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Dr. Jordan Asher, Saint Thomas Health Services

When it comes to recruiting physicians to a community, recruiters in Middle Tennessee have a distinct advantage: Doctors like the Nashville area.

“It’s a great place to recruit to from a physician standpoint,” said Dr. Jordan Asher, a physician network executive with Saint Thomas Health Services. “Now there’s lot of competition, but it’s a very good medical community. Except for the housing a little bit, we have a much lower cost of living. Our school systems are fine. We have four seasons. We have a growing population.” Those are all pluses in a recruiter’s book, he said.

Jessica Florida, associate vice president with HCA Physician Recruitment’s TriStar Division, concurred. “Nashville is a very attractive place to live, … so it does make our job a little bit easier than some other parts of the country,” she said. TriStar Health System is the HCA (Hospital Corporation of America) network of hospitals in Tennessee and a few communities in Kentucky and Georgia.

“We have more than 100 open opportunities just within our TriStar market. It does cross the gamut of all the specialties, but primary care is first and foremost,” Florida said, adding that general surgeons are also needed in the area.

Because Nashville is home to investor-owned hospital giant HCA, the city is also home to one of the nation’s largest hospital-based physician-recruitment organizations. HCA Physician Recruitment employs 55 regional recruiters and another four who focus just on young physicians coming out of training. Headed by Vice President Tom Rossi, the organization is recruiting for about 1,200 openings at its facilities in 20 states. “I would say that Tennessee is one of the top states that we recruit to,” Rossi said.

HCA recruiters scour the country for hot candidates, placing advertisements on Web sites and in journals, using direct mail, attending the conferences and meetings of medical specialists, and hosting what Rossi called “resident events” at medical schools. At the sessions, residents and fellows not only learn about HCA but also about the process of moving from training to practice, including how to craft a curriculum vitae and negotiate contracts. “We find that the residents and fellows really appreciate that,” he said. “They train for many, many years. They work very, very hard in their training, but there isn’t a lot of focus in their training on the business side. We even invite physicians from our current medical staffs to come to those presentations and visit with the residents and tell them some of the lessons they’ve learned as they’ve come into the private-practice world. They’ve been a big asset.”

Between 65 and 70 percent of HCA’s recruits are straight out of residency or fellowship, and Rossi acknowledged that most of them initially don’t know the HCA company by name. “Even though it’s the largest hospital and ambulatory surgery company in America, or in the world for that matter, most of the residents don’t know about it until you say one of the hospital names,” he said. While they’re interested in the for-profit versus not-for-profit model, Rossi said that, “the things they’re concerned about” include quality of life in the community, the other physicians they would practice with and the business arrangements of a practice. “Many of the physicians that we recruit are not being recruited to be HCA employees. They’re recruited to come to the community to fill a community need for that specialty and then be on staff at the hospital,” Rossi said.

On the flip side, all HCA hospitals now boast a hospitalist program, with physicians opting to be employees with set hours in the hospital setting. “We’ve found recently that as many as 30 percent of our doctors are coming into employment arrangements with HCA, where we are the employer. That way, they don’t have to worry about malpractice coverage or Medicare changes. All those things are taken care of and they can practice medicine,” Rossi said.

Asher said Saint Thomas and Baptist hospitals in Nashville and Middle Tennessee Medical Center in Murfreesboro all have hospitalist programs, and that 80 percent of those positions are filled. Saint Thomas Health Services is composed of those three large facilities, plus Hickman Community Hospital in Centerville. Thus, Asher said, he can offer candidates an urban or a rural setting, a hospital-employed or a private-practice model, and even the alternative of a large or a small practice. “I can give them lots of different options, which drives up my ability to land them somewhere,” he said. “The biggest benefit that we offer is that they really want to come work within our culture. Being a mission-based, spiritually driven organization is a very nice added value.”

Asher said Saint Thomas landed “a fair number” of physicians who fled New Orleans after Hurricane Katrina. As well, the healthcare system is “very flexible” in working with physicians who desire a balance between their professional and personal lives. “We’re definitely seeing a different type of recruit,” he said, adding, “Physicians, and especially hospitalists, are becoming much more mobile. They know what they’re looking for.”

Asher doesn’t think there’s much of a physician shortage, but Rossi disagreed, saying numbers of doctors are limited “in almost every specialty. This year, it’s most acute in internal medicine and primary care. What we’ve found is that the way the Medicare system and payer systems work is that they pay more for procedures, and the wellness and the caretaking that a family doctor or an internal medicine doctor will do isn’t rewarded as well.”

HCA offers recruits an assortment of benefits and incentives, including signing bonuses, relocation expenses and first-year salary guarantees that are “forgiven” after three more years. Rossi said one “very popular” incentive that has become a competitive advantage is a resident stipend program that offers $1,000 to $2,000 monthly while the individual is still in school. “It helps us to make contact with the residents early on in their training,” he said. “They don’t have to commit to a certain community. They can go to any of the 20 stateswhere HCA owns facilities.” About 225 residents so far have taken advantage of the program.



May 2008

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