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• Vendor Profile: MedLicense.com
• FTC Seeks Comment on CAN-SPAM Act
• National Conferences of Interest
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NAPR Board:
President
Sandi J. Brewer
President-Elect
Karen Zeller
Vice President
Jo-Ann Toldt
Secretary/Treasurer
Martin H. Osinski
Immediate Past President
Mike Broxterman
Directors:
Jane Born
John S. Daniel
Neal Fenster
Tammy Jamison
Michael Levison
Ronald Watson
NAPR Services, Inc.
Julie Sherriff
Ethics
Richard Glehan
Internet/Website
Daniel Stern
Executive Vice President
Bill Kautter
Subspecialties flourish as IM residents shun primary care
A new study documents how many internal medicine residents are choosing a subspecialty, where they are going and why.
Respondents
Generalist
Hospitalist
Subspecialist
O
1998
4,008
54%
--
42%
4%
1999
4,338
49%
--
47%
4%
2000
4,562
44%
--
51%
6%
2001
4,565
40%
--
54%
6%
2002
3,495
28%
4%
56%
12%
2003
4,732
27%
7%
57%
9%
Reason for career path
Generalist
Hospitalist
Subspecialist
Good
match with interests
85%
90%
94% More
time for nonwork activities
52%
59%
33% More
time with family
60%
62%
39% Higher
income
7%
24%
27% Caring
for ambulatory patients
62%
5%
26% Broad
practice area
73%
65%
27% Narrow
practice area
4%
9%
52% Long-term
relationships with patients
74%
14%
55% Short-term
relationships with patients
5%
47%
14% Caring
for critical care patients
16%
65%
46% Interest
in health care policy issues
21%
28%
16%
Dear Miss Deed: Dear No: Miss Deed is an expert on all things ethical, and is ready to answer
your questions. All questions to Miss Deed must be accompanied by the
individual's name, telephone and e-mail address. If the individual does
not want his or her name published, we will publish the question with the
statement: "Name Withheld By Request." No questions will be considered
without verifying who the sender is. Send your questions to Miss Deed at
the following e-mail address: DearMissDeed@napr.org and
your question may appear in an upcoming NewsFlash!
NAPR Services June Specialty Mailers
This June, we will mail to all recruitable Emergency Medicine physicians,
in private practice, hospital-based, academic, governmental, and military practices. You are a hospital seeking additional EM department coverage…
Your investment in this mailer is only $2,600 (payable in installments and only 10 cents each). Yes, you can reach all 25,012 EM physicians at this low price! Don’t forget, you can also include a list of your job openings so that every EM physician in the nation knows about your practice opportunities!
The mailing program is limited to the organizations which send in a commitment form before June 17, 2005, have signed the revised List Usage Agreement (dated 2/99) and paid their 2005 dues Total Specialty: Emergency Medicine Sign-Up Form (Adobe PDF)
Sizzling Specialty ERCP • Hepatology
As usual, in 2005, the demand for this specialty is unsurpassed! For only 11 cents each, you can place your job ads directly into the hands of 7,000 GI’s all across the country. This mailer provides you the most cost-effective source of candidates in the industry! Just imagine what an advantage this is over your competitors!
Don’t lose out - Register NOW – Only $775!
The mailing program is limited to the organizations that send in a commitment form on or before June 15, 2005, have signed the revised List Usage Agreement (dated 2/99), and paid their 2005 NAPR Membership dues.
You can advertise 10 job listings at NO ADDITIONAL cost in any of these mailers. The job listings will be inserted into each mailing piece. The physicians will indicate an interest on their reply form to one or more of your jobs. ALL PHYSICIAN RESPONSES ARE FORWARDED TO ALL PARTICIPATING MEMBERS, NO MATTER THE JOBS IN WHICH THE PHYSICIAN EXPRESSES INTEREST.
Total Specialty: Emergency Medicine Sign-Up Form (Adobe PDF) Vendor Profile: MedLicense.com
FTC Seeks Comment on CAN-SPAM Act
By Myrle Croasdale, AMNews staff. May 16, 2005.
It's well-known that fewer U.S. medical graduates are choosing primary care, a trend that the National Residency Matching Program has followed. Now in a study unlike others before it, researchers dig deeper, tracking internal medicine residents to find out exactly how many were going into primary care and how many were planning to subspecialize.
They found that only 27% of graduating residents were picking primary care careers in 2003, compared with 54% in 1998. There was even less interest among first-year interns in 2003, with just 19% expressing a desire for a primary care path.
