PHYSICIAN

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PHYSICIAN WORK FORCE
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Outline of Program Getting A Job

• Work Force Overview - - - - - - - - - - - - -
  - - - - - Ronald P. Kaufman. M.D.
• How to Interview and Assess Opportunities - -
  Janie Hirsch
• Contract Negotiations - - - - - - - - - - -
  - - - - - - - William Kalist, J.D.
• Ten (10) 1 hour noon conferences from October
  8, 2002 through
• February 19, 2003 at VA and TGH, covering
• Pros and Cons of a Large Multi-specialty Group
  Practice
• Small Group Practice
• Leaving One Practice and Joining Another or
  Going into Solo Practice
• How to Avoid Malpractice Suits
• Proper Way to Apply for Full Medical Licensure
  in the State of Florida
• Basic Financial Terms Part I
• Basic Financial Terms Part II will cover
  student loan repayment
• Pursuit of Perfection
• Gross Earnings vs. Spendable Income
• Personal Financial Planning
• Risk Management i.e. Malpractice Issues
• Government Compliance Requirements
• H.I.P.A.A.

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Shortage
or
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Make Up Your Mind How Many Doctors the Community
Needs to Keep it Well
Do Not Register More or Less Than This Number.
George Bernard Shaw, "The Doctor's Dilemma"
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The Production Line

• Students
• Residents

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National Medical School Applicant Pool
1990-2000
SOURCE AAMC Data Warehouse
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A Decade of Progress
SOURCE AAMC DATA Warehouse 2000 Applicant
Matriculant File
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Impact of Projected U.S. Medical
School Graduations and Retirements
1962 1964 1966 1968 1970 1972 1974 1976 1978 1980
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
2002 2004 2006 2008 2020 2012 2014 2016 2018 2020
Estimated Retirements National
Graduates
Source MGT of America, Inc. From Assessment of
the Adequacy and Capacity of Floridas Medical
Education System, 1999
Graduates are projected to retire after 35
years of practice. Graduates from 1997-2020
are estimated to remain constant.
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Total Enrollment in U.S. Medical Schools
YEAR M.D. DO DO as
GRANTING GRANTING of TOTAL 1970
40,487 2,151 5.0 1975
55,818 3,443 5.8 1980
65,189 4,940 7.0 1985
66,585 6,608 9.0 1990
65,163 6,792 9.4 1995
67,276 8,961 11.7
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What 1999 Graduates Owe
Source 1999 Medical School Graduation
Questionnaire, All Schools Report - AAMC
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Criteria for choosing a practice
( ranking it first or second)
Location Financial package Call/coverage Lif
estyle amenities Loan forgiveness Specialty
support
SOURCE Merritt, Hawkins Associates 1999
Survey of Final-Year Medical Residents
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Type of practice they seek
( citing it)
1997 1999
33 Multi-specialty group 25 29 Single-special
ty group 31 13 Partnership 15 4 Hospital
employee 8 6 Outpatient clinic 8
2 Solo 4 5 Association ¹ 2
5 HMO 1 5 Other ² 6
¹ An arrangement whereby physicians share staff
and office, but not finances. ² Includes
academic, locum tenens, urgent care, and no
preference.
Source Merritt, Hawkins Associates 1999 Survey
of Final-Year Medical Residents
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What Concerns Senior Residents Most?
1995
1997
1999
Right Practice Setting

• Finding a job
• Right practice setting
• Indebtedness
• Having free time

• Malpractice climate
• Managed care
• Medicine as a career
• Health reform

SOURCE Merritt, Hawkins Associates 1999
Survey of Final-Year Medical Residents
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Practices were desperately seeking ...
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Immediate job openings!
The top 10 states with shortages of primary care
doctors
Texas 1,103
Source Bureau of Primary Health Care, Health
Resources Services Admin, US Dept. of Health
and human Services
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There's not as much competition in these states
States with the lowest doctor-to-population ratios
U.S. Overall 227
Physicians Per 100,000 In population
S. D. 170
Idaho 144
Wyo. 156
Iowa 156
Ind. 178
Nev. 160
Okla. 155
Ark. 175
Miss. 148
Alaska 154
Source American Medical Association
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Want to avoid managed care?
States with the lowest HMO enrollment as a of
total population
Source InterStudy Publications, US Census Bureau
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PHYSICIAN SUPPLY
States with fewest physicians per capita
States with most physicians per capita
District of Columbia 811
Idaho 179
Massachusetts 454
Mississippi 180
New York 423
Alaska 186
Maryland 413
Oklahoma 187
Connecticut 387
Wyoming 188
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SUMMARY

