What motivates physicians to accept a specific practice opportunity involving relocation?  The trends today are far different from 20 years ago, when Jackson & Coker first surveyed doctors interested in permanent employment options.

	DECIDING FACTORS

	DEMOGRAPHICS 2007 Survey respondents fall into several distinct demographic groups. Over twice as many males as females responded. Nearly 74% of those surveyed live in the Southwest or Southeast. Just under 90% are in the 30-59 year-old breakdown, and slightly more than half of respondents have children.

AGE Survey respondents ran the gamut from residents completing their training and preparing to launch their careers, to seasoned physicians preparing to retire.	GENDER Two-to-one, male physicians responded to the survey questions, perhaps indicating their head-of-household status.	KIDS Over half of survey respondents are in the child-rearing category.
DESIRED REGION Respondents strongly favored relocating to the sunbelt areas, the Southwest and Southeast.	SPECIALTY Doctors in 25 highly marketable medical specialties were surveyed.

SUMMARY

Physicians accept career opportunities involving relocation for a number of reasons.  This survey shows an overall pattern related to chief motivational factors for relocating.  Compared to 20 years ago, doctors are less concerned about aligning with a hospital for a long period of time to build their practice, and more concerned with immediate income potential and quality-of-life issues. 

Survey Commentary

Twenty years ago, Jackson & Coker commissioned a survey to determine the leading factors that prompt career-minded physicians to accept new practice opportunities requiring relocation.   Doctors in major medical specialties were surveyed.  Their responses coalesced around several chief motivators for relocation.  The top three decision-making factors were ranked as follows:

1. Association with hospital facility
2. Potential income
3. Overall lifestyle concerns 

As important as it was for physicians and their families to move comfortably into a new community with appealing amenities, of greater concern was associating with a highly reputable hospital offering attractive potential income.  In fact, immediate income was the most remote factor in practice selection in the late 1980's. 

A lot has changed in twenty years.  We live in a more mobile society. The increased demand for quality health care and the acute shortage of physicians in most specialties means that candidates have more practice options and can be highly selective in deciding where they want to practice.   Knowing their personal “market worth,” today doctors have different motivations for making a career move.  According to the current survey, the top motivators for switching jobs are:   

1. Overall  lifestyle concerns
2. Potential earnings
3. Immediate income

Explaining the trends

What accounts for the difference in survey findings?  Three Jackson & Coker executives were interviewed and offer personal comments to put the survey results in perspective. 

Tim Sheley serves as Executive Vice President of Jackson & Coker Permanent Division.  Phil Middleton works in the same division as Vice President. 

Sandy Garrett is President of Jackson & Coker Locum Tenens.  Her division serves clients offering both temporary and temp-to-perm practice opportunities, most of which involve relocation.

What follows are their responses to a number of key questions the survey raises. 

• What apparently drove doctors to accept practice opportunities several decades ago?

TS:  Twenty years ago, doctors were chiefly concerned about security and stability.  They desired to build their practice in association with a financially stable hospital or medical organization.  Immediate income was not as important as establishing long-term relationships with the hospital staff and settling into a community for a long period of time.

PM:  Back then, physicians were content to establish their practice in a community where they intended to reside for a long time, or even permanently.  Not so concerned with immediate income, they were more focused on growing a practice with attractive income potential while serving a community that highly   valued their service.

SG:  It was surprising to me to see that call, medical malpractice and work hours did not even factor into the survey 20 years ago.  Apparently medical malpractice was a non-issue in the 80's.  Since lifestyle ranked so highly, one would have assumed that call and work hours would have factored in a more discernible way.  After all, it's difficult to have a great lifestyle if you are never at home to enjoy the fruits of your labor. 

• What drives physicians in selecting opportunities today?

TS:  Social trends have certainly had an impact.  Like other professionals living in a mobile society, physicians don't see themselves working the bulk of their career with a single employer.  Currently the trend is to accept practice opportunities that offer a better quality of life and more immediate income.    Doctors want to make more money now as well as enjoy a lifestyle that suits them and their families. 

PM:  The days of the “old country doc” are gone.  Now physicians are looking for a balance of what is important professionally and personally.  Whereas before, their practice involvement was their lifestyle; now they seek a lucrative income that supports their lifestyle. 

SG:  As opposed to 20 years ago, clearly physicians today are concerned about life outside of their practice.  Particularly with two household incomes, physicians are looking for a certain quality of life that they are not willing to compromise when investigating practice options. 

• How does the influx of more women into the medical profession impact the current survey results?

TS:  Although the current survey does not strictly correlate findings with the breakdown of gender, some observations can be drawn.  Obviously, there are more females in the medical profession today.  By and large, they are greatly concerned with safety and lifestyle issues, as well as balancing professional goals and family responsibilities. 

PM:  Female doctors are certainly concerned with quality-of-life issues.  In evaluating practices, they consider how they will structure their day, time they can spend with family, and community amenities that contribute to an enjoyable life outside of work.  This is not to suggest that they are not money-motivated, but they weigh compensation against other important factors to them as home makers and mothers. 

SG:  The biggest difference in this survey versus 20 years ago was immediate income.  I don't think the impact here is based on gender, but more a sign of the times.  A physician is seeking what most of the workforce is seeking today-- financial reward.  Twenty to thirty years ago, physicians, just like all of the workforce, held jobs within the same organization for 20-30 years and retired from that same job.  This isn't the case for anyone today, male or female. 

