Salsberg Texas Stakeholder Forum 4 8 08 V4


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  • © 2006 Association of American Medical Colleges.
  • Salsberg Texas Stakeholder Forum 4 8 08 V4

    1. 1. Edward Salsberg Senior Associate Vice President Director, Center for Workforce Studies April 8, 2008 Physician Workforce Needs: The National Perspective Presentation to: Texas Health Care Policy Council and The Texas Medical Association 2008 Stakeholder Forum
    2. 2. Overview of Presentation <ul><li>Key Workforce Trends and Findings </li></ul><ul><li>Factors Influencing Future Supply </li></ul><ul><li>Factors Influencing Future Demand </li></ul><ul><li>Comparing Future Supply and Demand </li></ul><ul><li>Beyond Overall Supply: Specialty and Geographic Distribution </li></ul><ul><li>Assessing Physician Workforce Needs </li></ul>
    3. 3. AAMC’s 2006 Workforce Position: Key Recommendations <ul><ul><li>Expand US MD enrollment by 30% by 2015 </li></ul></ul><ul><ul><li>Expand GME and eliminate Medicare GME caps </li></ul></ul><ul><ul><li>Expand National Health Service Corps awards by 1500/year </li></ul></ul><ul><ul><li>Leave specialty choice up to students </li></ul></ul><ul><ul><li>Increase the diversity of the workforce </li></ul></ul><ul><ul><li>Study of physician distribution </li></ul></ul>
    4. 4. Key Findings and Developments <ul><ul><li>Continued analysis and studies confirm the likelihood of a shortage </li></ul></ul><ul><ul><ul><li>A large cohort of physicians is approaching retirement age </li></ul></ul></ul><ul><ul><ul><li>Younger physicians, particularly women, appear to be working fewer hours </li></ul></ul></ul><ul><ul><ul><li>Use of services continues to rise </li></ul></ul></ul><ul><ul><li>Medical school expansion and new schools under development make it likely we will reach the goal of a 30% rise in MD enrollment but not by 2015 </li></ul></ul>
    5. 5. Key Findings (continued) <ul><ul><li>Number of residency positions is growing </li></ul></ul><ul><ul><ul><li>US MD enrollment is increasing steadily </li></ul></ul></ul><ul><ul><ul><li>DO enrollment continues to grow rapidly </li></ul></ul></ul><ul><ul><ul><li>IMGs, particularly US-IMGs, continue to increase </li></ul></ul></ul><ul><ul><li>US medical school graduates are increasingly selecting specialties with “controllable life styles” and IMGs are filling gaps </li></ul></ul><ul><ul><li>Under almost all scenarios the nation is likely to face a shortage of physicians </li></ul></ul><ul><ul><li>Increasing the physician supply has to be part of a multi-faceted effort to assure access to services including increased use of PAs, NPs and other health professionals </li></ul></ul>
    6. 6. Recent Reports of Physician Shortages: Specialty Studies <ul><li>Allergy & Immunology (2000) </li></ul><ul><li>Anesthesia (2003) </li></ul><ul><li>Cardiology (2004) </li></ul><ul><li>Child Psychiatry (2006) </li></ul><ul><li>Critical Care Workforce (2006) </li></ul><ul><li>Dermatology (2004) </li></ul><ul><li>Emergency Medicine (2006) </li></ul><ul><li>Endocrinology (2003) </li></ul><ul><li>Family Medicine (2006) </li></ul><ul><li>Geriatric Medicine (2007) </li></ul><ul><li>Medical Genetics (2004) </li></ul><ul><li>Neurosurgery (2005) </li></ul><ul><li>Oncology (2007) </li></ul><ul><li>Pediatric Subspecialty (2008) </li></ul><ul><li>Psychiatry (2003) </li></ul><ul><li>Public Health (2007) </li></ul><ul><li>Rheumatology (2007) </li></ul>
    7. 7. Recent Reports of Physician Shortages: State Reports <ul><li>Michigan (2005) </li></ul><ul><li>Mississippi (2003) </li></ul><ul><li>Nevada (2006) </li></ul><ul><li>New York (regional) (2007) </li></ul><ul><li>North Carolina (2007) </li></ul><ul><li>Oregon (2004) </li></ul><ul><li>Texas (2002) </li></ul><ul><li>Utah (2006) </li></ul><ul><li>Virginia (2007) </li></ul><ul><li>Wisconsin (2004) </li></ul><ul><li>Alaska (2006) </li></ul><ul><li>Arizona (2005) </li></ul><ul><li>California (2004) </li></ul><ul><li>Florida (2005) </li></ul><ul><li>Georgia (2006) </li></ul><ul><li>Hawaii (2008) </li></ul><ul><li>Idaho (2007) </li></ul><ul><li>Iowa (2007) </li></ul><ul><li>Kentucky (2005) </li></ul><ul><li>Maryland (2008) </li></ul><ul><li>Massachusetts (2007) </li></ul>
