HEALTH CARE TODAY& PHYSICIAN RECRUITING RESOURCES MICHIGAN PRIMARY CARE ASSOCIATION

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1 HEALTH CARE TODAY& PHYSICIAN RECRUITING RESOURCES MICHIGAN PRIMARY CARE ASSOCIATION BY: JEREMY SCHULTZ SENIOR MARKET CONSULTANT 2013 AMN Healthcare, Inc. All rights reserved. Redistribution of these materials beyond intended use is prohibited without the express written authorization of AMN Healthcare, Inc. Nothing herein is intended as legal advice. Affected parties are advised to consult legal counsel.

2 R E V I E 2013 O F P H Y S I C I A N A N D ADVANCED PRACTITIONER RECRUITING INCENTIVES An Overview of the Salaries, Bonuses, and Other Incentives Customarily Used to Recruit Physicians, Physician Assistants and Nurse Practitioners 2013 Merritt Hawkins 5001 Statesman Drive Irving, Texas (800) merritthawkins.com

3 A SURVEY OF AMERICA S PHYSICIANS: PRACTICE PATTERNS AND PERSPECTIVES An Examination of the Professional Morale, Practice Patterns, Career Plans, and Healthcare Perspectives of Today s Physicians, Aggregated by Age, Gender, Primary Care/Specialists, and Practice Owners/Employees Survey conducted on behalf of The Physicians Foundation by Merritt Hawkins Completed September, Copyright 2012, The Physicians Foundation

4 TESTIMONY BEFORE THE UNITED STATES HOUSE OF REPRESENTATIVES COMMITTEE ON SMALL BUSINESS SUBCOMMITTEE ON INVESTIGATIONS, OVERSIGHT AND REGULATIONS THE DECLINE OF SOLO AND SMALL MEDICAL PRACTICES

5 2011 Survey of Final-Year Medical Residents A Survey Examining the Career Preferences, Plans and Expectations of Physicians Completing Their Residency Training

6 Department of Health Care Administration 2013 Survey of Alumni Satisfaction & Health System Trends A Survey Examining the Professional Satisfaction, Morale and Healthcare Industry Perspectives of Trinity University Department of Health Care Administration Alumni Currently Serving as Healthcare Facility Administrators or Managers. Conducted for Trinity University Department of Health Care Administration By Merritt Hawkins, The Nation s Leading Physician Search and Consulting Firm and a Company of AMN Healthcare 2013 Merritt Hawkins

7 2013 Physician Inpatient/ Outpatient Revenue Survey A survey showing net annual inpatient and outpatient revenue generated by physicians in various specialties on behalf of their af"liated hospitals 2013 Merritt Hawkins 5001 Stateman Drive Irving, Texas (800)

8 MERRITT HAWKINS Al. an AMN Healthcare company "O r The Cost of a Physician Vacancy An Examination of the True Cost of a Physician Opening and the Economic Impact of Adding a Physician.

9 physicians in those markets K E Y F I N D I N G S 2014 Physician Appointment A survey examining the time needed to schedule a physician appointment in 15 major metropolitan markets and rates of Medicaid and Medicare acceptance by Average wait time in days to schedule an appointment with a physician in family Average wait time in days to schedule practice, cardiology, dermatology, orthopedic surgery, or obstetrics/gynecology. an appointment with a family physician. SEATTLE PORTLAND DENVER MINNEAPOLIS DETROIT PHILADELPHIA BOSTON NEW YORK LOS ANGELES SAN DIEGO DALLAS HOUSTON ATLANTA WASHINGTON D.C MIAMI CUMULATIVE WAIT TIME.5 ALL 18 SPECIALTIES 19.5 FAMILY PRACTICE Merritt Hawkins is the leading physician search and consulting firm in the United States and is a company of AMN Healthcare (NYSE: AHS). For additional information access merritthawkins.com or call

10 TEN KEYS TO PHYSICIAN RETENTION Guidelines for Promoting Positive Physician Relations and Retention 2011 Merritt Hawkins 5001 Statesman Drive Irving, Texas

11 MERRITT HAWKINS A an AMNI Healthcare company itilf TRENDS IN INCENTIVE-BASED PHYSICIAN COMPENSATION An Examination of How Physician Compensation Is Evolving From Volume to Value Based Metrics

12 RVU BASED PHYSICIAN COMPENSATION AND PRODUCTIVITY Ten Recommendations for Determining Physician Compensation/Productivity Through Relative Value Units 2011 Merritt Hawkins 5001 Statesman Drive Irving, Texas

13 IMMIGRATION LAW AND THE RECRUITMENT OF INTERNATIONALLY TRAINED PHYSICIANS FAQ Regarding Immigration Requirements for Internationally Trained Physicians Prepared for Merritt Hawkins by The Law Offices of Carl Shusterman

14 MERRITT HAWKINS A an AMNI Healthcare company itilf HOW TO ASSESS A MEDICAL PRACTICE OPPORTUNITY A Guide for Physicians Seeking the Right Practice

