In May 2020, the American Hospital Association released a report estimating that between March 1 and June 30, 2020, hospitals and health systems across the country will experience over $200 billion in losses because of COVID-19 expenses and lost revenue.
How will that impact physician job seekers?
Throughout this time, I’ve been on conference calls with in-house physician recruiters from hospital systems and large medical groups all over the country. We gather in national, regional and specialty professional groups on virtual meeting platforms like WebEx and Zoom to share best practices. Every call starts with a check in to share what is going on in our facilities and groups.
A handful of hospitals in unaffected areas are operating and hiring as usual, with just a pause in onsite interviews due to travel disruptions. Some health care systems in hard-hit areas closed practices and laid off physicians and staff. A lot of recruiters reported furloughs and pay reductions for physicians and staff as well as temporary shutdowns for clinical and administrative offices. Every single recruiter reported that their hospitals revisited their 2020 budget and revised physician recruitment planned expenditures for the remainder of the year and began adjustments to 2021. Even facilities that have not admitted a single COVID patient are preparing for the lost revenue and expenses they would experience if the virus spreads in their community at some point over the next year or so.
That said, we are all confident that physician hiring will recover long before other parts of the economy.
Here are a few of the impacts we saw as our health care systems’ leadership teams wrestled with the pandemic.
COVID Cancel was a quick end to positions tied to new site expansions, new service lines or recruitments requiring major capital investments. Not "never," just not this year, not early 2021.
Hold was a continuum - hold this one for 60 days. Revisit that one in 90 days. Look at this again at 120 days. Facilities want to fill positions, but they don’t want to start new physicians until they know volumes are rebounding and patient confidence is strong.
Push it Back was the directive for many retirement backfills. Whenever late career physicians’ 401(k)s suffer, they second guess retirement timing, preferring to wait until retirement accounts recover before hanging up the white coat. This was bad news for 2020 residents and fellows who had interviewed and were working on contracts when the pandemic hit the community they hoped to join.
Reduce It was one tactic to move forward within a drastically slashed budget. Full-blown hospital system income guarantee packages were reduced significantly. Large, established private practices helped reduce the burden on the hospital. Practice partners agreed to sacrifice perks like CME travel. Groups deferred bonuses in order to cover their new physician salaries during ramp up. Many graduating residents lost sign-on bonuses to the virus.
Proceed as Planned was the welcome directive to continue with contract development for physicians recruited to practices with volumes unaffected by the pandemic.
The AHA number bears repeating: $200 billion in losses due to lost revenue and COVID expenses between March and June 2020. Going forward, hospitals and private practices are proceeding very, very cautiously. Will a rush to reopen local economies bring about new hotspots, new surges? Will there be another wave in the fall? Will patients return to pre-COVID health care utilization patterns? Will the payer mix recover as Americans return to work and health care coverage?
Some thoughts for physician job seekers in the pandemic physician job market:
If you can, consider another year of fellowship, or stay in the job you have until we are firmly in recovery. Any time employers are experiencing uncertainty, they react by tightening reigns on sign-on bonuses and starting salaries. Your negotiating position will improve when the economic indicators are strong and patients once again feel safe in hospitals and medical offices.
Don’t leave a job without signing a contract for your next job. Pre-COVID, physicians in high-demand specialties were accustomed to leaving a job if they got mad at administration or just were not as happy as they thought they should be. "I’ll do locums or work PRN," they thought. When locums demand drops off and nobody is hiring PRN, those physicians are unemployed and ineligible for unemployment benefits.
Keep multiple irons in the fire until you have a contract. In this hiring environment, it may not matter how fabulously you interview or how great your references are. If patient volumes are not recovering quickly enough in the market where you interviewed, administration will hit the brakes.
Defer the gratification of buying the biggest house, the nicest car in your price range. There will be a time to stretch, but this is not that time.
A contract might not be what you hoped, heard or thought it would say. In times of financial uncertainty, employers are more conservative. Have a health care attorney review the formal draft so that you thoroughly understand if, when and how the contract could be rescinded or terminated.
Understand that the starting salary, sign-on bonus and education loan repayment deal your senior residents and fellows got pre-COVID is not relevant to what employers will be offering today. Candidates in 2020 are competing with a much larger than normal pool of displaced mid- and later-career physicians who lost jobs or are moving for personal reasons. With some positions pushed out as long as two years into the future, there will be more physician candidates competing for a smaller pool of jobs.
Despite disruption today, our country still needs many more physicians than we have in the pipeline. The challenges and disappointments for this year’s job seekers will eventually be a blip in a successful career. And with all this experience interviewing virtually, I predict that the survivors of the physician candidate pool of 2020/2021 will be our next media stars!
Therese Karsten is the division director for physician recruitment for the Continental Division of HCA Healthcare.