Kurt Mosley, VP of Business Development, The MHA Group

The older I get, the more things there are that date me, including television shows.

I still think of James Brolin, who played the hot-headed Dr. Kiley on the old “Marcus Welby, M.D.” TV drama, as a dashing young physician. While Mr. Brolin may still be dashing, the reality is he is no longer young. In fact, it is his son, Josh Brolin, who is getting the young man’s parts these days, in movies such as “True Grit” and “No Country for Old Men.”

I mention this because it is not just the actors who play doctors on TV who have changed, but doctors themselves. There is no more “Marcus Welby” on television just as there are very few “Marcus Welbys” left in real life. Dr. Welby, for those old enough to recall, was an independent, primary care physician who owned his own practice.

As a new Merritt Hawkins survey shows, the classic private practitioner is on his or her way out, to be replaced by the hospital-employed doctor.

Merritt Hawkins’ 2011 Review of Physician Recruiting Incentives tracks over 2,660 physician recruiting assignments the company conducted nationwide from April 1, 2010 to March 31, 2011. During that period, 56 percent of the physician search assignments Merritt Hawkins conducted featured jobs with hospitals, up from 23 percent five years ago. Only 2 percent of the firm’s search assignments featured openings for independent, solo practitioners such as Marcus Welby, down from 17 percent five years ago.

Physicians are eschewing private practice for a number of reasons, including declining reimbursement, rising malpractice and operational costs, and the growing administrative headaches of running a business. Emerging delivery systems such as accountable care organizations (ACOs), which depend on close physician/hospital cooperation, are causing hospitals to embrace the role of employer. The Medical Group Management Association projects that in just two years, only one-third of physicians in the United States will be in independent practice.

Today, private practice settings are very difficult to recruit into, and those hospitals that are not willing to employ doctors, or who are restricted from doing so by law, are at a distinct disadvantage. How this trend will affect quality of care remains to be seen.   However, growing physician employment is likely to reduce the overall access patients have to physicians, since employed doctors often work fewer hours than independent ones. As doctors cut back on work hours, more FTEs will be needed per population than were needed in the past, keeping physician recruiters busy.

The survey also indicates that primary care physicians, including family physicians and general internists, remain the type of doctors in highest demand. For the sixth straight year, family physicians were Merritt Hawkins’ most requested type of doctor, followed by internists, hospitalists, psychiatrists, and orthopedic surgeons. Fewer medical school graduates are choosing to enter primary care, constraining supply, while population growth, patient aging, and new delivery models emphasizing primary care are driving demand.

These new models also promote methods for compensating physicians that are based on quality of care and cost efficiency metrics. However,  the survey suggests that in the “real world” physicians are still compensated on volume-based formulas such as the number of patients they see, the amount of revenue they generate, or the number of work units (known as RVUs) they accrue. Over 90 percent of searches tracked in the survey featured physician production bonuses that reward doctors for fee-for-service style volume, while less than 7 percent reward physicians for meeting quality of cost objectives. So while quality and cost rewards may be the physician compensation standards of tomorrow, patient volume, revenue or work units remain the standards of today.

The 2011 Review of Physician Recruiting Incentives includes a wide range of additional information concerning average physician salaries by specialty, signing bonuses, relocation allowances and other perks. Please email me at kurt.mosley@amnhealthcare if you would like a copy.

Kurt Mosley serves as Vice President of Strategic Alliances for Merritt Hawkins and Staff Care, firms specializing in physician staffing that are companies of AMN Healthcare (NYSE: AHS).

Mark Smith, President, Merritt Hawkins

Lawyers, doctors and other professionals have the opportunity to offer their services on a pro bono basis in aid of the public good. Why not recruiters?

That’s a question we asked ourselves recently when trying to establish a public service campaign that would suit the talents and resources of our companies. Since we specialize in physician recruiting, we decided it would make sense to find a physician for a small town that needs one, waiving our professional fees.

