Your SlideShare is downloading. ×

Rural Health Roundtable

274

Published on

Published in: Health & Medicine, Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
274
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Rural Health Roundtable October 2, 2008 Robert A. Barish, M.D. Vice Dean, Clinical Affairs Professor , Emergency Medicine and Medicine University of Maryland School of Medicine Maryland Physician Workforce Study
  • 2. National Issue
    • The United States will face a serious doctor shortage in the next few decades. Our nation’s rapidly growing population, increasing numbers of elderly Americans, and aging physician workforce, and a rising demand for health care services all point to this conclusion.
    • Source: AAMC
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11. Goals of the Study
    • Document current and future shortages by region and specialty
    • Determine impact on access
    • Document key physician environment issues and potential impact on supply
    • Engage physicians and hospitals in the discussion and develop consensus for solutions
  • 12. Maryland Physician Workforce Study Steering Committee
    • *Robert A. Barish , M.D., Chair
    • Vice Dean for Clinical Affairs, University of Maryland School of Medicine
    • *John Colmers , Secretary,
    • Dept. of Health & Mental Hygiene
    • *Rex W. Cowdry, M.D., Exec. Dir., Maryland Health Care Comm.
    • Blair Eig, M.D., VP Medical Affairs, Holy Cross Hospital
    • Richard Grossi , CFO
    • Johns Hopkins Medicine
    • Scott Hagaman, M.D.
    • President, MedChi
    • *Harry C. Knipp, M.D., Chair
    • Maryland Board of Physicians
    • Scott E. Maizel, M.D.
    • Surgery Representative
    • Stephen J. Rockower, M.D.
    • Medical Specialty Representative
    • Joseph Twanmoh, M.D., FACEP
    • Vice President, American College of
    • Emergency Physicians, MD Chapter
    • Joseph W. Zebley, III, M.D., FAAFP
    • Primary Care Representative
    *State agency representatives participated on the Steering Committee to assist the effort without taking a position on its policy recommendations.
  • 13. Study Approach
    • Quantitative (Data) and Qualitative (Surveys)
    • Supply ->Refined Licensure Data
    • Requirements->Population-Based Demand Benchmarks
    • Study Period: 2007 - 2015
    • Analysis of Variation by Specialty Group
    • Analysis for Five Maryland Health Planning Regions
  • 14.
  • 15.
    • Primary Care
    • Family Medicine
    • Geriatric Medicine
    • Internal Medicine
    • Pediatrics
    • Medical Specialty
    • Allergy
    • Cardiology
    • Dermatology
    • Endocrinology
    • Gastroenterology
    • Hematology/Oncology
    • Infectious Disease
    • Nephrology
    • Neurology
    • Psychiatry
    • Pulmonary Medicine
    • Rheumatology
  • 16.
    • Hospital-Based
    • Anesthesiology
    • Diagnostic Radiology
    • Emergency Medicine
    • Neonatology
    • Pathology
    • Physical Medicine
    • Radiation Oncology
    • Surgical Specialty
    • General Surgery
    • Neurosurgery
    • OB/GYN
    • Ophthalmology
    • Orthopedic Surgery
    • Otolaryngology
    • Plastic Surgery
    • Thoracic Surgery
    • Urology
    • Vascular Surgery
  • 17. Step 1: Calculation of Baseline Practicing Physician Supply Currently Licensed Physician Supply 24,968 Adjusted Baseline Physician Supply 14,891 MINUS EQUALS Source: Maryland Board of Physicians Federally Employed Except VA 1,485 Practice Site Out-of-State 4,212 Non-practicing physicians 2,664 Non-renewals 1,716
  • 18. Step 2: Calculation of 2007 Clinical Physician Supply Adjusted by % Clinical Status Full-Time/Part-Time status and Clinical Status are based on edits of the Board of Physician data by the Medical Directors at Maryland hospitals. Adjusted Baseline Physician Supply 14,891 Adjusted by FT/PT Status Total Clinical Physician Supply 10,227
  • 19. Step 4: Forecast Physician Supply for 2010 & 2015 Clinical Physician Supply 2007 Retirements/ Deaths Gender/ Lifestyle Net In-Migration Residents Remaining In MD Forecasted Clinical Physician Supply 2010 & 2015 MINUS EQUALS PLUS
  • 20. Step 5: Calculate Impact of Residents in Graduate Medical Education Programs
    • Analyze resident data
    • Adjust for work effort based on recommendations by residency program directors:
      • Primary Care: 0.3 FTE
      • Medical Specialties: 0.3 FTE
      • Hospital Based Specialties: 0.15 FTE
      • Surgical Specialties: 0.15 FTE
