Center for Workforce Studies - Michigan · Prepared by AAMC Center for Workforce Studies, ... AMA...

Physician Workforce Issues

Atul Grover, MD, PhD, FCCPCenter for Workforce Studies

Wayne State University

March 9, 2007

AAMC’s 2006 Workforce Position• Expand US MD enrollment by 30% by 2015• Eliminate GME caps • Expand NHSC by 1500 positions• Increase the diversity of the workforce• Leave specialty choice up to students

• Study strategies to address mal-distribution• Examine options for assessing medical schools outside

of the US targeted to Americans• Support medical education in less developed parts of

the world© Copyright AAMC 2007. May not be reproduced without permission.

Cycles in Physician Workforce Policy• 1920’s – 1940’s: General concern regarding

physician surplus

• 1950’s –1970s: Concern with physician shortages; federal policies to stimulate increased supply, particularly primary care

• 1980 – 2000: Concern with potential surpluses and primary care/specialist mix; federal guidelines and encouragement to limit growth

• 2002 Onward: Global consensus on future shortages under current system

How can we think about, monitor supply & demand more effectively?

© Copyright AAMC 2007. May not be reproduced without permission.

Challenges to Effective Physician Workforce Planning

Very long time frames to change supply or distribution

Uncertain impact of new medical technology

Uncertain future organization, finance, delivery

Difficulty in distinguishing demand vs. need

Lack of good or consistent data

Who should/would be responsible?


The Per Capita Physicians in the US and Other CountriesPhysicians Per 100,000 (2000)

Source: The Supply of Physician Services in OECD Countries. OECD, Steven Simoens & Jeremy Hurst. Health Working Papers. 2006

130193

201210

222223

244264

304318

326326329

342351

368383386

405448

0 50 100 150 200 250 300 350 400 450 500

KoreaJapan

United KingdomCanadaIreland

New zealandAustralia

United StatesSwedenPortugalGermany

SpainFrance

DenmarkSwitzerland

Slovak RepublicAustria

BelgiumItaly

Greece


States Reporting Shortages• Nevada, 2006• Arizona, 2005• Georgia, 2005• Kentucky, 2005• Massachusetts, 2005• Michigan, 2005• Oregon, 2005• California, 2004• Mississippi, 2004 • North Carolina, 2004• Wisconsin, 2004• Texas, 2002

AAMC Center for Workforce Studies© Copyright AAMC 2007. May not be reproduced without permission.

Specialties Reporting Shortages(relative to “need” or “demand”)

• Family Medicine, 2006• Allergy and Immunology, 2004 • Cardiology, 2004 • Dermatology, 2004• Medical Genetics, 2004 • Radiology, 2004• Geriatric Medicine, 2003 • Neurosurgery, 2003 • Psychiatry, 2003 • Critical Care, 2006• Pediatric Subspecialties, 2000• Endocrinology, 2002


Factors Influencing Future Supply

• Medical school production (MD, DO)

• International migration and IMG policies• Aging of physician workforce & retirement

• Gender and generational differences

• Lifestyle choices

• Changing practice patterns

• Productivity changes (i.e. NPs/PAs, IT)

Total Numbers

Impacts “effective”supply


U.S. Medical Schools, 1904—2004

0

20

40

60

80

100

120

140

160

180

1904 1909 1914 1919 1924 1929 1934 1939 1944 1949 1954 1959 1964 1969 1974 1979 1984 1989 1994 1999 2004Year


Medical School Graduates, 1904—2004

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

1904 1909 1914 1919 1924 1929 1934 1939 1944 1949 1954 1959 1964 1969 1974 1979 1984 1989 1994 1999 2004

Total Graduates


Per-Capita MD Enrollment Has Fallen Since 1980 First Year Enrollment per 100,000

Source: AAMC Data Book; US Census Bureau.

Prepared by Center for Workforce Studies, AAMC, Feb 2006.

5.65.4

5.25

5.8

6.26.4

6.8

7.3

4

4.5

5

5.5

6

6.5

7

7.5

1980 1985 1990 1995 2000 2005 2010 2015 2020


US MDs Are Less Than 2/3 of Physicians Entering Graduate Medical Education, 2005

24,735* entered in ACGME and AOA training in 2005:

* Includes both allopathic and osteopathic residents.+ Number of DO graduates projected by AACOM. All the graduates are assumed to have entered ACGME or AOA GME.