This pro bono physician recruiting effort is intended to address one of the challenges facing rural America: a serious and growing physician shortage. The federal government keeps a running count of Health Professional Shortage Areas (HPSAs)  – places that fall below a minimum standard of one primary care physician for every 2,000 people. The majority of HPSAs are located in rural communities, though urban areas also can be designated as HPSAs. Currently, there are some 6,200 HPSAs across the U.S. in which over 65 million Americans live. Ten years ago, there were fewer than 3,000 HPSAs nationwide.

The government estimates it would take more than 17,000 medical providers to address physician shortages in the nation’s HPSAs. Bringing one doctor to a small town may have a positive effect on the people living there, but it obviously will make only a small dent in the overall physician shortage. However, our hope is that our pro bono program will draw needed attention to a growing crisis in rural medicine — one that has largely been overlooked lately as the national focus has been almost entirely on health reform.

We hope to illustrate that the physician shortage is not just a serious impediment to care in rural areas, but has broader economic and social implications. Hospitals typically are the largest employers in small towns, but they require the presence of physicians to remain financially viable. When too few physicians are available, hospitals are obliged to scale back or even close altogether. Communities without a hospital have a difficult time attracting new businesses or residents and sustaining economic growth. A dearth of physicians can therefore cause or contribute to a downward spiral in a community that may be hard to reverse. Conversely, a strong medical community can be an engine for economic growth.

As part of the pro bono program, Merritt Hawkins will conduct a full service physician search for a hospital, medical group or other facility in critical need of a physician. Services will include an on-site opportunity evaluation, consulting on contractual and incentive issues, candidate sourcing, screening, and interviewing. The bono physician search will be open to any hospital, medical group or community with a critical need for a physician that has been unable to find a doctor on its own.

Hospital or community representatives will be asked to complete an application for the search using a form that can be downloaded at our web site at www.merritthawkins.com.  All applications will be reviewed by a selection committee composed of Merritt Hawkins’ executives as well as health care leaders and other industry experts. Three finalists will be chosen based on the severity of their need for a physician, the time they have been seeking a doctor, and the impact that a lack of physician services has had on the community. One of the finalists will be chosen for the program pending an on-site interview.

Applications for Merritt Hawkins’ 2011 pro bono physician search are due by August 15, 2011.

In addition, I would be interested to learn of other community service programs that recruiters may be involved in and what impact they have had. Please feel free to contact me and share your stories.

Mark Smith is president of Merritt Hawkins, a national physician search and consulting firm and a company of AMN Healthcare. He can be reached at mark.smith@merritthawkins.com.

Mark Smith, President, Merritt Hawkins

Is there a doctor in the house?

Of all the questions facing the nation’s healthcare system, this one remains the most critical. After all, without physicians, no model of healthcare delivery, no matter how well conceived, will accommodate the needs of America’s growing and aging population. Despite the growing number and expertise of other health care professionals, it is still physicians who diagnose illness, admit patients to the hospital, order tests, perform procedures, and discharge the patient.

As providers of care, they remain indispensable. They also are an essential source of revenue. According to Merritt Hawkins’ Physician Inpatient/Outpatient Revenue Survey, a single physician generates an average of $1.5 million per year on behalf of his or her affiliated hospital through admissions, tests, stays, and procedures.

Without physicians, the old joke goes, hospitals are simply empty hotels with expensive equipment.

And it is physician recruiters who must supply the physicians on whom hospitals and medical groups depend. Whether working as in-house professionals, or with retained or contingent firms, physician recruiters are the “source of the source” from which virtually all patient treatments and revenues flow.

The title “physician recruiter” therefore carries with it a good deal of responsibility and the pressure that often goes with it. That pressure is not likely to lessen any time soon, and will probably increase. Estimates from the Association of American Medical Colleges indicate that by 2025, the United States will be short some 160,000 physicians. This does not take into account the fact that health reform will bring 32 million people into the ranks of the insured by 2019, further driving demand for doctors.