"More and more over the past few years, we've been seeing them choosing subspecialties instead of primary care. It's a trend most people in the trenches are aware of. The data verify these impressions," said Richard Garibaldi, MD, chair of the Dept. of Internal Medicine at the University of Connecticut Health Center, who decided to study the issue more closely.
Dr. Garibaldi's study -- "Career Plans for Trainees in Internal Medicine Residency Programs" published in the May Academic Medicine -- expands on what's been widely observed within the medical profession.
Other studies have focused on why students are turning away from primary care disciplines and have found that declining reimbursement for nonprocedural care, the opportunity for a controllable lifestyle and a medical culture in which subspecialists are seen as more prestigious have played a big part.
Dr. Garibaldi's study focused on internal medicine residents and quantifying precisely where they are going and why. The study found that more than half of these residents were seeking subspecialties, and the bulk of this group was choosing the higher-paid procedural disciplines.
Richard Cooper, MD, director of the Medical College of Wisconsin's Health Policy Institute, said the results were no surprise.
"Those are the realities, and you'll see even more in the current Match and the current students," Dr. Cooper said. "They just aren't thinking generalist careers."
The pull toward subspecialties
Jeff Gonzalez, MD, a third-year gastroenterology fellow, said he had considered general medicine during the first few months of his internship, but before the year was out he instead found himself deciding between two procedural subspecialties, cardiology and gastroenterology.
Dr. Gonzalez, chair of the American Medical Association's Resident and Fellow Section, said being able to work with his hands and finding a narrow field of expertise were among the factors that helped him make his gastroenterology career choice.
Though Dr. Gonzalez enjoyed his time in general medicine, he said he preferred tackling problems for which the outcome was clear.
"If it's a screening colonoscopy, and I see a polyp, I take it out," he said. "There's immediate satisfaction in doing something and seeing the result."
Dr. Gonzalez's preference for procedures is growing increasingly common. Among the internal medicine residents surveyed in 2002 and 2003 who said they intended to pursue subspecialties -- more than half of the residents in each year -- 73% wanted to specialize in procedure-oriented disciplines. Of this group, the breakdown of the fields chosen was:
Of those wanting to subspecialize, but preferring nonprocedural disciplines, 7% chose endocrinology, 6% chose infectious diseases and 5% chose rheumatology.
Although Dr. Gonzalez said narrowing his expertise was important, he also said income played a role in his decision, something primary care leaders have speculated was a factor in residents' decisions today.
"Even though I have to put in another three years, I'll be paid what my education is worth," he said.
He didn't think that would be the case if he went into primary care, where he might earn $110,000 a year and take home $70,000 to $80,000 after taxes. That's a salary someone with less education and training can earn in other fields, without the debt of medical school, years spent training and commitment to a lifetime of being on call, he said.
Re-igniting interest in primary care
Steve Fihn, MD, past president of the Society of General Internal Medicine and a professor at the University of Washington School of Medicine, said the mounting data show a strong need to take action to rekindle students' interest in primary care.
"Not only are the current numbers bad, but the [longer-term] trends are pretty profound as well," he said.
The number of students choosing internal medicine has held fairly steady during the same period that the number choosing to go into family medicine has declined. Dr. Fihn said this was most likely because students and trainees are heading into subspecialties instead of general medicine, an assumption Dr. Garibaldi's study upholds.
Primary care professional associations have task forces looking at the issue, but Dr. Fihn said solutions have been difficult to find.
"It's a pretty daunting task trying to reverse this trend when the economic forces are so strong," Dr. Fihn said. "Right now, the perception of the life of a primary care physician is justifiably not very attractive."
Students and residents realize they can work as much as or even less than primary care doctors while making a whole lot more money, Dr. Fihn said, so they subspecialize. "There's a feeling if you don't work for a large organization, you can't make a living in primary care."
Dr. Garibaldi said he thought medicine was headed for a crisis in primary care. "We're not going to have the physician people power that we've had in the past. We're going to have to come up with new strategies for handling patients."
Subspecialists could find they're becoming the principal caregiver for some patients, Dr. Garibaldi said.
While some in the physician work force debate say medical students and residents are in sync with public demand, Dr. Fihn noted that other developed nations had more primary care physicians than subspecialists. The United States health care structure is getting perilously out of balance, he said.
"I can't help but believe something important will be lost if we all decide to just see specialists," Dr. Fihn said. "Specialists are only one piece of the health care system."
