2017 REVIEW - Lead Physician Search Firm

1 2017 Merritt Hawkins | 8840 Cypress Waters Blvd. #300 | Dallas, Texas 75019 | (800) 876-0500 | REVIEWOF Physician AND advanced practitioner recruiting INCENTIVESAn Overview of the Salaries, Bonuses, and Other incentives Customarily Used to Recruit Physicians, Physician Assistants and Nurse Practitioners24 THEDITION199 4 -2017 Overview 2 Key Findings 3 recruiting Assignment Characteristics and Metrics 5 Trends and Observations 16 Conclusion 46An Overview of the Salaries, Bonuses, and Other incentives Customarily Used to Recruit Physicians, Physician Assistants and Nurse Practitioners1994 - 20172017 REVIEWOF Physician AND advanced practitioner recruiting INCENTIVES24 THEDITIONFor additional information about this survey, please contact:Phillip Miller Merritt Hawkins / Corporate Merritt Hawkins / Eastern Regional Office(800) 876-0500 8840 Cypress Waters Blvd. #300 100 Mansell Ct, E, Ste Dallas, Texas 75019 Roswell, GA 30076 (800) 876-0500 (800) 306-1330 2017 REVIEW of Physician and advanced practitioner recruiting incentives 2 OverviewMerritt Hawkins is a national healthcare Search and consulting firm specializing in the recruitment of physicians in all medical specialties, Physician leaders, and advanced practitioners.

2 Now celebrating our 30th year of service to the healthcare industry, Merritt Hawkins is a company of AMN healthcare (NYSE: AMN), the nation s largest healthcare staffing organization and the industry innovator of healthcare workforce solutions. This report marks Merritt Hawkins 24th annual REVIEW of the Search and consulting assignments the firm conducts on behalf of its clients. Merritt Hawkins REVIEW is the longest consecutively published and most comprehensive report on Physician recruiting incentives in the industry. The REVIEW is part of Merritt Hawkins ongoing thought leadership efforts, which include surveys and white papers conducted for Merritt Hawkins proprietary use, and surveys and white papers Merritt Hawkins has completed on behalf of prominent third parties, including The Physicians Foundation, the Indian Health Service, the American Academy of Physician Assistants, Trinity University, Texas Hospital Trustees, the North Texas Regional Extension Center/Office of the national Coordinator of Health Information Technology, American Academy of Surgical Administrators, Association of Managers of Gynecology and Obstetrics and Subcommittees of the Congress of the United States.

3 The 2017 REVIEW is based on the 3,287 permanent Physician and advanced practitioner Search assignments that Merritt Hawkins and AMN healthcare s sister Physician staffing companies (Kendall & Davis and Staff Care) had ongoing or were engaged to conduct during the 12-month period from April 1, 2016, to March 31, 2017. The intent of the REVIEW is to quantify financial and other incentives offered by our clients to Physician and advanced practitioner candidates during the course of recruitment. incentives cited in the REVIEW are based on formal contracts or incentive packages used by hospitals, medical groups and other facilities in real-world recruiting assignments. Unlike other Physician compensation surveys, Merritt Hawkins REVIEW of Physician and advanced practitioner recruiting incentives tracks Physician starting salaries and other perquisites, rather than total annual Physician compensation. It therefore reflects the incentives physicians are offered to attract them to a new practice settings rather than what physicians in general may actually earn.

4 The range of incentives detailed in the REVIEW may be used as benchmarks for evaluating which recruitment incentives are customary and competitive in today s Physician recruiting market. In addition, the REVIEW is based on a national sample of Search assignments and provides an indication of which medical specialties are currently in the greatest demand and the types of medical settings into which physicians are being are several key findings of the 2017 REVIEW of Physician and advanced practitioner recruiting IncentivesKey FindingsMerritt Hawkins 2017 REVIEW of Physician and advanced practitioner recruiting incentives reveals a number of trends within the Physician and advanced practitioner recruiting market, including: For the eleventh consecutive year, family physicians topped the list of Merritt Hawkins 20 most requested recruiting assignments, underscoring the continued urgent demand for primary care physicians in an evolving healthcare system. Combined, advanced practitioners, including Physician assistants (PAs) and nurse practitioners (NPs), were third on the list of Merritt Hawkins most requested recruiting assignments, their highest position ever and up from number five last year.