It will take every available resource for hospitals, medical groups, government facilities and other organizations to find the physicians they need. All types of physician recruiters – in-house, retained and contingent – will need work together to meet the goals of their employers or clients.

In the past, the relationship between in-house physician recruiting professionals and outside or agency recruiters could at times be characterized as a wary truce. Differences in approach, poor communication, and disputes over “turf” have on occasion created conflicts where there should be cooperation.

Moving forward, in-house physician recruiting professionals and outside agencies will have extra motivation to work together. Consolidation throughout the healthcare industry is creating larger organizations composed of multiple facilities. In-house recruiters at these organizations will have enhanced influence and outside agencies will have to work even harder to earn their trust.

In addition, new delivery models are coming online which depend on physician hospital/integration. Known as accountable care organizations (ACOs) these models will require cooperation between physicians and hospitals on clinical, IT, administrative and other issues. As ACOs proliferate, in-house recruiters will become more influential, serving not only in a recruiting capacity, but also as liaisons between physicians and hospitals, helping to build alignment and communication between the two parties on the front end.                                 

As their duties and responsibilities increase, in-house physician recruiters will for their part require the resources and expertise of outside agencies, particularly on high volume, high challenge, or temporary search assignments. Agencies will need to understand the dynamics of the new delivery models and bring to bear national candidate sourcing systems and specialty-specific knowledge to be effective. They also will need to create productive partnerships with their in-house peers, finding ways to complement the services in-house personnel provide through value-added consultation.

Healthcare is changing, but physicians – and, by extension, physician recruiters – will remain at the center of the system. Whether in-house or with an agency, it’s an exciting time to be a physician recruiter. I am proud to be a member of this vital and dynamic profession and welcome comments or questions from others in the industry.

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Mark Smith is President of Merritt Hawkins, a national physician search and consulting firm and a company of AMN Healthcare. Mr. Smith can be reached at mark.smith@merritthawkins.com.

New Report Marks the Decline of the Private Practice Physician

Kurt Mosley, VP, Merritt Hawkins/AMN Healthcare

The traditional private practice physician, personified for millions of viewers by the actor Robert Young of the classic television show Marcus Welby, M.D., (http://www.museum.tv/eotvsection.php?entrycode=marcuswelby) is becoming a relic of another time.

This is one finding of a new report which should be of interest to anyone who recruits physicians, or, for that matter, to anyone who is likely to see a physician (which means just about everybody). The report, which is entitled Health Reform and the Decline of Physician Private Practice, was completed by Merritt Hawkins on behalf of The Physicians Foundation – a national not-for-profit organization dedicated to enhancing the work of practicing physicians and the quality of patient care.

In July of 2010, Merritt Hawkins assembled a panel of leading healthcare experts, ranging from heads of major hospital systems to private practice physicians, to project the effects of health reform on medical practice in the United States. The panel’s report, released in November, includes a survey in which 2,400 physicians revealed their reactions to health reform and provided insight into their future practice plans.

The great majority of physicians surveyed (74 percent) said they plan to make one or a combination of the following career changes in the next one to three years as reform is phasing in. Nineteen percent plan to cut back on the hours they work, 16 percent plan to retire, 11 percent plan to become hospital employees, 14 percent plan to work on a temporary (i.e. locum tenens) basis, 12 percent plan to seek a job outside of healthcare, and eight percent plan to work part-time, while only 26% plan to continue practicing as they are.

The survey suggests, and the report’s panel members agreed, the traditional model of private practice, in which a physician owns his or her own shop, works a full week, and sees all comers, is no longer tenable. Both market forces and the new healthcare reform bill are pushing doctors to consolidate into larger groups, to align with hospitals, or to become hospital employees. New payment systems, which reward doctors for both quality and efficiency, not just for volume of services performed, require data systems which private doctors often cannot afford or maintain. Private practice physicians also are faced with a growing amount of regulatory compliance responsibilities and with declining reimbursement, making private practice increasingly difficult to sustain.