Sources: AMA and AACOM, 2004 Annual Report on Osteopathic Medical EducationPrepared by the AAMC Center for Workforce Studies

(Osteopathic Graduates in ACGME Training 1,478)

15,329 (62%)

2,888+ (12%)

65 (0.3%)

6,436 (26%)

17 (0.1%)

(US IMGs 1,462)

Allopathic Graduates

Other

IMGs

Canadian Graduates

Osteopathic Graduates

`


Physician Workforce Age Distribution:1985 and 2005

Source: AMA PCD for 1985 data; AMA Masterfile for 2005 data. Active physicians include residents/fellowsNOTE: 1985 data excludes 24,000 DOs. Prepared by AAMC Center for Workforce Studies, Mar 2006

94

73

44

224 231

153

99

146133

139

0

50

100

150

200

250

Under 35 35-44 45-54 55-64 65 and Over

Num

ber

of P

hysi

cian

s(I

n th

ousa

nds)

1985 2005


One out of three would retire today if they could afford to

Percent of active physicians over 50 who would retire today, by age

42% 41%

33%

21%16%

12%

32%

0%

10%

20%

30%

40%

50%

50-54 55-59 60-64 65-69 70-74 75+ Total

Age Category

Source: 2006 AAMC Survey of Physicians 50 and Older© Copyright AAMC 2007. May not be reproduced without permission.

The Percent of Physicians That are Female Is Rising Steadily

Source: AAMC Facts; AMA PCD 2006 Edition.Prepared by AAMC Center for Workforce Studies, Jan 2006

MD Graduates: Percent Female

Patient Care MDs: Percent Female

23.1%

28.9%33.9%

39.1%42.4% 43.7% 45.3% 45.8% 47.1%

9.8%12.7% 14.9%

19.6%23.1% 24.3%

27.1% 28.1% 29.0%

0%

10%

20%

30%

40%

50%

1980 1985 1990 1995 2000 2002 2003 2004 2005


Women more likely to work part time and more interested in part time work

29%

17%

41%

4%9% 14%

19%22%27%

18%

0%

10%

20%

30%

40%

50%

Wor k P ar t T i me Consi der i ngf or f ut ur e

Avai l abl e - noti nt er est ed

Not avai l abl ebut I woul d l i ke

t he opt i on

Not avai l abl e /Not i nt er est ed

Male Female


Time for Family/Personal Life Most Important Factor in Desirable Position For Physicians Under 50

% Very Important

Time for family/personal 69%Adequate support staff and services 41%Long term income potential 39%Practice income 37%Health insurance coverage 34%Flexible scheduling 33%No or very limited on-call 28%Adequate patient volume 28%Opportunity to advance professionally 27%

Source: 2006 AAMC Survey of Physicians Under 50 (preliminary data)© Copyright AAMC 2007. May not be reproduced without permission.

Not interested in working more hours to earn more money

Willing to work longer hours for more pay

66% NO

Would reduce hours if could afford to

80% YES

Currently working/interested in part-time hours

43% YESSource: 2006 AAMC Survey of Physicians Under 50 (preliminary data)


Factors Affecting Demand for PhysiciansAging & growth of population

Wealth of the nation

Public expectations

Growth in non-physician clinicians

New medical interventions

Evolution of care delivery

Cost containment efforts

MorePredictable


Population Over Age 65 Doubles by 2030United States Population Projection

36,695,904

71,453,471

-0.2

0

0.2

0.4

0.6

0.8

1

1.2

2000 2005 2010 2015 2020 2025 2030

Year

Perc

ent G

row

th fr

om 2

000

Total Population 65+ Supply of Physicians


Utilization of Services Rises with Age and Time

Source: NAMCS, 1980, 1990, 2000 & 2003Center for Workforce Studies

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

Under 5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85 andover

Age

Aver

age

Num

ber o

f Vis

its p

er U

ser

1980 19902000 2003


Age-Specific Cancer Incidence Rates/100,000, 2000

0

500

1,000

1,500

2,000

2,500

3,000

3,500

<1 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Male

Female

Source: CDC, Age-Specific Invasive Cancer Incidence Rates by Primary Site and Race, United Sates (U.S. Cancer Statistics, 2000). Prepared by AAMC Center for Workforce Studies © Copyright AAMC 2007. May not be reproduced without permission.

