Healthcare staffing has always required many options, from telecommuting to locum tenens to extensive recruiting searches for full-time physicians and technologists. Radiology is one specialty that has increased in demand nationwide. As hospitals and imaging centers scramble to fill vacancies for radiologists and techs, many have had to retool their benefit packages and increase salaries in order to be more competitive.

Merritt, Hawkins & Associates' 2003 Review of Physician Recruiting Incentives indicates that a shift or redirection has taken place in the physician recruiting marketplace over the past year. Since 1997, demand for specialists has centered on four specialty areas: radiology, orthopedic surgery, cardiology, and anesthesiology.

The report also notes that average salaries or income guarantees offered to radiologists increased 11% in one year, from $286,000 in 2002 to $317,000 in 2003.

"All research I have indicates that the shortage in radiology is acute and going to get worse before it gets better," says Pamela McKemie, senior VP of LocumTenens.com (Alpharetta, Ga). "The reasons are linked to an increase in medical imaging technology, an aging population, and the push to train primary care physicians versus specialists 12 years ago, when managed care was introduced as the panacea to healthcare delivery. The directive was to train more primary care physicians rather than specialists to meet the gate-keeper model."

The Two Rs: Recruiting and Retaining
"Any hospital, group, or other organization seeking physicians today, particularly such specialists as radiologists, must understand current market conditions," says Floyd Cotham, executive VP of Merritt, Hawkins & Associates (Irving, Tex). "Due to a variety of factors-the aging of the population and the growth of the population, enhanced and more varied imaging technology, patient preferences, insurance plans that allow direct access to specialists, shifting trends in medical education, and the changing practice styles of physicians-the demand for physicians has increased while the net supply in some specialties has decreased. Radiologists are at the forefront because imaging has become central to medicine today-almost nothing can happen by way of diagnosis or procedures without a picture."

Any radiology department that is seeking technologists and radiologists today has learned that it is difficult to recruit and retain staff in traditional ways. Successful recruiting involves developing a diverse sourcing program, according to Patty Tejes, recruiter for Radiological Associates (Sacramento, Calif).

"It's essential to recognize early in the process what candidates are really looking for and the factors that motivate individuals. Technologists can get jobs anywhere. Offer the things that they are looking for: the opportunity for professional and personal growth," Tejes explains.

Although a variety of methods are available today to recruit radiology staff, a combination program, rather than a "one-size-fits-all" approach, might work best. Standard of living and lifestyle options in a new community are especially important to a recruit, whether it be a technologist or a radiologist.

"Many factors affect recruitment efforts, such as the community size, the drawing area, the referral base, the existing staff makeup, the financial compensation, and the economic and demographic realities of the community," McKemie says. "Retaining physicians also is managed in different ways, depending on the circumstances and goals of the community. We have been recruiting physicians for more than 20 years, and not one standard incentive package fits everyone and every situation. Most packages include a base salary, a fee-based incentive, vacation, and CME time. You have to know what is motivating the recruit before you develop an incentive package that fits their needs. More and more, we see lifestyle issues as the number one factor physicians review before relocating."

Cotham notes that physician recruiting, especially in radiology, has become more competitive and more time-intensive. It's no longer incentive enough to offer a higher salary. Radiologists today ask for-and command-not only big money, but also a host of benefits.

"Most specialists have a variety of practice options to choose from. Talk to radiologists, and you'll hear that many of them receive multiple solicitations from recruiters every week. Our firm sends out more than 10 million recruitment letters to doctors a year-many of them to radiologists who, on average, I would guess receive 10 or more letters from our company alone every year," he says. "Though we only recruited a handful of radiologists 6 or 7 years ago, since the year 2000, radiologists have been our top search. In the last several years, an unprecedented focus has been on recruiting radiologists. This is reflected in the recruiting offers being made to radiologists. Our average offer was $317,000 in 2003, and offers exceeding $400,000 were fairly common. The frenzy has subsided somewhat in the last 6 or 8 months, but radiology remains one of the most difficult searches in medicine."

Cotham believes facilities must be competitive and aggressive. "The market is national now, so you aren't just competing with the hospital or group across town, you're competing with hospitals and groups across the country," he says. "To be successful, you have to craft a competitive package of incentives-a salary or guarantee in the $300,000 to $400,000 range; full benefits, including malpractice; 8 weeks of vacation; teleradiology; and more. Just about every practice today offers pretty good money, so the bargaining chip often can be flextime or more free time-we have seen vacation packages of 17 weeks. It's difficult to find radiologists who will work in a classic solo setting where they always are on call, so teleradiology and off-site outsourcing can be a must for smaller communities that can support only one radiologist. In this market, you have to demonstrate to the candidate that your level of interest and commitment are higher than the other people who are courting him or her. It's really a question today of who wants it more."