Many private physicians unable or unwilling to become a part of larger organizations are seeking alternatives. Some are embracing part-time work in order to opt out of the rigors of private practice and to have more family time. Others are joining the growing ranks of locum tenens physicians – doctors who accept temporary practice assignments which can last from a few days to a year. Staff Care, a company affiliated with Merritt Hawkins which places locum tenens physicians, estimates 38,000 doctors now work on a temporary basis each year, up from 26,000 six years ago.

The result is an evolving physician workforce which is increasingly diverse and much less homogenous in terms of practice style than it has been in the past. Physician recruiters will need to adapt to these changes and incorporate all types of doctors – full-time, part-time, employed, independent, hospital-based, locum tenens – into their staffing plans in order to be successful.

To illustrate this point, the new report includes case studies of practice styles which Merritt Hawkins and the panel believe will be prevalent in the post reform era. Cases studies of a medical home, a community health center, an accountable care organization, and a concierge practice are included in the report.

The report also includes an analysis of the regulatory challenges health reform presents to physicians and a detailed discussion on how health reform is likely to affect physician supply and demand. Readers who would like a full copy of the report are welcome to email me at kurt.mosley@amnhealthcare.com.

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Kurt Mosley is Vice President of Strategic Alliances with Merritt Hawkins and Staff Care, companies of AMN Healthcare, the largest healthcare staffing organization in the United States. He can be reached at kurt.mosley@amnhealthcare.com.

Kurt Mosley, VP of Business Development, The MHA Group

Though it may not be a “dog bites man” story, I believe it is nevertheless telling that demand for psychiatrists today is growing faster than for any other medical specialty.

That is one finding of Merritt Hawkins’ latest annual survey of physician recruiting trends, which examines the incentives being offered to recruit doctors and indicates the types of physicians in most demand.  This is the 17th year Merritt Hawkins has conducted the national survey, which is widely used by hospital and medical groups to benchmark physician incentive packages.

The firm’s 2010 Review of Physician Recruiting Incentives tracks over 2,800 physician recruiting assignments Merritt Hawkins conducted nationwide from April 1, 2009 to March 31, 2010. During that period, Merritt Hawkins fielded 179 requests for psychiatrists, up 47 percent from the previous year and 121 percent from three years ago. The increase in demand for psychiatrists is noteworthy, because it is taking place during an economic recession which generally has inhibited recruiting of other types of doctors.

It is a fact of life when the economy goes down, mental health problems tend to go up. However; there is more to the rising demand for psychiatrists than the recession.  A combination of factors is driving a psychiatrist shortage which could soon reach crisis levels.

More than half of all psychiatrists are 55 years old or older and are nearing retirement age, while fewer medical school graduates are showing an interest in psychiatry. As the supply of psychiatrists decreases, population growth, population aging, economic challenges, and two wars are driving demand for mental health services higher. The U.S. Department of Health and Human Services (HHS) projects demand for psychiatric services will increase by 19 percent from 1995 to 2020. HHS already designates 3,132 Health Professional Shortage Areas (HPSAs) nationwide for mental health, in which 80 million Americans live. This number is likely to grow significantly if steps are not taken to address the problem.

For years, mental health challenges facing Americans have long flown under the radar. Although the shortage of psychiatrists may be a silent one, it is real nonetheless.

While demand for psychiatrists is growing faster than any other specialty, primary care doctors such as family physicians and internists remain the most recruited types of physician, as the list below indicates.