5 Urgent care physicians moved to 12th on the list of Merritt Hawkins most requested searches, up from 20 two years ago, highlighting growing consumer demand for convenient care services. For only the second time in the 24 years Merritt Hawkins has conducted the REVIEW , psychiatrists were second on the list of our most requested recruiting assignments, reflecting a severe shortage of mental health professionals nationwide. Among medical specialists, pulmonologists are in particularly strong demand, due to the continued prevalence of chronic obstructive pulmonary disorder (COPD), the third leading cause of death in the United States. Radiologists, absent from Merritt Hawkins list of top 20 Search assignments for several years prior to 2016, entered the top ten for the first time since 2007, signaling an increase in diagnostic imaging procedures, a more limited candidate pool, and the proliferation of teleradiology services. 2017 REVIEW of Physician and advanced practitioner recruiting incentives 4 Orthopedic surgeons, neurologists, dermatologists, gastroenterologists, cardiologists and other specialists also remain in steady demand, underscoring the growing need for medical specialists caused by an aging population.

6 Anesthesiology, absent from Merritt Hawkins top 20 Search assignments since 2010, returned in 2017, suggesting an increase in procedures requiring anesthesia and a more limited candidate pool. Over 90 percent of Merritt Hawkins searches feature employment of the Physician , rather than the private practice model. Physician employment is seen as necessary to implementation of value-based, capitated systems and to attracting today s Physician candidates. The use of value/quality-based payment incentives for physicians rose. Thirty-nine percent of Physician production bonuses tracked in the 2017 REVIEW featured a value/quality-based component, up from 32% in 2016. Despite the rise in value/quality based incentives , volume-based incentives , particularly Relative Value Units (RVUs), continue to be the most frequently utilized Physician productivity metric. The 2017 REVIEW indicates that value-based incentives only account for about four percent of overall Physician compensation.

7 55% of Merritt Hawkins recruiting assignments tracked in the 2017 occurred in communities of 100,000 or more, indicating that demand for physicians is not confined to traditionally underserved rural areas. Following is a breakout of the characteristics and metrics of Merritt Hawkins 2016/17 recruiting assignments. 5 2017 REVIEW of Physician and advanced practitioner recruiting IncentivesMerritt Hawkins 2017 REVIEW of Physician and advanced practitioner recruiting incentives : recruiting Assignment Characteristics and Metrics(All of the following numbers are rounded to the nearest full digit.) Total Number of Physician / advanced practitioner Search Assignments Represented The REVIEW is based on the 3,287 permanent Physician and advanced practitioner Search assignments Merritt Hawkins/AMN healthcare s Physician staffing companies had ongoing or were engaged to conduct during the 12 month period from April 1, 2016 to March 31, 2017. Medical Settings of Physician Search Assignments2016 /172015/162014 /152013 /142012 /13 Hospital1,415 (43%)1,639 (49%)1,596 ( 51%)2,006 (64%)1,975 (64%)Group886 (27%)628 (19 %)625 (20%)4 01 (13 %)493 (16%)Solo/Direct Pay Concierge34 (1%)181 ( 5%)125 ( 4 %)17 (<1% )29 (1%)CHC/FQHC/IHS497 (15%)434 (13 %)406 (13%)378 (12%)305 (10 %)Academics374 (11% )367 (11%)252 (8%)188 ( 6%)153 ( 5%)Urgent Care66 (2%)80 (2%)33 (1%)N/AN/AOther15 (<1%)13 (1%)59 (2%)30 (1%)20 (1%)12 HospitalGroupSolo/Direct Pay/ConciergeCHC/FQHC/IHSA cademicsUrgent CareOther1,415 (43%)2017886 (27%)34 (1%)497 (15%)374 (11% )66(2%)15 (<1%)08001,2004001,600 2017 REVIEW of Physician and advanced practitioner recruiting incentives 6If Academics, what type of position?

8 (Of 374 Academic positions) States Where Search Assignments Were Conducted (Searches also conducted in the District of Columbia and Canada.)AK, AL, AR, AZ, CA, CO, CT, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MO, MN, MS, MT, NC, ND, NE, NH, NJ, NM, NY, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, VA, VT, WA, WI, WV, WYNumber of Searches by Community Size342016 /17 2015/162014 /152013 /142012 /1305001,5001,0002,000 Research Administration/Leadership Faculty1%5%72%68%27%27%77%18%2015/162016 /172014/155% 0-25,000 25,001-100,000 100,001+870(26%)766(23%)1,706 ( 51%)1,184 (38%)689(22%)1,247(40 %)1,04 4 (33%)819 ( 26%)1,295 (41%)804(26%)775(25%)1,518 (49 %)755(23%)742(22%)1,790 ( 55%)7 2017 REVIEW of Physician and advanced practitioner recruiting IncentivesTop 20 Most Requested Searches by Medical Specialty 2016 /172015/162014 /152013 /142012 /13 Family Medicine (includes FP/OB) 607627734714624 Psychiatry256250230206168 Internal Medicine193233237235194 Nurse Practitioner13715014312869OB/GYN10911211 27077 Hospitalist94228176231178 Emergency Medicine90708089111 Physician Assistant8766636150 Dermatology8371443022 Radiology8040242235 Pediatrics7676719287 Urgent Care7480331616 Gastroenterology6658435437 Pulmonology6246381824 Cardiology6233363238 Orthopedic Surgery61811065857 Neurology61101606171 General Surgery4458635874 Anesthesiology4328161410 Otolaryngology42445232405 2017 REVIEW of Physician and advanced practitioner recruiting incentives 8 Other Specialty Recruitment Assignments Addiction MedicineAddiction PsychiatryAdolescent MedicineAdult MedicineAdult Reconstructive Orthopedic Surgery (Total Joint)