Age Group

Future Supply and Demand: The Bottom Line

The gross physician to population ratio in the US will peak around 2020, even with expansion

Effective supply of physicians likely to be lower as physicians work fewer hours

The baby boom generation – with higher expectations - will begin to turn 70 years old in 2016, increasing per capita demand


International Medical School Graduates (IMGs): Why the Concern Now?

International concern about brain drain from less-developed to more-developed countries.

Global shortage of human resources in health.

Growth of off-shore for-profit schools primarily for US citizens but outside of US accrediting systems (15 new schools in the past decade)

1,500 US-IMGs entering GME annually.

As many as 2,500 US-citizens each year now enter a foreign medical school.


Barriers to Expansion: 2006 Deans Survey

49%

44% 44%

41%39%

0%

10%

20%

30%

40%

50%

60%

Available Scholarships Classroom Space Ambulatory Preceptors Costs Ambulatory TrainingSites


Active Physicians per 100,000

NewEngland

Mid-Atlantic

East North Central

West North Central

West South Central

Mountain

Pacific

EastSouth Central

South Atlantic

247

201226

204

239

213 249

337

363NewEngland

Mid-Atlantic

East North Central

West North Central

West South Central

Mountain

Pacific

EastSouth Central

South Atlantic

247

201226

204

239

213 249

337

363

All Workforce Is Local© Copyright AAMC 2007. May not be reproduced without permission.

Unmet Need Already Exists--30 million People Live in Federally Designated Shortage Areas

Source: HRSA/AAFP© Copyright AAMC 2007. May not be reproduced without permission.

Number of Active Physicians in Michigan by Gender

US Michigan

Number Percent Number Percent

Male 657,140 (72.8%) 19,564 71.6%

Female 244,913 (27.2%) 7,752 28.4%

Total 902,053 (100.0%) 27,316 100.0%

Source: AMA Physician Characteristics and Distribution in the US, 2007© Copyright AAMC 2007. May not be reproduced without permission.

Physicians Per Capita (2005)

Sources: AMA Physician MasterFile, January 2005; U.S. Census Bureau, Population Division, Interim State Population Projections, 2005.*Includes active, federal and non-federal physicians who are not in graduate medical training/fellowship and are residing in the 50 States or District of Columbia.

Physicians per 100,000 People

245.6 243.4

0.0

50.0

100.0

150.0

200.0

250.0

300.0

United

States

Indian

a (37

)Wisc

onsin

(23)

Illinois

(22)

Michiga

n (19

)Minn

esota

(18)

Ohio (1

7)Pen

nsylv

ania

(9)

State (Rank)

Num

ber

of P

hysi

cian

s/10

0,00

0


IMGs as a Percentage of Active Physicians (2005)

AMA Physician MasterFile, January 2005

Percent of Physicians that are IMG

23.4%

26.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

United

States

Minnes

ota (3

4)Wisc

onsin

(26)

Indian

a (20

)Pen

nsylv

ania

(16)

Ohio (1

1)

Michiga

n (7)

Illinois

(5)

State (Rank)

Perc

ent o

f Phy

sici

ans


Medical School Enrollment Per Capita (2003)

Medical School Enrollment by Type of School

21.3

13.5

26.626.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

United

State

s

Indian

a (34

)Minn

esota

(29)

Wiscon

sin (2

3)

Michiga

n (18

)

Ohio (1

3)

Illino

is (8)

Pennsyl

vania

(4)

State (Rank)

Enr

ollm

ent/1

00,0

00

Public MD All MD & DO


Medical Student Retention Rates (2005)

AMA Masterfile data: Includes DO, MD

Medical Student Retention

39.0%

45.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

US

Illinois

(35)

Penns

ylvan

ia (31

)Wisc

onsin

(25)

Ohio (2

0)Mich

igan (

17)

Minnes

ota (9

)

Indian

a (7)

State (Rank)

Perc

ent M

edic

al S

tude

nt R

eten

tion


Proportion of MD Matriculants from In-State (2004)

Proportion of MD Matriculants from In-State

63.1% 67.8%

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

US

Minnesota (3

2)

Pennsylvania (28)

Wisconsin

(25)

Michigan (2

3)

Illinois

(15)

Indiana (11)

Ohio (8)

State (Rank)


Residents and Fellows in Training Per Capita (2005)


Residents and Fellows in Training per 100,000

38.8

48.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

US

Indian

a (38

)Wisc

onsin

(23)

Minneso

ta (11

)

Ohio (1

0)

Michiga

n (9)