Top Ten Most Recruited Physicians

1. Family practice                                                             6. Orthopedic surgery
2. Internal medicine                                                        7.  Pediatrics
3. Psychiatry                                                                      8.  Obstetrician/gynecology
4. Hospitalist                                                                      9. Radiology
5. Emergency medicine                                                 10. General surgery

Source:  Merritt Hawkins 2010 Review of Physician Recruiting Incentives

The survey also suggests traditional models of physician practice may be changing. In the past, physicians have typically worked as independent contractors who own their practices. Today, a growing number of physicians are working as hospital employees. Of the physician searches tracked in the survey, 51 percent featured settings in which hospitals employ physicians, up from 45 percent the previous year and 23 percent four years ago.

Clearly, the independent, private medical practice is a model which may be going the way of the dinosaur. Physicians are simply tired of the risks and hassles of owning their own shops and are choosing to work as employees. Indeed, the key to physician recruiting today is to create not just a strong incentive package, but a working environment which minimizes bureaucratic and reimbursement hassles and allows doctors to do what they do best – treat their patients.

Those who would like a complete copy of Merritt Hawkins’ survey are welcome to email Kurt at kurt.mosley@amnhealthcare.com.

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Kurt Mosley is Vice President of Strategic Alliances for Merritt Hawkins and Staff Care, companies of AMN Healthcare, and can be reached at kurt.mosley@amnhealthcare.com.

By Kurt Mosley

Kurt Mosley, VP of Business Development, The MHA Group

The three trillion dollar question to which no one yet has a clear answer is what effect will the new health reform law have on how, when, and where health care is delivered in the United States?

What is clear, however, is that reform will create both opportunity and challenges for health care recruiting professionals. Over the next several years, over 30 million previously uninsured patients will obtain medical coverage thanks to the new law. Millions of these people will come from the ranks of the sick and the economically disadvantaged, two groups that require a disproportionately large volume of medical services.

Significantly enhanced demand for health care will put an additional strain on an already limited supply of health care professionals, including physicians, nurses and allied providers. Massachusetts, which implemented a health reform program very similar to the one mandated by the new federal law, provides a test case. Since access to medical services was expanded in the state, many patients have had a difficult time getting in to see a doctor. In 2009, Merritt Hawkins conducted a survey to determine how long patients have to wait for physician appointments. Of the 15 major cities examined in the survey, Boston had the longest average wait time – 49 days – despite having more physicians per capita than almost any other region in the United States.

No wonder that many health facility administrators are apprehensive about the new law. AMN Healthcare (Merritt Hawkins’ parent company) conducted a survey in April of this year asking hospital and medical group administrators about their initial reaction to health reform. Only about one quarter said they were pleased about the new law, whereas over 70 percent said the law was a cause for concern. Of most interest to recruiters, the majority of health administrators surveyed indicated that the new law would create the need for additional physicians, nurses, and allied providers at their facilities (please email me at kurt.mosley@amnhealthcare.com if you would like a copy of the AMN survey).

While reform is likely to significantly increase demand for health services, it will not have a particularly significant impact on the supply of clinical professionals. The new law acknowledges the shortage of health care professionals and takes some steps to address it. For example, the law calls for redistribution of a number of physician residency training slots that are not being used to training facilities where they will be used. Currently, there are 121,000 medical residency positions available at teaching facilities throughout the U.S, but only 109,000 are being used. Only a limited number of teaching facilities, however, have the funds and infrastructure needed to absorb redistributed slots. It is projected that redistribution of residency positions will only lead to several hundred more physicians coming out of training each year, when most experts agree that several thousand are needed to address current and projected shortages.

On the nursing front, the law provides funds to bolster faculty at nurse training programs. This is a useful measure since it is lack of faculty at nurse training programs, not lack of student applicants, which is inhibiting nurse supply. This measure, however, will not in itself create the hundreds of thousands of new nurses that are needed to remedy the nurse shortage.

It will therefore fall to recruiters to find ways to be successful in an era where demand for professionals will increase but supply will be constrained. Get ready – things are going to get interesting.

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Kurt Mosley is Vice President of Strategic Alliances for Merritt Hawkins and for its parent company, AMN Healthcare. He can be reached at kurt.mosley@amnhealthcare.com.