    8. 8. Key Factors Influencing the Future Supply of Physicians <ul><ul><li>US Medical school enrollment </li></ul></ul><ul><ul><li>Osteopathic enrollment </li></ul></ul><ul><ul><li>Inflow of IMGs </li></ul></ul><ul><ul><li>GME positions </li></ul></ul><ul><ul><li>Aging and retirement of physicians </li></ul></ul><ul><ul><li>Gender and generational differences </li></ul></ul>
    9. 9. First-Year Medical School Enrollment Projected to Increase 21% by 2012 Existing + New Schools Existing Schools 16,488 19,909
    10. 10. After 25 Years of No Growth, Numerous New Medical Schools Under Development or Discussion New or Possible Schools since 2003 Osteopathic Allopathic
    11. 11. Key Factors Influencing the Future Supply of Physicians <ul><ul><li>US Medical school enrollment </li></ul></ul><ul><ul><li>Osteopathic enrollment </li></ul></ul><ul><ul><li>Inflow of IMGs </li></ul></ul><ul><ul><li>GME positions </li></ul></ul><ul><ul><li>Aging and retirement of physicians </li></ul></ul><ul><ul><li>Gender and generational differences </li></ul></ul>
    12. 12. First Year Enrollment in Osteopathic Schools Expected To Surpass 5,000 by 2012 Source: 2007 AACOM Enrollment Survey Actual Projected 2,035 (1993-94)
    13. 13. First Year MD and DO Enrollment in 2013 is Likely to be more than 5,500 (28%) Higher than in 2002 <ul><ul><li> 2002 2013 # and % Increase </li></ul></ul><ul><ul><li>MD 16,488 19,909 3,421 21.0% </li></ul></ul><ul><ul><li>DO 3,079 5,227+ 2,148 69.8% </li></ul></ul><ul><ul><li>_______________________________________________ </li></ul></ul><ul><ul><li>Combined 19,567 25,136 5,569 28% </li></ul></ul>Source: 2007 AAMC Dean’s Enrollment Survey 2007 AACOM Enrollment Survey
    14. 14. Key Factors Influencing the Future Supply of Physicians <ul><ul><li>US Medical school enrollment </li></ul></ul><ul><ul><li>Osteopathic enrollment </li></ul></ul><ul><ul><li>Inflow of IMGs </li></ul></ul><ul><ul><li>GME positions </li></ul></ul><ul><ul><li>Aging and retirement of physicians </li></ul></ul><ul><ul><li>Gender and generational differences </li></ul></ul>
    15. 15. The Number of IMGs Entering GME Has Increased More Than 25% Over The Past Decade Sources: 1995/96 to 2002/03 data based on Form 246 filings as of Aug. 2004. 2003/04 to 2006/07 data are from AAMC GME Track. Note: IMG numbers include Fifth Pathway IMGs Entering GME* 1996-1997 5,379 1997-1998 5,414 1998-1999 5,371 1999-2000 5,905 2000-2001 6,097 2001-2002 6,170 2002-2003 6,208 2003-2004 5,985 2004-2005 6,338 2005-2006 6,570 2006-2007 6,802 Change 1996 – 2006 +1423 (+26%)
    16. 16. Key Factors Influencing the Future Supply of Physicians <ul><ul><li>US Medical school enrollment </li></ul></ul><ul><ul><li>Osteopathic enrollment </li></ul></ul><ul><ul><li>Inflow of IMGs </li></ul></ul><ul><ul><li>GME positions </li></ul></ul><ul><ul><li>Aging and retirement of physicians </li></ul></ul><ul><ul><li>Gender and generational differences </li></ul></ul>
    17. 17. Total Number of Residents in ACGME Programs is Up for the Fifth Consecutive Year
    18. 18. The Overall Change: The Number Training in Most Specialties Increased Between AY 2002 and AY 2006 Change in Total Residents
    19. 19. There Has Been a Significant Shift in the Number of US MDs Training in Different ACGME Specialties Change in Number of Residents (2002-2006) Anesthesiology Diagnostic Radiology Pathology Psychiatry Emer Med IM Sub- specialties Ped Sub- specialties Family Med Internal Med OBGYN Peds IM/Peds
    20. 20. There Has Been a Shift of IMGs As Well – But Most Often in the Opposite Direction from US MDs Change in Number of IMGs in Training 2002-2006