Illino

is (8)

Pennsyl

vania

(5)

State (Rank)

Res

iden

ts &

Fel

low

s/10

0,00

0


Residents/Fellows who are IMGs (2004)


Residents/Fellows who are IMGs

26.9%

37.5%

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%35.0%40.0%

US(28

) India

na (13

16)

(25) M

inneso

ta (21

09)

(23) W

iscon

sin (1

545)

(14) O

hio (4

757)

(12) P

ennsyl

vania

(6720

)(10

) Illin

ois (5

563)

(7) M

ichiga

n (41

34)

State (Number of IMGs)

Perc

ent o

f Res

iden

ts/F

ello

ws

who

are

IM

G


GME Retention (2005)GME Retention

47.6% 46.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

US Minnesota(31)

Pennsylvania(30)

Ohio (26) Michigan(22)

Wisconsin(20)

Illinois (15) Indiana (6)

State (Rank)


Proportion of Active Physicians who Completed In-State GME (2005)

Percent of Active Physicians who Completed In-State GME

44.7%

55.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

US Indiana (19) Wisconsin(18)

Ohio (9) Minnesota(7)

Michigan (5) Pennsylvania(3)

Illinois (2)

State (Rank)


Mean Scores for Applicants (2006)

Source: AAMC: Data Warehouse: Applicant Matriculant File as of 10/27/2006

State Verbal Physical BiologicalWriting (Median)

Science GPA

GPA Total

Total Applicants

Illinois 9 9.1 9.4 O 3.34 3.45 1,844

Indiana 9.2 9.1 9.5 O 3.46 3.57 702

Michigan 8.9 9.3 9.7 O 3.37 3.48 1,347

Minnesota 9.3 9.4 9.7 P 3.42 3.52 761

Ohio 9 9 9.4 O 3.41 3.52 1,485

PA 9.2 9.3 9.7 P 3.4 3.5 1,423

Wisconsin 9.4 9.4 9.9 P 3.49 3.57 680

All Applicants 9 9.1 9.5 O 3.38 3.48 39,108


Matriculant Data by State (2006)

Source: AAMC: Data Warehouse: Applicant Matriculant File as of 10/27/2006

Matriculation Status

Matriculated In StateMatriculated Out of

State NOT Matriculated

N % N % N %

Illinois 1,844 627 34 216 11.7 1,001 54.3

Indiana 702 240 34.2 90 12.8 372 53.0

Michigan 1,347 394 29.3 212 15.7 741 55.0

Minnesota 761 193 25.4 132 17.3 436 57.3

Ohio 1,485 565 38 147 9.9 773 52.0

PA 1,423 438 30.8 237 16.7 748 52.6

Wisconsin 680 213 31.3 104 15.3 363 53.4

All Applicants 39,108 10,823 27.7 6,547 16.7 21,738 55.6

Applicants by State Applicants


US Medical School Matriculants

15,40015,60015,80016,00016,20016,40016,60016,80017,00017,20017,40017,600

1992 1996 2000 2004 2006

Cooper et al

AAMC


Medical Schools Under Discussion/DevelopmentTouro Florham Park, NJFlorida International Miami, FLCentral Florida Orlando, FLTexas Tech El Paso, TXUniv. of California Riverside, CAUniv. of California Merced, CAUniv. of Arizona Phoenix, AZFlorida Atlantic Boca Raton, FLUMDNJ Camden, NJNortheast Pennsylvania Scranton, PAMemorial Health Savannah, GAVA Tech Roanoke, VA© Copyright AAMC 2007. May not be reproduced without permission.

UME Expansion Will Not Expand the Workforce Without Added GME Training


Growth in GME Slots, 1980--2005 Total Residents

60,00065,00070,00075,00080,00085,00090,00095,000

100,000105,000

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004


Active Physicians per 100,000 Pop 2005 –2030 With and Without an Increase in MD Enrollment

255

260

265

270

275

280

285

290

295

300

2005 2007 2009 2011 2013 2015 2017 2019 2021 2023 2025 2027 2029

30% Increase

15% Increase

No Increase

Includes residents and fellows.

Prepared by Center for Workforce Studies, AAMC, Mar 2006.


Center for Workforce Studies - Michigan · Prepared by AAMC Center for Workforce Studies, ... AMA...

Documents

Transcript of Center for Workforce Studies - Michigan · Prepared by AAMC Center for Workforce Studies, ... AMA...