By Kurt Mosley

Kurt Mosley, VP of Business Development, The MHA Group

There is an old saying that I am fond of using when discussing the relationship between doctors and hospitals – “without doctors, hospitals are simply expensive hotels with no guests.”

Though healthcare delivery has changed dramatically in many ways – especially in recent years, one fundamental paradigm has remained the same – physicians still refer patients to hospitals and they are still the key drivers of both patient care and revenue throughout the health system. Indeed, the most powerful tool in healthcare remains the physician’s pen. Hospital patient admissions and discharges, tests, treatments, procedures – all require a physician’s signature.

That is why physician recruiting is a strategic priority for virtually every hospital in the United States. Physicians are the key providers of care and are obviously critical to any hospital seeking to offer quality medical services to their communities. However; they are also a vital source of revenue to hospitals.  According to a 2009 survey by AMN Healthcare, 95 percent of hospital CEOs consider physicians to be a very important source of revenue for their facilities.

Just how important a source is underlined by a survey Merritt Hawkins periodically conducts, which tracks the average amount of revenue physicians in various specialties generate on behalf of their affiliated hospitals per year. According to Merritt Hawkins’ newly released 2010 Survey of Physician Inpatient/Outpatient Revenue, the overall average amount of annual revenue a single, full time equivalent physician generates for his or her hospital is $1.5 million. This includes revenue generated by patient referrals, tests, treatments and procedures conducted in the hospital.

The survey examined 17 different medical specialties and includes an average amount of revenue generated by one FTE physician in each specialty.

Neurosurgeons topped the list of specialists examined in the survey in terms of annual revenue generated. According to survey data, a single, full-time neurosurgeon generates an average of $2,815,650 a year on behalf of his or her affiliated hospital. Other high revenue generating specialists include invasive cardiologists ($2,240,366 a year), orthopedic surgeons ($2,117, 764 a year), general surgeons ($2,112,492 a year) and hematologists/oncologists ($1,485,627 a year). The survey also indicates that primary care physicians also generate substantial revenue for hospitals. According to the survey, a general internist generates $1,678,341 a year on average for his or her affiliated hospital, a family physician can generate $1,622,832 a year, and pediatricians only generate $856,154 a year.

Merritt, Hawkins last conducted the survey in 2007, when the average annual revenue generated per physician across all specialties was $1,496,432, a number slightly lower than the 2010 average.   That average revenue increased even during a recession suggests that physicians continue to provide a high level of hospital-based services and are seeking closer ties with hospitals, including employment.

The survey also points to the importance of physician recruiters, who are responsible in many ways for the quality of care hospitals provide through the recruitment of well trained, motivated clinicians. These physicians also are essential to the financial well being of hospitals, and the survey quantifies the significant contributions recruiters make to the bottom line when they are able to secure revenue producing doctors.

The survey offers some interesting data for anyone interested in physician recruiting or the general topic of healthcare economics. I would be happy to email a copy of the survey to readers who send me an email at kurt.mosley@amhhealthcare.com.

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Kurt Mosley is Vice President of Strategic Alliances for AMN Healthcare, the nation’s largest healthcare staffing and management services company and the parent company of Merritt Hawkins and Staff Care.  He can be reached at kurt.mosley@amnhealthcare.com.

Kurt Mosley, VP of Business Development, The MHA Group

When asked recently to come up with an adjective to describe the year 2009, the most positive word I could think of was “interesting.” 

One of the “interesting” things those of us in healthcare recruiting learned last year is that while the healthcare industry may be “recession-resistant” it certainly is not “recession-proof.” Many people lost their health insurance last year and choose not to seek medical attention they could not afford.   Others who were insured felt the financial pinch and passed on seeing a doctor in order to avoid co-pays and deductibles.   Still others decided to forego such elective procedures as botox and bariatric surgery – procedures that kept quite a few healthcare professionals busy during more robust economic times.  The result was an overall dip in the utilization of healthcare services and a corresponding decline in demand for healthcare professionals.   The fact that many healthcare professionals (nurses in particular) who had left the clinical field returned to clinical roles during the recession contributed to a less than dynamic market for recruiters. 

