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Physician Supply and Demand Consultation To the Ohio Board of Regents

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Title: Physician Supply and Demand Consultation To the Ohio Board of Regents


1
Physician Supply and Demand ConsultationTo the
Ohio Board of Regents
  • The Robert Graham Center
  • January 9, 2007

2
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

3
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

4
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

5
Report Layout
  • pp 89-97 Appendix D Comparison States
  • pp 98-99 Appendix references

6
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7
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

8
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

9
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

10
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

11
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

12
  • 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)

13
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

14
Table 4 Ohio Graduates
15
Findings
  • 42.9 retention Ohio graduates
  • About 60 retention Ohio residency and fellowship
    graduates
  • Considerable variation
  • Case Western SOM 29
  • Ohio University COM 62

16
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

17
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

18
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

19
Peer State Comparison
20
Findings
  • 35 Primary Care (General Internal Medicine,
    General Pediatrics, FP/GP)
  • 65 practice in a subspecialty
  • Subspecialty physician population has grown
    faster

21
Growth in Ohio
22
Population Trends
  • Slowing growth of Ohio Population through 2020
  • Population 65 years old increase 31
  • Increases from 12 to 17 of the population

23
Potential Shortages/Dependence
24
Balance of Trade
25
Maps
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33
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

34
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,

35
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

36
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37
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

38
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

39
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)
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