    21. 21. Key Factors Influencing the Future Supply of Physicians <ul><ul><li>US Medical school enrollment </li></ul></ul><ul><ul><li>Osteopathic enrollment </li></ul></ul><ul><ul><li>Inflow of IMGs </li></ul></ul><ul><ul><li>GME positions </li></ul></ul><ul><ul><li>Aging and retirement of physicians </li></ul></ul><ul><ul><li>Gender and generational differences </li></ul></ul>
    22. 22. The Physician Workforce is Aging: 253,000 Active Physicians are Over 55 Sources: AMA Physician Characteristics and Distribution in the US, 1986 and 2008 Editions Notes: Active physicians include residents/fellows. 1985 data excludes approximately 24,000 DOs. Prepared by AAMC Center for Workforce Studies, April 4, 2008
    23. 23. The Number of Active Physicians Approaching Retirement Age is Increasing Sharply: At the Current Level of Production, the US population Will Grow Faster Than the Physician Supply by 2015 Source: AMA Physician Masterfile (January 2007) 25,000 Physicians Enter Training Each Year
    24. 24. Key Factors Influencing the Future Supply of Physicians <ul><ul><li>US Medical school enrollment </li></ul></ul><ul><ul><li>Osteopathic enrollment </li></ul></ul><ul><ul><li>Inflow of IMGs </li></ul></ul><ul><ul><li>GME positions </li></ul></ul><ul><ul><li>Aging and retirement physicians </li></ul></ul><ul><ul><li>Gender and generational differences </li></ul></ul>
    25. 25. The Percent of Physicians That are Female Is Rising Steadily Sources: AAMC Facts accessed online April 4, 2008 AMA Physician Characteristics and Distribution in the US Prepared by AAMC Center for Workforce Studies, April 2008 MD Graduates: Percent Female Patient Care MDs: Percent Female
    26. 26. Time for family and personal life very important to young physicians, especially women physicians Source: AAMC 2006 Survey of Physicians Under 50 Percent “Very Important” to Physicians Under 50 BALANCE Male Female Time for family/personal life 66 82 Flexible scheduling 26 54 No / limited on call 25 44 Minimal practice mgmt resp 10 18 CAREER/INCOME Practice income 43 33 Long term income potential 45 36 Opportunity to advance professionally 29 27
    27. 27. Women More Likely to Work Part-time and to Take Extended Leave Source: AAMC 2006 Survey of Physicians Under 50
    28. 28. Female Physicians Work Fewer Hours Per Week Than Men Source: AAMC/AMA Survey of Physicians Under 50 Male Female Average Hours Per Week (Including Part-time and Full-time)
    29. 29. <ul><li>Trends in Demand and Utilization </li></ul>
    30. 30. Drivers of Future Demand for Physicians <ul><ul><li>Population growth </li></ul></ul><ul><ul><ul><li>US Pop Growing by 25 million/decade </li></ul></ul></ul><ul><ul><li>Aging of the population </li></ul></ul><ul><ul><ul><li>Over 65 will double 2000-2030 </li></ul></ul></ul><ul><ul><ul><li>Major illness/chronic illness far more prevalent among the elderly </li></ul></ul></ul><ul><ul><ul><li>Over 65 make twice as many physician visits as under 65 </li></ul></ul></ul><ul><ul><li>Public expectations </li></ul></ul><ul><ul><ul><li>Baby boom generation: high resources and expectations </li></ul></ul></ul><ul><ul><li>Life Style factors </li></ul></ul><ul><ul><ul><li>Rates of obesity, diabetes, etc. rising rapidly </li></ul></ul></ul><ul><ul><li>Economic growth of the nation </li></ul></ul><ul><ul><li>Medical advances </li></ul></ul>
    31. 31. The Eleven Most Costly Medical Conditions: Far More Prevalent Among the Elderly and Generally Chronic Source: Thorpe, K.E., C.S. Florence, & P. Joski (2004) Prepared by AAMC Center for Workforce Studies Condition US 2000 Treated Prevalence per 100,000 Spending (millions of dollars) % in total health care spending Heart disease 6,226 56,700 9% Trauma 12,338 41,100 7% Cancer 3,348 38,900 6% Pulmonary conditions 15,526 36,500 6% Mental disorders 8,575 34,400 5% Hypertension 11,382 23,400 4% Diabetes 4,260 18,300 3% Arthritis 6,966 17,700 3% Back problems 5,092 17,500 3% Cerebrovascular disease 854 15,000 2% Pneumonia 1,370 12,600 2% Total 312,000 50%
    32. 32. Average Visits to Physicians by People Over Age 45 Have Risen Significantly Over the Past 15 Years Source: 1990, 2000, and 2005 NAMCS
