mail or by telephone and forward their data to the client by E-mail. In a recent family practice search, I E-mailed more than 600 candidates and one of them called the next day. Two weeks later, she was packing her bags for the move to her new location. Prior to the surge in technology, this assignment could have taken 2 months or more.

 What's A Job Hunter To Do?

No matter what the cause of the tight job market, NPs and PAs can take the following steps to optimize their chances of securing a position.

Check Internet job posting boards. Candidates and employers who don't use the Internet are missing many opportunities. Bookmark Web sites and visit them frequently.

Network with NPs and PAs in the geographic area in which you are seeking employment. "Networking with those who know you best is the best advice," said Stephen Crane, executive vice president of the AAPA. "Fellow PAs in the state where you want to practice or your specialty organization are an excellent resource. Contact information for state chapters and specialty organizations is available on the AAPA Web site." The AANP's DeMarchi recommends that candidates experiencing difficulty contact the Academy for influential contacts for locating employment when relocation is involved.

Market yourself to employers. Don't just mail your résumé to every practice in town. Instead, market yourself to them by telephone and send your résumé only if the hiring authority asks for it. Unsolicited résumés may wind up in the trash rather than in the hands of a decision-maker.

Call the employers who are advertising. Be assertive. Try to arrange a face-to-face interview. I've never seen a résumé get a job.

Contact local PA and/or NP programs. The NP or PA programs in the states in which you're seeking employment may have a job bank.

Network with the educators who trained you. They may know of employers who might hire you or who may lead you to other prospective employers.

Sign up with recruiters. Register with two to five recruiting firms.

Call the providers who trained you. Tell them about the type of position that you want, and ask for referrals. The AAPA's Hughes disclosed that the Academy markets the "strategy" of physicians "precepting students as a method of recruiting PAs."

Seize a good opportunity when it arises. Yes, make well-thought-out decisions, but don't take too long. Employers want to fill their jobs, and there are more candidates than ever

Don't expect anything from anyone. You are responsible for your actions and your future.

Conclusion

Traveling, temporary, or locum tenens jobs may provide some help; but they are not usually an option for new graduates because employers seeking temporary help need autonomous providers. According to our clients and affiliates, most new graduates are not yet prepared for that level of responsibility.

Further discussion about the development of new programs is needed. If things continue the way they are going, the economics of supply and demand will eventually yield reduced salary growth, decreased salaries in some specialties, and increased unemployment.