AMN Healthcare, which is Merritt Hawkins & Associates’ parent company, was curious about exactly how the recession affected the recruitment of physicians, nurses, allied professionals and pharmacists at the nation’s hospitals and conducted a survey of hospital chief executive officers to find out. 

AMN’s 2009 Survey of Hospital CEOs reveals that while the recession inhibited the recruiting efforts of some hospitals, it actually spurred recruiting efforts at others.   Hospital leaders were asked how the recession had affected their recruiting efforts for physicians, nurses, allied healthcare professionals and pharmacists.   A significant number (24%) said that they had decreased their nurse recruiting efforts because of the recession, though 12% said the recession caused them to increase their nurse recruiting efforts.  Interestingly, about 25% of CEOs said the recession caused them to increase physician recruiting, while only 8% said the recession caused them to decrease physician recruiting.   These numbers may be explained by the fact that one physician, on average, generates $1.5 million per year on behalf of his or her affiliated hospital through patient admissions and procedures, according to a Merritt Hawkins’ survey.   In bad times or in good, many hospitals are motivated to recruit the doctors they need to keep patient admissions and procedures flowing. 

While the survey shows that the recession did slow down recruiting efforts at some hospitals, the majority of CEOs said that the recession did not cause them to alter their physician, nurse, allied health professional or pharmacist recruiting plans. 

The even better news is that many hospital CEOs said they plan to maintain or increase their recruiting efforts over the next six months.   Over 92% of CEOs said they will either maintain or increase their physician recruiting efforts over the next six months; 84% said they will maintain or increase their allied health professional recruiting efforts; 90% said they will maintain or increase their pharmacist recruiting efforts, and 76% said they will maintain or increase their nurse recruiting efforts. 

Though the shortage of clinical healthcare professionals has eased during the recession, many CEOs surveyed by AMN believe shortages are still a significant challenge.   Over 53% of CEOs said there is a serious shortage of physicians; 40% said there is a serious shortage of pharmacists, 38% said there is a serious shortage of nurses, and 19% said there is a serious shortage of allied healthcare professionals. 

Healthcare reform remains the x factor.   The majority of CEOs (70%) said that their service areas would not have enough physicians to meet demand if health care reform leads to universal access to medical coverage, and many others said their areas would not have enough nurses, allied professionals or pharmacists should healthcare access be expanded.   The survey includes various other data points and I will be happy to send RecruitingTrends readers a copy of the complete results (please email me at kurt.mosley@amnhealthcare.com).

While it is too early to say what 2010 has in store for healthcare and other recruiters, let’s all hope that this year is a little less “interesting” than last.

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Kurt Mosley is Vice President of Strategic Alliances for Merritt Hawkins & Associates, a national physician recruiting firm, and for its parent company, AMN Healthcare.   He can be reached at kurt.mosley@amnhealthcare.com

Carl Shusterman, Managing Partner, Law Offices of Carl Shusterman

Why immigration over other areas of legal practice? Recruiters familiar with international employment trends can no doubt supply one answer. While the economic downturn has suppressed hiring of international workers (and workers of all kinds) the global workforce is here to stay. In business, government, education, entertainment, sports, healthcare and just about every other field, recruiters are looking for talent wherever they can find it. Long-term, the career prospects of attorneys who can assist in the process of worldwide talent acquisition are good.

Perhaps even more important are the emotional rewards immigration law offers. Immigration law involves more than dry legal research or the filing of briefs on behalf of faceless corporations. Immigration lawyers become intimately involved in the dreams and aspirations of their clients, and can help them gain access to free and productive lives.