  • 21. Total Clinical Physicians per 100,000 Residents by Region Compared to State and National Levels US MD
  • 22. Percentage of Medical Specialists Age 60 and Older by Region 2007
    • Medical Specialties significantly impacted by retirements (age of the workforce)
    • Capital and Eastern regions have highest percentage of physicians over Age 60
  • 23. Overall Observations Regarding Primary Care Requirements versus Supply
    • Quantitative Observations
      • Greatest shortages in 3 rural regions
      • Southern Maryland has shortages under all 3 scenarios and decreasing resources from 2007-2015
      • Maryland becoming more dependent on allied health professionals to supplement primary care physicians
    • Qualitative Observations by Medical Directors
      • Primary care cited as greatest physician recruitment need by 43% of Medical Directors
      • Out-of-state recruitment increasingly difficult- (Maryland not competitive from a compensation & cost-of-living standpoint)
      • Recent graduates not selecting community-based practice
  • 24. Medical Specialty Requirements “ Pediatric sub-specialties are hard to find. Half the pediatric population in hospitals are on medical assistance or uninsured. If I see a complex MA patient in the clinic I get paid $15. If the hospital nutritionist sees the patient the hospital receives $80. Medical Director-Pediatric Program
  • 25. Overall Observations Regarding Medical Specialty Requirements versus Supply
    • Quantitative Observations
      • Medical specialty shortages in 3 rural regions
      • Principal statewide shortages: Dermatology, Gastroenterology, Hem/Onc & Psychiatry
      • Medical specialists predicted to decrease per 100,000 residents statewide from 39.9 in 2007 to 37.3 in 2015 — greatest decrease in Capital Region (i.e. from 44.2 to 37.3)
    • Qualitative Observations by Medical Directors
      • Greatest need: Gastroenterology cited by 17% of medical directors
      • Major concerns cited: Call coverage of ED & ability to replace retiring physicians
  • 26. Overall Observations Regarding Surgical Physician Requirements versus Supply
    • Quantitative Observations
      • General Surgery: Specialty with greatest need
      • Downward Supply Trends 2007-2015: Forecasted in-migration and new residents insufficient to cover retirements in many surgical specialties
      • Thoracic Surgery: Greatest impact from retirements
    • Qualitative Observations by Hospital Medical Directors
      • Recruitment Priorities: (% of medical directors citing surgical needs): General Surgery (38%), Orthopedic Surgery (30%), OB/GYN (28%), ENT (23%), Neurosurgery (17%) & Vascular Surgery (17%)
      • Hospital Recruitment Strategy: Pursuing employed model to address both competitive compensation & on call needs
  • 27. Future vs. Historical Trends
    • Major variables where change may occur:
    • In- and Out-Migration of Physicians
    • Percent of medical residents staying to practice in Maryland
    • Physician retirement trends, especially in high stress specialties
    • Physician productivity
    • Economic growth in Maryland.
    • Need to update physician workforce analysis every few years.
  • 28. Summary of Findings
  • 29. Maryland Physician Workforce Study – Current Physician Shortages by Region 2007 Legend Adequate Physician Supply Borderline Physician Supply Physician Shortage *Physician Only **Physician & Resident Model Capital Central Eastern Southern Western Primary Care *: Primary Care MDs Medical Specialty : Allergy Cardiology Dermatology Endocrinology Gastroenterology Hematology/Oncology Infectious Disease Nephrology Neurology Psychiatry Pulmonary Medicine Rheumatology Hospital-Based : Anesthesiology** Diagnostic Radiology Emergency Medicine Neonatology Pathology Physical Medicine Radiation Oncology Surgical Specialty : General Neurosurgery Obstetrics/Gynecology Ophthalmology Orthopedic Otolaryngology Plastic Thoracic Urology Vascular Total 8 5 18 25 20 % of Shortages 27.6% 17.2% 62.1% 86.2% 69%
  • 30. Maryland Physician Workforce Study – Current Physician Shortages by Region 2015 Legend Adequate Physician Supply Borderline Physician Supply Physician Shortage *Physician Only **Physician & Resident Model Capital Central Eastern Southern Western Primary Care *: Primary Care MDs Medical Specialty : Allergy Cardiology Dermatology Endocrinology Gastroenterology Hematology/Oncology Infectious Disease Nephrology Neurology Psychiatry Pulmonary Medicine Rheumatology Hospital-Based : Anesthesiology** Diagnostic Radiology Emergency Medicine Neonatology Pathology Physical Medicine Radiation Oncology Surgical Specialty : General Neurosurgery Obstetrics/Gynecology Ophthalmology Orthopedic Surg Otolaryngology Plastic Thoracic Urology Vascular Total 11 4 17 27 27 % of Shortages 37.9% 13.8% 58.6% 93.1% 75.9%