ADDITIONAL INFORMATION:
General medicine vs. subspecialties
The number of third-year internal medicine residents choosing a subspecialty has risen each year for the past six years. The newly emerging field of hospital medicine was not tracked as a career choice until 2002.
Note: The "other" category includes respondents who did not respond to the resident survey portion of the internal medicine in-training exam, those who selected "other" as their career option and those who were undecided.
Source: "Career Plans for Trainees in Internal Medicine Residency Programs," Academic Medicine, May
Behind the decisions
When asked what led them to choose primary care or a subspecialty, internal medicine residents who chose a subspecialty cited a need for a narrow practice area and long-term relationships with patients as among the top reasons.
Note: Residents could list more than one reason.
Source: "Career Plans for Trainees in Internal Medicine Residency Programs," Academic Medicine, May; data for this table came from a 2002 internal medicine in-training examination survey
Women say primary care can allow more family time
Women physicians training in internal medicine programs are more likely than their male counterparts to factor in time with their families and other nonwork activities when deciding their specialties.
Consequently, they are more likely to choose primary care than men, according to the new study "Career Plans for Trainees in Internal Medicine Residency Programs."
Though primary care can demand long hours, women told researchers that they believe the field would allow them to more easily limit their work hours, share a job, restrict their practices to office hours only or join large group practices where they would be on call less of the time.
The result: 27% of women in internal medicine choose a primary care route; 19% of men do.
Women accounted for 40% of the internal medicine residents surveyed in the study, and their answers show that time for family and nonwork activities continue to be big factors when women pick fellowships. Women who pursued fellowships favored endocrinology, rheumatology, hematology/oncology, infectious diseases and geriatrics, according to the study.
Women were less likely than men to go into subspecialties, with 47% of women choosing that path versus 58% of men. But there wasn't a gender gap in the reasons men and women gave for becoming subspecialists, the research showed. Both genders said control over their time was less important, while higher income was more important.
Richard Garibaldi, MD, lead author of the study, said medical schools and residency programs need to find ways to support residents balancing family with work.
"We all have to be aware that more women are in medical school now, and some of their desires and needs are different than the traditional graduate of 30 years ago," Dr. Garibaldi said. "We need to be more sensitive to those needs."
AMNews, 5/16/05; 48;1,2. Copyright © (2005), American Medical Association, All rights reserved.
I am a recruiter for a hospital and did something that I think is perfectly okay, but a colleague in another hospital says what I did is a “no-no.”
I received a referral from a recruiting firm and sent the candidate to several of my local practices. One practice was interested but nothing came of it.
Several months later I was talking to a colleague in another hospital, not affiliated with mine, who asked if I knew of any family doctors who did obstetrics. I recalled the referral I received a while ago from the recruiting firm and thought the candidate would be perfect for my colleague’s practice, so I gave him the CV. After all, I didn’t have any opportunity for this doctor.
It seems perfectly straightforward to me; I wasn’t ever going to need this doctor so why not help him find a good job. I think this is a…
No Brainer
In all honesty, I think your thought processes may have taken a mini vacation. The Code of Ethics states “In house recruiters may not refer a candidate presented to them, by a member, to any other person or entity without written permission from the referring member.”
You were obligated in four ways to the referring member (the recruiting firm). First, the recruiting firm probably had a clause in the contract you signed (virtually all firms have them) stating a fee is due if you refer the candidate to another entity within a specified period of time. Second, even if the referring firm is not an NAPR member, their contract language usually covers third party referrals. Third, you can make a referral without written permission to any group of doctors on your medical staff as called for in the Code of Ethics. And fourth, for practical reasons alone, if you made referrals of unwanted candidates you received from recruiting firms to your buddies around the country, it would create chaos and lawsuits.
Your heart was in the right place, but your knowledge of the Code and ethical business practices was a bit shy of perfect.
Cordially yours,
Miss Deed
EMERGENCY MEDICINE
25,012 Pieces ! !
You may find this mailer particularly useful if:
You are an EM staffing company…
You are a Locum Tenens provider…
You are a contingency recruiter who can market EM candidates…
You are a retained recruiter with EM clients expecting the best from you…
Mailer
Gastroenterology
7,000 Pieces!
Pediatric GI • Endo Center Work
Transplant Specialization
Sizzling Specialty: Gastroenterology Sign-Up Form (Adobe PDF)
and fax it to NAPR headquarters
Questions? Call or e-mail Victor Fernandez at NAPR Headquarters:
Phone: (407) 774-7880, e-mail: vfernandez@napr.org
An Interview with Michael Brooks, Managing Member
By NAPR Headquarters Staff
What does this company do?
