Physician Supply and Demand Consultation To the Ohio Board of Regents

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Physician Supply and Demand ConsultationTo the
Ohio Board of Regents

• The Robert Graham Center
• January 9, 2007

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The Robert Graham Center

• Functional division of the American Academy of
  Family Physiciains
• Editorial Independence
• Mission To bring an evidence-based perspective
  of family medicine and primary care to policy
  deliberations
• Purposefully placed in Washington, DC

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Report Layout

• pp 2-4 Executive Summary
• pp 5-10 Intro, Background, Methods
• pp 11-21 Findings
• pp 22-29 Policy Options
• pp 30-42 Figures, Tables
• pp 43-44 Research Team
• pp 45-46 References

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Report Layout

• pp 47-60 Maps
• pp 61 Appendix A Your questions
• pp 62-84 Appendix B Past Workforce Studies
• pp 85-88 Appendix C State based GME support

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Report Layout

• pp 89-97 Appendix D Comparison States
• pp 98-99 Appendix references

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Intro/Background

• Higher Education Funding Study Council
• Assess current supply of physicians
• Assess pending healthcare needs of Ohio (Pending
  Shortage?)
• Need more data on current workforce and future
  trends

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Background

• COGME, AAMC, Cooper have called for
• Expansion of medical school training
• 85,000 200,000 by 2020
• Increase in Graduate Medical Education
• None of these studies have a Need or Demand
  curvePurely supply curves of what market will
  bear based on past trends

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Background

• Several states building or expanding
• Ohio is not alone in approaching more cautiously
• Not much discussion of the good evidence of
  problems with
• Composition and Distribution

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Background

• Answer a series of questions from the
  Consultation (Appendix A)
• Explore issues of Supply, Composition,
  Distribution and trends
• Consider policy options
• Capacity to use Ohio work x 50

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Methods

• AMA Masterfile(s) Federal Area Resource File--MD
  and DO data
• Census data
• Shortage designations
• Primary Care Health Profession Shortage Area
• Physician Shortage Area
• Medically Underserved Area/Population
• Community Health Centers

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• Total Ohio Physicians in 2006 38,701
• 34,483 MD (89.1 ) 4,218 DO (10.9) Total
• Direct patient care 22,199 (64.4) 3,059
  (72.5) 25,258 (65.3)
• Teaching 380 (1.1) 43 (1.0) 423 (1.1)
• Research 425 (1.23) 11 (0.3) 436 (1.1)
• Administration 454 (1.3) 18 (0.4) 472 (1.2)
• Retired 3,242 (9.4) 191 (4.5) 3,433 (8.9)
• In training 5,465 (15.9) 657 (15.6) 6,122
  (15.8)
• II. In Direct Patient Care 25,258 (65.3 of
  Total Ohio Physicians)
• 22,199 MD (87.9) 3,509 DO (12.1) Total
• Primary Care 7,597 MD (85.0) 1,342
  DO (15.0) 8,939 (35.4)
• Family Medicine 2,616 (11.8) 732 (23.9) 3,348 (
  13.3)
• General Practice 294 (1.3) 249 (8.1) 543 (2.2
  )
• FP/GP 2,910 (13.1) 981 (28.0) 3,891 (15.1)

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Findings

• 38, 701 physicians
• 25,258 (65) direct patient care
• One for every 454 people in Ohio
• 40 trained in Ohio medical schools 35 trained
  in other states 25 trained outside of
  the US

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Table 4 Ohio Graduates
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Findings

• 42.9 retention Ohio graduates
• About 60 retention Ohio residency and fellowship
  graduates
• Considerable variation
• Case Western SOM 29
• Ohio University COM 62

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Findings

• Of 24 largest physician specialties
• 8 have a majority of Ohio graduates
• 7 have a majority of other state graduates
• 9 have a majority of International Grads
• Physicians from other some states, Canada, and
  foreign medical schools tend to practice in rural
  or underserved areas at higher rates than Ohio
  graduates

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Findings

• 88 are allopaths (MD)
• 12 are osteopaths (DO)
• Osteopaths more likely
• primary care physicians
• direct patient care
• practice in rural areas and physician shortage
  areas

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Findings

• 1985-2005 physician workforce grew 44
• Ohio population only grew by 7
• Ohio total population growth slowing
• The 65 year-old population will increase by 31
  in the next 15 years

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Peer State Comparison
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Findings

• 35 Primary Care (General Internal Medicine,
  General Pediatrics, FP/GP)
• 65 practice in a subspecialty
• Subspecialty physician population has grown
  faster

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Growth in Ohio
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Population Trends

• Slowing growth of Ohio Population through 2020
• Population 65 years old increase 31
• Increases from 12 to 17 of the population

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Potential Shortages/Dependence
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Balance of Trade
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Maps
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Conclusions

• Difficult to make the case for a shortage
• Physician growth 7x higher than population
• There are some focused shortages and dependencies
• Expansion by itself does not guarantee that
  physicians are distributed where they are most
  needed
• Real problems with Composition Distribution

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Conclusions

• Substantial variation Ohio medical schools
• retention in state
• primary care physician production
• service in rural and underserved areas
• likely important differences in mission,
  mission-based strategy culture, student
  selection,

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Conclusions

• There are some concerning holes in the health
  care safety net
• If the goal is a workforce that meets the health
  and health care needs of Ohios taxpayers, the
  entire training pipeline must be considered

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Policy Options

• Targeted state and federal funded support of
  medical schools and residencies
• Already lead nation (top 4) in GME
• Title VII needs federal advocacy
• Emphasis on residency growth may increase
  retention
• Targeted medical school admission policies
• School and residency partnerships
• safety net clinics
• Minority populations
• Public schools

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Policy Options

• loan repayment
• practice start up cost support
• programs that increase minority and rural-born
  student participation in medical education
• shortage area designations, safety net clinic
  development, help physicians get shortage bonuses

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Policy Options

• Targeted support for shortage and dependent
  specialties
• Maximize J-1 Waiver use
• Aggressive recruitment of other states students
  and residents (Canadians?)
• Better data collection (state medical board)