Job prospects in health care are among the brightest anywhere. Even before health reform promised to add 32 million people to insurance rolls, the government's employment prognosticators had predicted upward of 3 million new jobs between 2008 and 2018.
"Even when the economy slowed down, people kept hiring physicians," says Tommy Bohannon, a vice president at Merritt Hawkins, a Dallas-based physician recruiting firm. "I do not see it changing."
There are openings at every level, from home health aide and medical technician to highly specialized physician. But primary care practitioners are particularly hot.
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Lower incomes and unfriendly hours compared to those of specialists have long swayed many medical students against a career in primary care. Family practice and internal medicine doctors are the top two most requested searches for Merritt Hawkins, and hospitalists—the primary care-trained physicians who work exclusively in a hospital—came in third last year.
In fourth place: psychiatrists, thanks to the profession's graying ranks, improved mental health coverage, and the woes brought on by a foul economy and two wars.
But a significant shift in career paths, from independence to on-staff employment, is unfolding as health systems struggle to contain costs and private practice physicians grow increasingly overwhelmed.
"The two big reasons were money and quality of life. I have a 2-year-old," says pediatrician Marty Thomas, 38, who gave up her private practice in Searcy, Ark., late last year to take a job with North Texas Medical Center in Gainesville.
As a solo doctor, she'd found it too hard "to make ends meet and to treat patients the way I felt they need to be treated." Now, as a medical center employee, Thomas makes $180,000 to $200,000 annually and works from 8 a.m. to 5 p.m., with half days on Thursdays.
"I am very happy," notes urologist Ken Weisman, who, after 26 years of late nights running his Pennsylvania and Connecticut private practices, moved last year to take a salaried position at a group affiliated with Marietta Memorial Hospital in Ohio. Some 56 percent of Merritt Hawkins's physician search assignments are for employee positions, up from 11 percent in 2004.
Not surprisingly, given the shortage of primary care docs, nurse practitioners and physician assistants are enjoying a seller's market, too. These providers increasingly are seeing and treating more patients themselves and are taking on traditional physician duties such as writing prescriptions.
And nurse practitioners cost an employer about half what internists do; their average pay now runs around $99,000. They also tend to be pros at coordinating patient care to avoid mistakes and gaps in treatment, a cornerstone of health reform.
"The demand will be there for care coordination alone," says Peter McMenamin, senior policy fellow with the American Nurses Association in Silver Spring, Md. Advocate Health Care, a multi-hospital system in Oak Brook, Ill., has recently hired more than 60 care managers, many of them nurse practitioners.
And "we could hire 60 nurse practitioners within the year," says spokeswoman Stephanie Johnson. As doctors leave, some will be replaced with nurse practitioners, she predicts. "Strategically, that's where we are going."
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