9 advanced Practice MidwifeAllergy & ImmunologyAmbulatory CareAnatomic Pathology & Clinical PathologyAudiologistBariatric SurgeryBreast SurgeryCardiac AnesthesiologyCardiothoracic SurgeryCertified Registered Nurse AnesthetistClinical GeneticsClinical Social WorkerColon & Rectal SurgeryCornea and Refractive OphthalmologyCorneal and Contact ManagementCritical Care-Intensivist MedicineDentistryDermatopathologyDevelop mental/Behavioral PediatricsElectrophysiologyEndocrinology Facial Plastic SurgeryFemale Pelvic Medicine and Reconstructive SurgeryFoot and Ankle SurgeryGeriatric MedicineGeriatric PsychiatryGynecologic OncologyHand SurgeryHead and Neck OtolaryngologyHeadache & Neuropathic PainHematologyHepatologyHospice and Palliative MedicineInfectious DiseaseLaboristMammographerMaternal & Fetal MedicineMedical GeneticsMedical OncologyMedical ToxicologyMOHS-Micrographic SurgeryMusculoskeletal RadiologyNeonatologyNephrologyNeuro-Inte rventional RadiologyNeurological SurgeryNeuromuscular MedicineNeuromusculoskeletal Medicine & OMMN octurnistNurse ManagerOccupational MedicineOccupational VisionOculoplastic OphthalmologyOncologyOphthalmologyOphtha lmology, GlaucomaOptometryOptometric TechnicianOral & Maxillofacial SurgeryOrthopedic Spine SurgeryOrthopedic Trauma SurgeryPain ManagementPain MedicinePathologyPediatric CardiologyPediatric Critical Care MedicinePediatric Emergency MedicinePediatric EndocrinologyPediatric Hematology-OncologyPediatric IntensivistPediatric NeurologyPediatric Orthopedic SurgeryPediatric OtolaryngologyPediatric PulmonologyPediatric RadiologyPediatric RheumatologyPediatric SurgeryPediatric UrologyPharmacyPhysical Medicine & RehabilitationPlastic and Reconstructive SurgeryPreventive MedicinePsychologistRadiation OncologyReproductive EndocrinologyRetina SurgeryRheumatologySleep MedicineSocial WorkerSports MedicineSurgical Critical Care (Trauma Surgery)

10 Surgical OncologyTeleradiologyThoracic SurgeryUndersea and Hyperbaric MedicineUrologyVascular & Interventional RadiologyVascular Neurology (Stroke)Vascular SurgeryVision Therapy69 2017 REVIEW of Physician and advanced practitioner recruiting IncentivesAdministrative, Academic and Executive Titles Include: Administrative DirectorAssistant DeanAssociate Dean for Educational Affairs Associate ProfessorAssociate Vice President, Physician AdvisorsBusiness ManagerChair, Clinical Sciences and Medical EducationChair, Department of AnesthesiologyChair, Department of DermatologyChair, Department of Medical EducationChair, Department of Ophthalmology & Visual SciencesChair, Pediatric AnesthesiaChair of SurgeryChief Executive OfficerChief Financial OfficerChief Medical OfficerChief of Adolescent MedicineChief of Anatomic PathologyChief of Breast PathologyChief of Cardiothoracic SurgeryChief of Cardiovascular MedicineChief of Cell BiologyChief of CytopathologyChief of DermatologyChief of GastroenterologyChief of Hematology and OncologyChief of Pediatric CardiologyChief of Pediatric Critical Care MedicineChief of Pediatric EndocrinologyChief of Pediatric GeneticsChief of Plastic SurgeryChief of Regional Pain AnesthesiaChief of Service LineChief of Trauma SurgeryChief Operating OfficerClerkship Director, Family MedicineClerkship Director, Internal MedicineClinical InstructorDean, College of MedicineDirector.