    33. 33. 1998 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2006 (*BMI  30, or about 30 lbs. overweight for 5’4” person) 2006 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    34. 34. <ul><li>Forecasting the Supply and Demand for Physicians </li></ul><ul><li>Center for Workforce Studies: Work in progress </li></ul>
    35. 35. Baseline Projections Yield Shortage of 123,000 FTEs in 2025
    36. 36. Even with an Increase in GME Positions, the Nation is Likely to Face a Major Shortage AAMC Center for Workforce Studies; Preliminary, March 2008
    37. 37. What Can be Done to Better Assure Access to Care in the Future? <ul><ul><li>Continue to increase medical school enrollment </li></ul></ul><ul><ul><li>Increase GME positions </li></ul></ul><ul><ul><li>Increase use of non-physician clinicians </li></ul></ul><ul><ul><li>Improve efficiency and effectiveness, including through improved IT and EMR </li></ul></ul><ul><ul><li>Increase inter-disciplinary education and practice (especially for non-physician clinicians) </li></ul></ul><ul><ul><li>Design service delivery responsive to needs of younger and older physicians, such as flexible scheduling and part time work </li></ul></ul>
    38. 38. Beyond Supply <ul><ul><li>While a shortage is likely to disproportionately impact underserved areas and some specialties more than others, increasing supply is necessary but nor sufficient to address geographical and specialty mal-distribution </li></ul></ul><ul><ul><li>Additional programs and policies are needed to address geographical and medical mal-distribution </li></ul></ul>
    39. 39. Geographical Mal-Distribution: Four Strategies Being Explored <ul><ul><li>Loan Repayment programs and other fiscal incentives to locate and practice in underserved areas </li></ul></ul><ul><ul><li>Factors influencing the practice location decisions of resident physicians </li></ul></ul><ul><ul><li>Expanding the role of Academic Medical Centers (AMCs) in serving underserved communities </li></ul></ul><ul><ul><li>Structures to encourage part-time and volunteer service to underserved populations </li></ul></ul>
    40. 40. How Texas compares to the US average Sources: AMA Physician Masterfile (January 2007) National GME Census (2006) AAMC Student Database Population Division, U.S. Census Bureau Texas US Texas Rank Students in medical or osteopathic schools 2007-08 AY per 100,000 population 24.9 29.2 25 Residents in GME per 100,000 population 28.7 35.6 22 Active physicians per 100,000 population 197.5 249.7 42 Active primary care physicians per 100,000 population 67.7 88.1 47 Percent of medical or osteopathic school graduates retained in-state 58.6% 38.8% 2 Percent of GME residents retained in state 56.4% 47.2% 7 Percent of UME and GME retained in state 79.5% 66.0% 5
    41. 41. How to Measure and Project Physician Needs in a State <ul><ul><li>No single correct number; needs vary based on wide range of factors such as demographics and disease patterns of population, and extent of poverty </li></ul></ul><ul><ul><li>Can compare to benchmarks such as national average or similar states but very indirect measure of need </li></ul></ul><ul><ul><li>Importance of considering current system and needs and desired system </li></ul></ul><ul><ul><li>For assessing today’s needs can consider from perspective of: </li></ul></ul><ul><ul><ul><li>providers (hospitals, clinics, health plans: i.e. recruitment difficulties) </li></ul></ul></ul><ul><ul><ul><li>practitioners (i.e. waiting times, not taking new patients, assessment of shortages) </li></ul></ul></ul><ul><ul><ul><li>patients (i.e. access problems and waiting time) </li></ul></ul></ul><ul><ul><li>For forecasting, critical to assess projected population demographics, utilization patterns and health system </li></ul></ul><ul><ul><li>Recommend a systematic review in the short run and a comprehensive study of needs in the state in the longer run </li></ul></ul>