MedLicense.com provides complete Physician Licensure services to physicians seeking a timely medical license in any of the 50 States, Canada, Mexico, or Europe.
What is your position there?
I am the Managing Member and Founder of MedLicense.com. My main responsibilities lie in the general oversight of the licensure process for our clients and management of our Department Managers.
What services or products do you provide that would be of interest to physician recruiters?
The Physician Recruiters of NAPR do not need me to explain the problems related to recruiting out of State Physicians for open positions. Without a valid medical license the Physician cannot fill the position. The Licensure process can take 6 to 9 months in many cases due to the individual complexities of the individual Board Requirements and histories of the Physician Applicants. Our program considerably streamlines the licensure process. Our internal procedures guarantee that each of the Physician's verifications will be followed up with every 7 business days until the license is issued. Our commitment to provide the industries highest level of service is clearly seen through our 500% growth last year with 50% of our growth coming from Referrals and Returning Physicians seeking additional licenses. More Physician Recruiters are outsourcing the State Medical Licensure process for their Physician Clients due to the high overhead and expense of maintaining a Licensure Department. Our commitment to our client's is seen through the results. MedLicense.com had 1200 licenses approved in 2004. This is roughly 2% of all licenses issued in the USA. We experienced only 2 Denials due to issues related to the Physician's non-disclosure. MedLicense.com is thorough and we follow through until the license is issued.
Please provide a brief profile about yourself
Michael Brooks, the Managing Member of MedLicense.com, founded MedLicense.com in 2002. Before MedLicense.com, he was the Director of the Eastern Division of a HR Firm, one of Florida's 100 Largest Privately Owned Companies. His experience in Government Regulatory issues, red tape, and statutory rules has allowed him to easily transition into the licensure field and develop MedLicense.com into the rising star of the physician licensure industry.
Contact information
MedLicense.com
Michael Brooks 706-478-1480
info@medlicense.com
www.medlicense.com
By Kathleen A. Ream
Principal, KAR Associates, Inc.
NAPR/NALTO Legislative Consultant
Implication
Final rule could negatively affect the use of unsolicited e-mail as a viable method of communication for associations and businesses.
Current Status
On May 12, the Federal Trade Commission (FTC) published a Notice of Proposed Rulemaking concerning the CAN-SPAM Act, the first federal law designed to combat unsolicited commercial e-mail, or spam. This law has been in effect since January 1, 2004.
In its notice, the FTC addressed a number of topics that were raised in previous rulemakings and asked for comments on several new proposed rules. The following proposed rules are important to the association and business community.
The deadline to submit comments to the FTC is June 27, 2005. Comments can be submitted electronically by going to the FTC Web site at https://secure.commentworks.com/ftc-canspam/
A copy of the Federal Register Notice can be found at http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/pdf/05-9353.pdf
National Conferences of Interest
American College of Emergency Physicians
www.acep.org
American College of Osteopathic Emergency Physicians
www.acoep.org/meetings.htm
American Board of Psychiatry and Neurology Examination Schedule
847-374-4226
American College of Occupational and Environmental Medicine
www.acoem.org
International Academy of Cardiology
www.cardiologyonline.com
12th World Congress on Heart Disease
July 16 – 19, 2005
Vancouver, BC Canada
If you have questions or comments about
NewsFlash, please contact: Bill Kautter at bkautter@napr.org (800-726-5613)
or Public Relations Chair Niki Hogan at niki_hogan@daniel-yeager.com
Please note that letters and comments sent to the publisher are
automatically considered for use in upcoming issues unless you expressly
request that they not be used. You may request that you remain anonymous
in the case that your letter or comments are used. We reserve the right to
edit for brevity and/or clarity.
This eNewsletter is automatically sent to all NAPR members as an added,
free benefit of membership. Non-NAPR Members are invited to subscribe to
this newsletter by contacting Judy Clark at jclark@kmgnet.com.
The National Association of Physician Recruiters (NAPR), headquartered
near Orlando, Florida, was founded in 1984, for the purpose of creating a
national organization through which professional physician recruiters
could work together to maintain standards of excellence within the
industry and ensure the highest degree of quality in recruitment services.
Today, the NAPR represents over 400 members, including recruitment firms,
in-house staff physician recruiters, as well as contract staffing and
management, trying to make a difference in the physician recruiting
industry.
NAPR, 222 S. Westmonte Dr, Ste 101, Altamonte Springs, FL 32714, 800-726-5613.