15 WHAT IS THE PHYSICIAN RECRUITING ICEBERG? Let s discuss what happens BENEATH THE SURFACE

16 WHO ARE THEY? OUR FRAGILE, FRAGMENTED PHYSICIAN WORKFORCE 16

17 WELCOME TO THEIR WORKING WEEK AFTER 4 YEARS OF COLLEGE, 4 YEARS OF MEDICAL SCHOOL, 3 TO 7 YEARS OR MORE OF TRAINING Third parties control their fees Tell them how to treat patients Require hours of paperwork Sue them on a whim Require them to change their practice structure/processes Make them question their career choice 17

18 IN A NATIONWIDE SURVEY, 14,000 PHYSICIANS REVEAL ALL The day will come when the practice of medicine will have no more appeal than digging ditches with an overseer standing next to you with a whip. 18

19 KEY FINDINGS 77% of physicians are pessimistic about the future of the medical profession 84% agree that the medical profession is in decline 58% of physicians would not recommend the medical profession to their children Over 60% of physicians would retire today if they had the means, including 46% of physicians 39 or younger Over 80% of physicians rate their morale as either somewhat or very negative 19 Edit Footer Text 01/07/10

20 OKAY, DOCTORS ARE UPSET. SO ARE A LOT OF PEOPLE. WHY DOES IT MATTER? 20 Edit Footer Text 01/07/10

21 BECAUSE EVERYONE NEEDS A DOCTOR THE FIRST PERSON YOU SEE COMING IN THE LAST PERSON YOU SEE GOING OUT 21 Edit Footer Text 01/07/10

22 BUT NOT EVERYONE IS GOING TO SEE ONE KEY FINDINGS: Physicians are working 6% fewer hours than in 2008.a loss of 44,250 FTEs Physicians are seeing 16.6% fewer patients than in 2008 a loss of over 100 million patient encounters a year Physicians spend over 22% of their time on non-clinical paperwork a loss of 165,000 FTEs 22 Edit Footer Text 01/07/10

23 IN AN ERA OF PHYSICIAN SHORTAGES, HOW DOCTORS PRACTICE IS AS IMPORTANT AS HOW MANY THERE ARE AMERICA S 750,000 PATIENT CARE PHYSICIANS ARE FRAGMENTING 23 Edit Footer Text 01/07/10

24 THE COMMON DENOMINATOR? PHYSICIANS WILL PRACTICE IN A GROWING NUMBER OF WAYS.MOST OF WHICH WILL REDUCE ACCESS TO THEIR SERVICES PART-TIME CONCIERGE HOSPITAL EMPLOYED LOCUM TENENS NON-CLINICAL ROLES ELMINATE CERTAIN PAYERS (MEDICAID/MEDICARE/CHARITY) COMMUNITY HEALTH CENTERS TRADITIONAL (INDEPENDENT) 24 Edit Footer Text 01/07/10

25 THERE WILL BE TWO TYPES OF PHYSICIANS: THOSE WHO NEVER VISIT THE HOSPITAL AND THOSE WHO NEVER LEAVE IT 64% of doctors to be employed by 2014, up from 43% in 2000 Source: Accenture 25 Edit Footer Text 01/07/10

26 MEDICAL PRACTICE IS EXPERIENCING A PROFOUND TRANSFORMATION FROM AN ART TO A TRADE Responsibility for the task, not the patient

27 TENS OF THOUSANDS OF FTES WILL BE LOST, JUST IN TIME FOR..HEALTH REFORM

28 REFORM: CONSPICUOUS FOR WHAT IT DID NOT DO Does not remove the cap on GME funding Just 889 new residency slots through redistribution

29 OUR AGING PHYSICAIN WORKFORCE: Association of American Medical Colleges 20,000 too few physicians today 91,000 too few physicians by ,000 too few physicians by % of all physicians over 51 yrs.. 250,000 Physicians to Retire over the next 10 years.. Footer Text: Detail/Disclaimer 01/07/10

30 OUR AGING AMERICAN POPULATION: Association of American Medical Colleges 10,000 Americans turning 65 everyday & continue to do so over the next 20 years. That s one every 8 seconds According to the CDC, this age group sees their physician at 3x the rate of those 30 or younger, and account for 33% of all community hospital stays While only making up 12% of the population Given all this: What are some recruitment challenges to overcome, and how to plan for the future?? Footer Text: Detail/Disclaimer 01/07/10

31 Most candidates prefer larger communities Community Size by Population TODAY S RECRUITMENT CHALLENGES 10k - 49k 6.5% <10k 4.3% 500k % 50k - 99k 30.0% 100k - 499k 32.0% Source: Association of American Medical Colleges

32 MULTIPLE SITES OF SERVICE Community hospitals Hospital systems ACOs Academic Centers Urgent Care Centers Large groups Retail Large Employers Insurance Companies ARE SEEKING FAMILY PHYSICIANS

33 TODAY S RECRUITMENT CHALLENGES External Challenges Who s Looking 6,000+ Recruiters 75+ Retained Firms 250+ Contingency Firms 4,500+ In-House Recruiters 100 s of internet recruiting sites Physician Supply and Demand Changing Medical Environments Geographic's Source: Association of Staff Physician Recruiters