• How important is relocation itself as a component of practice selection? 

TS:  Relocation is an important family matter as it involves everyone in the household.  Children are uprooted from their schools, and working spouses need to find other employment.  Furthermore, as spouses become more entrenched in their careers, it takes more to move them to accompany the physicians to a new destination.  When contemplating relocation, the entire family needs to be convinced that they will enjoy a similar, or better, quality of life.

PM:  Invariably, relocation involves “unplugging” a doctor and his family from their current surroundings and moving them comfortably into a new community and work environment.  Our job is to help them make a smooth transition and quick adjustment so that their world is not turned upside down. 

SG:  When investigating opportunities, physician candidates focus on the area and the income potential above all.  To sell the community, it's highly beneficial to schedule in advance for the physician to see the sites, attractions and special amenities offered.  Also, pay attention to what special interests the doctor has.  If he's shown primarily sporting attractions but is more into the cultural arts, that won't make a favorable impression.  “Know your customer” is a key principle of successful sales. 

• How do physicians determine a suitable “quality of life”?

TS:  Quality of life means something different for everyone.  However, certain concerns are important to all practitioners.  Such as: time they can spend with family during the week and weekends; community amenities that match the interests of family members; proximity to major metropolitan areas for shopping, entertainment and better schools for their children; and other perks that enhance the doctor's lifestyle—such as a liberal amount of vacation time. Working at one location and not traveling extensively to different facilities is also an important consideration. 

PM:  For many doctors, quality of life relates to geography, climate, and proximity to other family members and to areas that offer special recreational outlets.  Having numerous options for enjoying life outside the practice environment is extremely important when considering quality of life. 

SG:  Quality of life concerns a lifestyle that is comfortable for the doctor, and his or her spouse and family.  Since it's obviously different for everyone, it's important for hospitals and healthcare organizations to find out what lifestyle the physicians they are recruiting are seeking.  Asking key questions during the recruitment process helps to put quality-of-life concerns in clearer perspective.

• What implications does the survey offer for physician recruiters wanting to attract the best candidates?

TS:  Although we don't like to say that doctors chase “the almighty dollar,” in reality they do.  Based on their specialty, they know their market worth and where they can go to substantially increase their earnings over the near term and long term.  Physician recruiters need to discuss opportunities in regards to leveraging the doctor's immediate earnings and enhancing his or her quality of life.

PM:  Recruiters should recognize that every doctor has unique motivations for making a career move.  However, it's important to focus on the “four dimensions” that drive their decision-making process.  These include:  quality of life, quality of practice, geography and money.  It's crucial to help candidates find the balance that's right for them and structure an offer that will be difficult to turn down.

SG:  As with the hospitals and practices, agencies are going to have to identify what “lifestyle” means to the physician. It is important that agency recruiters find out the goals of the physicians they are placing so that they find the best match.

When I started in this industry (in late 1980's), a lot of time was spent getting to know the spouse and making the spouse comfortable.  The results of the current survey may change that assumption somewhat.  Immediate and potential income are huge factors, and recruiters need to educate their clients:  If they want to hire a great physician, they are going to have to be prepared to be competitive with compensation. 

• Given the survey trends, what should hospitals keep in mind when structuring compensation packages?

TS:  Obviously, there are different compensation models operative today--straight salary, net income guarantee and gross income guarantee, among others.  In weighing job offers, doctors are sensitive to what it will cost them to establish their practice and earn a comfortable living that reflects their worth to the practice.  Obviously, they want to “stack the odds in their favor” when negotiating the terms of an offer.  If a facility really wants to hire a candidate, they need to clearly communicate that verbally and in the offer they make, which can include addressing partnership potential sooner than later, for instance.   

PM:  One trend we're seeing is for hospitals to offer “monthly stipends” for young doctors to offset the cost of living while they complete their training and prepare to join a practice.  In this manner, the employer demonstrates a willingness to invest in the doctor's career before he or she actually comes on board   This personal investment pays off in terms of successful physician recruitment—i.e., “locking up the placement”—and long-term retention.

SG:  Without doubt, hospitals need to recognize the supply-and-demand of physician specialists across the board.  Seasoned physicians, in particular, know their market value and are not hesitant to pursue opportunities that fully meet their compensation demands.  

• What final thoughts come to mind when evaluating the survey trends?

TS:  Specifically, to improve practice management and reduce call rotation, medical practices might consider using more physician extenders as part of their staffing model. 

PM:  Realistically, physician candidates are willing to make some trade-offs when comparing offers involving relocation.  If the money is right, they will consider a less desirable location.  But they look at the entire package, including long-term earning potential and enhancement to their existing lifestyle. As they evaluate 4 or 5 practices at the same time, they look for one that really stands out in an exceptional way. 

SG:  Physicians who are actively or even passively job hunting need to be honest with the hospital or hiring practice about their goals and what they want.  By taking time to really figure out what their goals are, they can narrow their search parameters to achieve more successful results.  They've spent far too many hours training to settle for a job that is in an area that they will hate in six months, or that pays substantially less than what they can earn elsewhere.  This survey gives them the opportunity to see what their peers are seeking and how it matches up with their own objectives and expectations.