Rural America always has had a harder time recruiting and retaining physicians. The states that have no tort reform in place, as it relates to medical malpractice insurance, are having harder times recruiting physicians than other states, according to McKemie. The northeastern United States has higher demands than the northwestern region of the country, but the cause is more population driven, rather than regional.

Along with radiologists comes the need for radiologic technologists, who are also in demand and recruited heavily. A radiology team needs to have a complete staff, from techs to physicians to support staff, in order to function efficiently. Techs also have their pick of jobs nationwide, although the demand for them (as well as radiologists) is higher in rural areas. Techs also command competitive salaries and incentives.

Radiology departments and imaging centers are learning how to be creative and flexible in order to retain staff members. Facilities are learning to create workable situations for employees, like job sharing and offering part-time and temporary positions to attract top candidates. Radiology departments also are learning to use their technical staff as technologists, according to Tejes, and incorporating assistants to do the nontechnical work.

Staff retention can involve some time, but is not necessarily difficult. New employees appreciate being asked how to help them achieve their goals. Stay in touch with them and "ask more than just how they are; find out who they are," Tejes advises. Everyone appreciates being recognized for serving above and beyond the call of duty. Timely reviews, monthly informational meetings, and informing employees of news or changes regarding their department or workplace are all important aspects of job satisfaction. Provide opportunities for additional training for new employees, and promote from within.

Recognition doesn't need to be costly. Fun ways to recognize employees are popular and much appreciated: a gift certificate for dinner, coffee, or even an ice cream cone; a lapel pin that shows how special they are; and/or recognition in an employee newsletter or with an email or handwritten note from the organization president.

"Radiology needs are just as great today as they were last year," Tejes says. "A rejuvenation of attendance in radiology programs is happening across the country; however, it is estimated that during the next 10 years, more than 60% of radiological technologists will be leaving the workforce. With the limited number of seats in school programs, a shortage of technologists will continue over the next decade."

Get to the Source
Locating potential recruits (ie, sourcing) can and should take many forms in order to reach as wide an audience as possible. Sourcing options range from word of mouth to Internet job boards to newspaper and radiology publication advertisements.

"A good sourcing program will incorporate a mixture of advertising," Tejes says. "It is important to keep in mind such factors as cost, delay times, and level of candidates received from such sourcing. Know if your advertising campaign is working, or if it's just a money pit. The key is to use a mix of sourcing that works. Many corporations will target sourcing that works and advertise quarterly in trade publications for corporate branding. A career fair is a good place to get your company name across to a large group of people. Your primary focus should be on the talent you do know: your employees. Most people know someone who is willing to explore a great career opportunity, even if he/she already has a job."

Online job boards are an inexpensive sourcing option, although they usually result in too many unqualified applicants. A resumé database is another low-cost advertising option, but again, it requires a long period of time with only marginal results. A corporate Web site is a no- to minimal-cost way to advertise job openings, but care must be taken to ensure that the application is easy to follow, or applicants might give up.

A direct mail piece works only if an organization has something to offer that makes it unique, such as advanced training or another incentive that would draw potential applicants. Third-party recruiters (aka headhunters) are a high-cost sourcing option. Plus, as with any other recruiting method, recruiters take time to find the right candidate for the job.

Another low-cost advertising method is networking or an employee referral program (ERP), which could result in good potential candidates, but must be done with enthusiasm or it will not succeed. Tejes recommends that radiology departments and employers build ERPs with creativity and fun.

"ERPs generate more talented people than any other sourcing," she explains. "Identify your best employees-they know other top people. Tap into who they know, and create a network of truly extraordinary people. If you have a well-run ERP, you can reduce the cost and time for hiring great people. Network with your staff and develop a list of target names. Your list should include individuals who would be interested in your opportunity as well as those who can refer you to other great people. Finally, if you have a top candidate, offer them an exciting career, not just a job."

McKemie of LocumTenens.com adds that other recruiting pathways or options include contacting residency programs, loan reimbursement programs, and full-service and locum tenens agencies. However, she extols the benefits of using a recruitment firm to locate potential radiology staff members.

"The benefits of using an agency are multiple. You can increase staff based on seasonal demands and census, reducing overhead when it is not needed. It takes a hospital approximately 9 to 11 months to recruit a physician, and most agencies can do it in half the time, saving time and money. Adding staff to assist other radiologists is a strong retaining tool. The drawbacks are continuity of care and cost," McKemie says.