34 FACTOR THREE: PHYSICIAN EMPLOYMENT Merritt Hawkins s searches featuring hospital employment: % % Source: Merritt Hawkins 2013 Review of Physician Recruiting Incentives

35 ONE EFFECT OF EMPLOYMENT: TURNOVER Annual physician move rates: Family medicine.12.6% General Surgery.14.4% Internists..13.0% Pediatricians 10.4% DOES NOT INCLUDE SWITCHING FLAGS Source: Physicians on the Move, SK&A, October 26, 2012

36 CANDIDATE PARAMETERS WHO ARE DOCTORS TODAY? Medical Specialties by Age Specialty % 46 and older % 56 and older Psychiatry 73% 46% Urology 66% 42% Orthopedic Surgery 64% 37% General Surgery 74% 45% Family Practice 55% 25% Internal Medicine 51% 25% Source: AMA Physician Master File, 2012

37 CANDIDATE PARAMETERS WHO ARE DOCTORS TODAY? International Medical Graduates by Specialty Nephrology 41% Internal Medicine 37% Gen Surgery 20% Psychiatry 32% Neurology 32% Pulmonology 29% Family Practice 20% Source: AMA Physician Master File, 2012

38 CANDIDATE PARAMETERS TWO WAYS TO IMMEDIATELY IMPROVE YOUR CHANCES OF RECRUITING SUCCESS 1. Open the search to older physicians 2. Seriously consider International Medical Graduates

39 ASSEMBLE YOUR RECRUITING TEAM Start with anyone that has a say in hiring a candidate Important to elect a willing provider to be the face of your health center when speaking with candidates CEO/Exec. Director must have a presence throughout the recruitment process If the board is involved, elect 1-2 champions to be the voting voice for the rest Clearly define parameters before sourcing candidates 39

40 STRUCTURING OUR OFFER Candidates will look for 4 things. What you can t control Geography Quality of Life What you can control Quality of Practice Compensation

41 CANDIDATE SOURCING SYSTEM Multiple Resource/Strategic Coordination

42 National Sourcing Network Largest Database in the Industry 250,000 Active Physicians MH invests approximately $1.5 million annually into keeping database updated

43 Online Presence Multiple physician employment sites 25,000-30,000 physician hits per month on practice opportunities section Over 1,000 channel partners

44 Text Job Alerts Home Opportunity Search Request A Call Merritt Hawkins' permanent physician placement services fill more physician jobs than anyone in the the industry. We create enduring matches between healthcare organizations and candidates by locating outstanding job opportunities. Ready for your perfect opportunity? Take a look at a few of our Pediatric opportunities now available or contact us at (855) for more information about these positions. Pediatric FEATURED OPPORTUNITIES Florida (#162343) $185k base, hospital employed, sign-on bonus, outpatient only, Jacksonville area, malpractice, tail coverage, and relocation. Georgia (#162535) $200k base plus production incentive, outpatient only, Columbus area, rich benefits package and full relocation.

45 Social Media Largest Social Media platform 1,969 Facebook Likes 1,715 Twitter Followers 905 LinkedIn members on Merritt Hawkins Group Placed 3 physicians through LinkedIn platform in Q4

46 Mobile Media MH launched the first mobile physician recruiting app Search MHA in the itunes store to download

47 Personalized Campaigns Essential to Reaching Passive Candidates

48 Personal Campaign Mobile Text ALERTS! Download our MOBILE APP! Daytime Shifts Only / No Nights Hospital Employed Merritt Hawkins, the nations leading physician search and recruiting frim, invites you to consider this oustanding hospitalist opportunity in a unique hospital-employed practice setting. To Learn more or to submit an application, Sean Crosswhite, Divisional Vice President of Recruiting, or by calling toll free at (866) Opportunity Snapshot: * $220k starting base salary plus quality bonus * Day shifts only Southeastern City of Nearly * Block Schedule of 7 on/ 7 off Two Million * Average volume of 12 to 15 patients per day * State-of-the-art hosptial with excellent subspecialists, nursing, and EMR Community Snapshot * One of the "15 Best U.S. Cities for Work and Family" - Fortune * Vibrant economy, recognized as one of the Best Cities for Job Growth * Home to world-class galleries, theaters, museums, festivals and events * Enjoy excellent schools and low cost of living Contact Sean Crosswhite, Divisional Vice President of Recruiting, at Merritt Hawkins no to learn more via or by calling toll-free at (866)

49 New Physician A Resource for Residents Seeking Practices

50 Thought Leadership Millions of touch points / impressions on the marketplace Surveys White Papers Major Publications Speaking Engagements

51 Comprehensive Approach

52 QUESTIONS & ANSWERS 2013 AMN Healthcare, Inc. All rights reserved. Redistribution of these materials beyond intended use is prohibited without the express written authorization of AMN Healthcare, Inc. Nothing herein is intended as legal advice. Affected parties are advised to consult legal counsel.

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