  • 31. Summary of Findings “ We need to develop models that allow doctors to come together to command economic value for their services, but allow them to maintain their autonomy.” Medical Director-Community Hospital
  • 32.
  • 33. Major Conclusions. . . Maryland has a Growing Physician Crisis
    • Maryland has 16 percent fewer physicians (clinical full-time equivalent) per population than the U.S.
    • Physician shortages are acute in most specialties in the state’s three rural regions.
  • 34. Major Conclusions. . .
    • Statewide shortages exist in Primary Care, Psychiatry, Hematology/Oncology, Anesthesiology, Emergency Medicine, Pathology, General Surgery, Thoracic Surgery, and Vascular Surgery. Maryland has only a borderline supply of needed Orthopedic Surgeons.
  • 35. Major Conclusions. . .
      • Critical shortages in primary care physicians and most medical specialties exist today and into 2015 in Southern Maryland, Eastern Shore, and Western Maryland.
      • Surgical specialties; e.g., general surgery and thoracic surgery, experiencing critical shortages.
  • 36. Major Conclusions. . .
    • Hospital-based specialty shortages most acute in Emergency Medicine in the Central, Southern, and Western Maryland regions, and in Anesthesiology & Diagnostic Radiology in all regions except Central.
    • Physician workforce will experience significant retirements between 2007 and 2015; especially in medical/surgical specialties and in the Capital area.
    • Maryland historically retains 52% of its medical residents, but adverse payment, medical liability, and other environmental factors may reduce retention significantly, leading to greater physician shortages.
  • 37. Major Conclusions. . .
    • If resident in-training retention rates decrease, forecasted physician supply in 2010 and 2015 will be dramatically less . . . resulting in greater physician shortages.
    • In many specialties, physician in-migration plus new medical residents remaining in Maryland will not offset retirements.
    • National and international markets for physicians is now extremely competitive. Maryland needs to act to remain competitive.
  • 38. Recruitment and Retention: Reimbursement POLICY RECOMMENDATIONS
    • Governor’s Task Force on Health Care Access and Reimbursement: Adopt recommendations to make physician reimbursement rates in Maryland nationally competitive.
    • Enact legislation to permit physicians to form practice associations to enhance physician recruitment efforts, improve practice efficiency, and negotiate competitive fees.
    • Enact legislation to require insurers to pay newly credentialed physicians retroactive to the date they applied to the payor for credentialing.
    • Establish enhanced Medicaid reimbursement in shortage areas similar to Medicare.
  • 39. POLICY RECOMMENDATIONS Recruitment and Retention: Medical Liability
    • Make Maryland competitive from a medical liability perspective with those states that are currently attracting physicians. Examples include:
      • Caps on non-economic damage awards equal to Texas’s $250,000
      • Alternative dispute resolution mechanisms
  • 40. POLICY RECOMMENDATIONS
    • State : Loan forgiveness program to attract and retain residents in rural areas with specialty shortages.
    • Hospitals : Loan forgiveness for residents who practice in their areas.
    • Maryland teaching programs : Rotations in regions/hospitals with shortages.
    • Gain federal support for increased access to National Health Service Corp (NHSC) physicians.
    Retention of Maryland Residents in Training
  • 41. POLICY RECOMMENDATIONS
    • Residency program directors : Create forum to increase in-state retention of their trainees.
    • Develop regional capitation of some medical school slots.
    • GME programs : Partner with hospitals in the three rural regions to identify potential residents for positions in those areas.
    Retention of Maryland Residents (Cont’d.)
  • 42. POLICY RECOMMENDATIONS
    • Increase the number of residency slots.
    Retention of Maryland Residents (Cont’d.)
  • 43. Comments/Questions

×