Where have all the physicians gone?

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Where have all the physicians gone?

• Kim Streit, VP/Healthcare Research and
  Information
• Florida Hospital Association

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Floridas Healthcare Environment

• 1st in of population covered by Medicare
• 2nd highest in of uninsured
• 3rd in of paid medical malpractice claims
• High penetration of managed care
• 17th in of medical school graduates
• 26th in patient care physicians per 100,000
  population

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As the demand for health care services is
growing..
ED visits are estimated and outpatient surgery
data are for twelve months ending
6/30/06 Sources AHCA Discharge Data, 1997-2006
AHCA Financial Filings, FY1997-2006
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while the supply of physicians is shrinking.
Physicians per 100,000 Population
Source Physician Characteristics and
Distribution in the U.S., American Medical
Association, 1997-2007
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Number of Physicians in Florida1996 - 2005
Source Physician Characteristics and
Distribution in the U.S., American Medical
Association, 1997-2007
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44 Percent of Floridas Physicians are 55 years
or older
2005
Source Physician Characteristics and
Distribution in the U.S., American Medical
Association, 2007
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Little Growth in Medical School Enrollment
Source Association of American Medical Colleges,
Web site, 2007
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Florida Ranks 43rd in Residency PositionsRatio
of MDs and DOs in Training

• State Residency Positions Ratio Shortage
• (1) NY 15,903 82.7 0
• (2) MA 4,841 75.4 0
• (4) PA 7,153 57.7 0
• (6) MI 5,166 51.1 0
• .
• (41) KS 502 18.4 -182
• (42) ND 113 17.8 -46
• (43) FL 2,963 17.0 1,386

Source AAMC GME Track 2004, AOA, US Census
Bureau, State Population Estimates, 2005
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Demand for Physicians will Exceed Supply of
Physician by 2020
Subtitle
Source HRSA, Physician Supply and Demand
Projections to 2020
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Projections of Supply and Demand by Physician
Specialties in 2020
Surplus/ Supply Demand Shortage Primary
Care General Family Practice 134,700 135,900 (1,
200) General Internal Medicine 143,900 143,500 40
0 Pediatrics 66,100 57,900 8,200 Medical
Specialty Cardiology 22,900 29,600 (6,700) Surgic
al Specialties General Surgery 30,800 52,200 (21,
400) Obstetrics/Gynecology 51,600 47,200 4,400 O
phthalmology 19,100 25,200 (6,100) Orthopedic
Surgery 25,500 31,600 (6,100) Otolaryngology 10,3
00 12,400 (2,100) Urology 9,600 14,400 (4,800) Ot
her Specialties Emergency Medicine 36,300 31,800
4,500 Pathology 18,200 22,600 (4,400) Psychiatry
43,100 47,400 (4,300) Radiology 36,500 41,100 (4
,600)
Source HRSA, Physician Supply and Demand
Projections to 2020
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A survey of Florida physicians, designed to
assess the effect of the personal liability
insurance market on access to care found that 54
of the physicians had indicated that the delivery
of services have been decreased or
eliminated.. JAMA Availability of Physician
Services in Florida, Revisited, 10/10/05
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More than two-thirds of hospital CEOs
identified physician shortages as a serious
problem that must be addressed soon Council on
Physician and Nurse Supply, AMN Healthcare, May
2007
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SB 770 Physician Workforce Assessment and
Development

• ..recognizes that physician workforce planning
  is an essential component of ensuring that there
  is an adequate and appropriate supply of
  well-trained physicians to meet this states
  future health care service needs as the general
  population and elder population of the state
  increase. The Legislature finds that items to
  consider relative to assessing the physician
  workforce may include
• Physician practice status
• Specialty mix
• Geographic distribution
• Demographic information
• Must ensure the availability and capacity of
  quality graduate medical education
• Must use new or existing state and federal
  programs or incentives to practice in needed
  specialties and underserved areas

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Coordination and Strategic Planning for Physician
Workforce Needs

• Department of Health will serve as a coordinating
  and planning body to assess the state's future
  physician needs. 
• Develop a model and quantify the adequacy of
  Floridas current and future physician workforce.
• Develop strategies for addressing the current and
  future workforce needs, including programs to
  stimulate interest in the medical profession and
  expansion of GME positions in Florida.
• Monitor, evaluate and report on the supply and
  distribution of physicians, including maintaining
  a database that serves as the source of
  information on Florida's physician workforce

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Expanded Florida Physician Database

• Additional information collected through
  licensure renewal process 
• 1.  Frequency and geographic location of their
  practice
• 2.  Practice setting
• 3.  Percentage of time spent in direct patient
  care
• 4.  Anticipated change to license or practice
  status
• 5.  Areas of specialty or certification
• 6.  Availability and trends relating to
  critically needed services such as as OB care,
  mammography, ED call coverage
• Will not renew license if fail to complete the
  survey with the renewal application

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FHA Survey on Physician Supply and Shortages,
August 2007

• Projected need 15,279 additional physicians in
  next 3 to 5 years
• Specialties in greatest need
• Internists
• General practitioners
• Pediatricians
• OB/GYN
• Orthopedic surgery
• Cardiology
• General surgery

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97 of hospitals reported physicians
relinquishing privileges in past 2 years

• Leaving state
• No longer need hospital setting
• Retirement
• ED call coverage requirement

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One out of Three Hospitals Reduced or Eliminated
Services Due to a Physician Shortage in past 2
years

• Eliminated Services
• Neurosurgery
• Hand surgery
• OB
• Opthalmology
• Reduced
• ENT
• Urology
• Orthopedics
• Plastic
• Neurosurgery

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Causes of the Shortage (Hospital Perspective)

• Supply of available physicians 95
• Low reimbursement rates 82.5
• Medical liability climate 76
• Working conditions 73
• Retirement 54

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Hospital Employment of Physicians

• 93.5 are anticipating employing more physicians
  in next 5 years
• Specialties
• Internal Medicine
• Family Practice
• General Surgery
• Neurology
• Gastroenterology
• Orthopedics
• OB/GYN

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Hospitals Actively Recruiting Physicians

• 97 are actively recruiting physicians
• Recruited 1,418 physicians in last two years
• Currently recruiting 984 physicians
• Specialties being recruited
• Family practice
• Internal medicine
• Orthopedic surgery
• OB/GYN
• Hospitalists
• General surgery
• Cardiology
• 9 months to recruit (range is 5 to 24 months)
• Takes between 6 and 12 months to take on patients

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Hospital Challenges in Recruiting Physicians to
Florida

• Medical liability climate 83.1
• Supply of qualified candidates 78.5
• Low reimbursement rates 56.9
• ED on-call requirements 49.2
• Cost of living/affordable housing 41.5

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In Summary

• Ensuring adequate supply of physicians will be
  major challenge for Florida
• Major systemic changes must occur to reverse
  trend
• Must adopt approaches to use physicians more
  efficiently
• Funding critical to increasing physician supply

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Florida Hospital Association www.fha.org 407-841-6
230 850-222-9800