The stakes in immigration law are high, for would-be immigrants, their employers, and recruiters. That is what makes this area of legal specialization so rewarding, and why it is so important to select an immigration attorney who is capable and qualified.

This lesson was brought home to me yet again recently when a business executive and his daughter consulted me in my office. When I analyzed their case, it quickly became apparent that nothing could be done to help them. The man had applied for immigration benefits based on his status as a multinational executive, but he had done so in such a way that his case had no demonstrable validity. When his application was denied, his former attorney had advised him not to appeal but to have his employer file a new visa petition. The new petition was also denied and eventually he and all his family members were placed under deportation proceedings. The damage was done and it was too late to correct it.

I have seen many similar situations where immigrants, employers and recruiters were the recipients of poor legal advice. When selecting an immigration attorney it is important to consider that there are over 11,000 members of the American Immigration Lawyers Association (AILA). Some of them are excellent attorneys, some average, and some are under qualified. How can recruiters tell the difference?

A number of states put attorneys through a rigorous evaluation system in which they must pass a difficult examination regarding the intricacies of immigration law. Attorneys also must demonstrate experience in various facets of immigration law, such as employment based, which is of most relevance to recruiters, family-based, and other areas. In addition, they must submit recommendations from peers and prove their good standing with state bar association. Only then can an attorney be deemed a Certified Specialist in Immigration Law. Several years ago I had the privilege of serving on the committee which writes and grades the examination for California attorneys seeking Certified Specialist status. I can state without hesitation that the exam is extremely difficult and that every attorney who the committee recommended for Certified Specialist status was a true expert in the field.

At present, four states – California, Florida, North Carolina, and Texas – offer Certified Specialist in Immigration Law status to attorneys. This is not as limiting as it may seem, because all immigration law is federal and therefore an immigration attorney in one state can represent individuals or corporations in any of the others. Generally, the location of the immigration attorney is of much less importance than his or her level of skill and experience. There are web sites that offer links to every Certified Specialist in Immigration Law in the United States. The site for California specialists, for example, is http://members.calbar.ca.gov/search/ls_search.aspx (please contact me if you would like sites for other states).

It is particularly important for recruiters to find immigration attorneys who have experience with employment-based immigration. In addition, consider that there are nuances in immigration law affecting the employment of professionals in different fields. The rules and strategies for immigrating physicians and nurses, for example, may differ in subtle but important ways from those involving computer professionals or business executives. In evaluating immigration attorneys, determine if they have experience in the profession for which you are recruiting. Ask them on the front end what their strategy is for immigrating your candidate or candidates, how long they believe the process will take, and what they think are the chances for success. There should be a game plan in place, and timeframes, costs and expectations should be delineated before the process is initiated.

While it is emotionally rewarding to help immigrants achieve their dreams, it is equally discouraging to see such dreams dashed. Recruiters can avoid a poor outcome by selecting qualified immigration attorneys to represent their candidates in a professional, ethical and effective manner.

Carl Shusterman is principal of The Law Offices of Carl Shusterman, Los Angeles, and is a Certified Specialist in Immigration Law (state of California). He can be reached at carl@shusterman.com.

As America continues to reel from the effects of the worst recession since the 1930s, the unemployment rate for September registered at 9.8%, with a loss of 263,000 jobs. Furthermore, many saw a reduction in the average workweek as well as overtime decreasing in many industries, reports the Bureau of Labor Statistics (BLS).

And while Health care continued to see an upward trend in September (19,000), the number of jobs in financial activities, professional and business services, leisure and hospitality, and information reflected little or no change over the month. The largest job losses registered were in construction (-64,000), manufacturing (-51,000), retail trade (-39,000), and government (-53,000).

In the meantime, while businesses are beginning to make money again, the majority will not be rehiring their workers laid off anytime soon. With unemployment remaining at a 26-year high, Democrats will want to see a faster recovery as the 2010 mid-term elections draw closer.