PHYSICIAN WORKFORCE: Issues for the Commonwealth of Virginia

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PHYSICIAN WORKFORCEIssues for the Commonwealth
of Virginia

• Arthur Garson, Jr., MD, MPH
• Chair
• Workforce Working Group
• Virginia Health Reform Commission

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PHYSICIAN WORKFORCE

• U.S.
• 264/100,000
• 13 from highest /20 OECD Countries
• OECD
• Median 326 (Germany)
• High 448 Greece
• Low 130 Korea
• Australia, NZ, England, Canada, UK
• All lt 264 (UK 201)
• All in process of doubling of physicians

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PHYSICIAN DEMAND

• Where are we now?
• Can you get in to see any doctor this week?
• 12 State reports 2002-2006
• e.g. Massachusetts, Mississippi, Texas,
  California
• All say current shortages
• 12 Specialty reports 2000-2004
• e.g. Cardiology, Dermatology, Allergy, Radiology
• All say current shortages

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PHYSICIAN DEMAND

• 1980
• 45 yo 2.8 visits per person
• 65 yo 4.0
• 45 vs. 65 36 more
• 2003
• 45 yo 3.5 visits per person 25 increase
• 65 yo 6.0 50 increase
• 45 vs. 65 71 more

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PHYSICIAN DEMAND

• More patients
• Baby boomers
• Turn 65 in 2010
• More of them
• Live longer
• White teeth
• Want it NOW
• Five times as many physicians per 100,000 needed
  for age 75 than age 17.
• Uninsured soon will be 20 of US
• Use half as much services
• If covered, will require 10 increase

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PHYSICIAN DEMAND

• More complex medicine
• Genetic engineering doctors
• New technology
• May move from surgeons to procedural internists
  (e.g. cardiologists)
• But same number
• Personalized medicine
• Seen just as frequently

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PHYSICIAN SUPPLY

• Total number
• MD production from Medical Schools flat 16,000
  6,000 International Medical Graduates who enter
  residency
• Total MD first year residents 22,000
• DO production 2,000 ? 3,000 (now)
• 5,000 by 2015

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PHYSICIAN SUPPLY

• Aging
• 1985 117,000 gt55 yo
• 2005 252,000 gt55 yo
• Retirement
• Currently increasing from 10 to 20 next 10
  years
• 1/3 over 50 yo would retire if could afford to
• The Dow

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PHYSICIAN SUPPLY

• Lifestyle
• AAMC Survey Desirable position
• Family/Personal time 80 Women, 62 Men
• Income 30 Women, 40 Men
• Currently women 16 less hours
• 80 of all would work less hours if could afford
  to
• Productivity
• Electronic Health Records
• ?15
• 8 minute doctor visit to 10 minutes

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PHYSICIANSUPPLY / DEMAND

• By 2020, HRSA / Lewin estimates 31,900 physician
  shortage (others up to 191,000)
• Add 7,000 primary care for geographic
  distribution
• Difference by specialty
• Shortage
• Cardiology, Urology
• Psych, GSurg, Ortho, Oto, Ophthal, Radiology,
  other Medicine specialties
• Equal
• Family Medicine, General IM, Anesth
• Surplus
• Pediatrics, OB / Gyn, Emergency Medicine

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PHYSICIAN SUPPLY / DEMAND

• AAMC has called for an increase of in physician
  graduates by 30 by 2015
• 21,400 graduating physicians
• Currently on track for class size increase by 15
  ?19,500
• 5 new schools 5 ? Total of 20,250
• Would take us to 283/100,000
• Would not change our ranking in OECD

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ADDED STRATEGIES

• Less M.D. burnout
• Lifestyle
• Paperwork
• International medical graduates
• D.O.
• Greater use of teams
• Leverage
• Generalists
• Nurse practitioner
• Physician Assistant

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INCREASING PHYSICIAN SUPPLY IN VIRGINIA

• Increase number of physicians State / Federal
  approaches
• Expand size of medical school classes
• Payment for teachers
• Loan forgiveness
• Facilities
• Increase applicants
• Free medical school tuition
• Loan forgiveness
• Attract more physicians to practice in Virginia
• Address diversity
• Loan forgiveness
• Quid pro quo National Health Service Corps
  model
• Service in underserved location (2-5 years)
• Specialty

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INCREASING PHYSICIAN SUPPLY IN VIRGINIA

• Increase number of residents US or
  International
• Federal reduction / elimination of Medicare cap
  on numbers of residents
• Federal or state
• Competitive payment for residents
• All payer payment (Public and private)

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INCREASING PHYSICIAN SUPPLY IN VIRGINIA

• Improve efficiency
• Physician / nurse teams
• May require change in licensure
• Electronic Health Records
• Will also improve working conditions
• Reduce demand
• Patient / physician guidelines
• Healthier lifestyles
• Payment for electronic communication
• Email, telephone, telemedicine

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PHYSICIAN WORKFORCENEXT STEPS

• Virginia-specific data
• Ongoing data collection and analysis of supply
  and demand by location and specialty
• Approaches to increasing number of physicians
• Loan forgiveness
• 100,000 per medical student
• Graded incentives by length of time, specialty,
  and rural area
• Supplemental payment for residents
• Future class size expansion
• Medical School Facilities
• Payment for teachers

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PHYSICIAN WORKFORCENEXT STEPS

• Improve efficiency
• Grants to study physician / nurse teams
• Consider change in licensure if recommended
• Grants for Electronic Health Records
• Reduce demand
• Facilitate healthier lifestyles
• Payment for electronic communication
• Email, telephone, telemedicine