A recruiting firm should be able to help structure the search by creating the right incentive package and presenting the opportunity to the most appropriate group of physicians, according to Cotham of Merritt, Hawkins & Associates. A search firm should be able to identify, for example, all of the radiologists born, trained, or licensed in your state. Though you are located in Indiana, physicians now practicing in Alaska could have been either born, trained, or licensed in Indiana and are looking to return to the Hoosier State. The firm should also handle all of the legwork-screening candidates, preparing written reports about them, scheduling the interview, and arranging for travel. The recruiting firm should assist in the negotiating process, acting as a third party to ensure the rapid resolution of the search. The drawback is that you are taking a risk, Cotham says. No reputable search firm can guarantee results. As with good attorneys, recruiters do their best to represent an individual or organization, but they cannot ensure a happy ending.

Tejes adds that a recruiting firm can fill job vacancies quickly, but this option is an expensive one, and radiology departments or imaging centers lose the ability to select the best fit for their organization. She calls it a "fast-fill, plug-a-hole" approach that comes with issues that can be costly in both time and money.

Recruiters are specialty focused and "keep their finger on the pulse of the market," explains Sheri Carlton, director of Delta Locum Tenens (Dallas). They have inside knowledge of the recruiting process and knowledge of a particular specialty-in this case, radiology.

Some radiology departments and imaging centers choose to use their own human resources (HR) department to recruit new staff members.

"It is really a question of time, resources, and money," McKemie explains. "If your facility has more time, an in-house department can be the right choice. If your facility has more money, using an agency will expedite getting the physician on the job. Most agencies have hundreds of physicians credentialed and ready to work; most in-house departments have a few candidates, and once they have run through their internal resources, the time and money it takes to find the ideal candidate can be daunting."

An in-house recruiter, however, can identify behaviors that fit with the organization's goals and values, helping to avoid employee-relations issues that take time and money to resolve. Using an in-house department to recruit staff ensures that the recruiter isn't motivated by money to take the "fast-fill" approach, Tejes says.

Larry Stewart, president of the physician search division at CompHealth (Salt Lake City), notes that in-house HR departments are usually more cost-efficient, but often not equipped to put forth an aggressive recruitment plan because they are usually involved in other departmental staffing searches and projects. HR department personnel are not always "well versed" in all medical specialty terminology, which could limit their effectiveness in recruiting potential candidates.

Another sourcing option Tejes mentions is to contact local technical colleges and schools and then offer scholarships and loans as incentives for students. Such incentives might inspire some students to seriously consider a radiology career. Healthcare organizations also can benefit from offering scholarships and loans to current employees who would like to further their educations or change their careers and pursue radiology. She also recommends creating a bureau of speakers, who can visit local high schools and colleges during career days as well as high school math and science classes to talk about careers in healthcare, particularly radiology.

Tejes advises, "Help to shorten the gap between those who know about careers in radiology and those who don't."

Consider the Alternative
"Because of the radiologist shortage, some groups and hospitals are choosing to shift studies off-site," says Cotham. " 'Remote radiology' entails a hospital or group in one location sending images via the Internet to radiologists who are in another state or even out of the country. Mostly, this [process happens] at night or on weekends, but more facilities and groups are shifting studies even during the day when they have excess volume. This option is good for smaller communities with just one or two radiologists who could become burned out if they have to be on call all the time. However, there often is no substitute for on-site radiologists, particularly with all the interventional procedures available today."

Tejes suggests some alternatives for radiology department staffing, a combination of which could be helpful during times of shortage:

1. Be creative in scheduling;
2. Create or pump up your ERP, which is essential to successful recruiting;
3. Sit down with employees and create a network of "who is who" in the community and "who knows who"; and
4. Use "locum" or temporary staff sparingly (offer overtime to employees, retirees, and other technical staff from the local community instead).

"We are beginning to see an increase in the number of physicians choosing radiology residencies," McKemie says. "Telemedicine will become more available. There is discussion on training mid-level practitioners in radiology and increasing the use of locum tenens agencies."

Coming Up Short
Radiology staffing shortages will continue, but creative ways to fill job openings will continue to be used as radiology departments seek to recruit and retain permanent staff members.

"Radiologists will be difficult to recruit for the foreseeable future," Cotham says. "Although more medical graduates are choosing radiology residencies, we are still playing catch-up-for much of the 1990s, the number of radiology residents declined as graduates were advised to enter primary care. In addition, studies show that older people use imaging at a much higher rate than younger people, so demographics indicate demand will go nowhere but up. It's going to be a challenge for groups and hospitals to find the radiologists they need, but by being competitive, committed, persistent, and realistic about the market, you usually can be successful."

Laura Gater is a contributing writer for Medical Imaging.