• Job opportunities not as readily available as
  in the past

• Varies by specialty and varies by geography

• Shifts year to year
• in demand
• in compensation
• in specialty opportunities

• Primary Care - demand and compensation flat

• Selective specialty demands will grow
• increase in procedural technology and demand
• radiology cardiology G.I.
• increase in early retirement
• aging of America

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U.S. Physician Supply
Physicians per 100,000 Population
300.0
274.4
260.7
266.0
236.9
250.0
Supply (1000s)
200.0
195.9
155.8
150.0
142.2
141.6
100.0
50.0
0.0
Reproduced from Lohr and Colleagues (5)
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STUDIES OF PHYSICIAN SUPPLY
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Predicting a Dearth of Doctors
1929 2000 2010
2020 Physicians, total 144,000
772,000 887,300 964,700 Physicians/10
0,000 pop. 119 270
283 280 Population (in
Millions) 121 286
325 345 Effective
supply adjustment
- 5
-7 Storage of physicians
50,000 200,000
2010 and 2020 projected using Cooper, et al,
Trend Model assumes 1st-year residents holds
steady at 23,000 a year, 20 of IMGS return to
home country, and current retirement trends
continue. Adjustment due to reduced work effort,
including a 10 reduction in production by
physicians ages 55 to65 and a 20 production
reduction in women physicians (American Journal
of Public Health, 1990).
Source Health Affairs, January/February
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NEW MEDICAL SCHOOLS
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MARKET FORCES
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Hospital Beds/100,000 Population, 1975-1995 and
Non-Federal Physicians/100,000 Civilian
Population, 1975-1996
Hospital Beds Physicians
75 79 80 83
85 87 90 91
95 96
Source Kaiser Family Foundation analysis of
American Hospital Association and U.S. Bureau of
the Census data and American Medical
Association, Physician Characteristics and
Distribution in the U.S., 1997-98 Edition.
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PHYSICIAN NET INCOME
Source AMA
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PHYSICIAN COMPENSATION
Surgery Cardiovascular Cardiology
Invasive Surgery Orthopedic Radiology
Diagnostic Cardiology Non-invasive OBGYN Surgery
General Neurology Internal Medicine Pediatrics
500,000 400,000 300,000 200,000 100,0
00
Family Practice
(MGMA) Physician Compensation and Production
Survey 1998 Report Based on 1997 Data
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The Ratio of Physicians to Population Has
Something to do with Managed Care
Ratio of Physicians/100,000 Population
171 (37)
189 (31)
NH-189 (19)
195 (18)
196 (26)
151 (50
157 (45
190 (29)
139 (48)
NJ-249 (8)
151 (44)
200 (22)
166 (42)
183 (33)
146 (46)
179 (34)
176 (35)
206 (16)
180 (32)
197 (27)
180 (39)
194 (24)
208-(20)
147 (47)
176 (38)
160 (43)
182 (25)
180 (30)
170 (41)
180 (36)
130 (51)
173 (40)
203 (23)
Low Concentration
228 (10)
Source AMA, Physician Characteristics
Distribution in the US,1996-97
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HMO Enrollment as a Percentage of Total State
Population -
Me. 24
Wash. 19
Vt. 26
N.H. 34
Mont. 5
N.D. 3
N.Y. 38
Minn. 29
Mass. 42
Ore. 39
Wis. 31
R.I. - 50
Idaho 7
S.D. 5
Mich. 27
Conn.- 41
Wyo. 3
Pa. 45
N.J.-29
Iowa 13
Neb. 11
Ohio 25
Ill. 20
Nev. 25
Del. - 49
Ind. 17
Utah 37
Md. - 34
W.V. 11
Va. 21
Colo. 38
Calif. 55
Kan. 19
Mo. 31
Ky. 38
N.C. 17
Tenn. 40
Okla. 15
Ark. 12
S.C. 12
Ariz. 32
N.M. 37
Miss. 4
Ga. 18
Ala. 7
Alaska 0
Texas 19
La. 17
Fla. 33
Hawaii 45
All HMOs 25 Source Medical Data
International Inc., April 2000
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Median Physician Incomes Also Seems to Go Down in
High Managed Care Regions
New England 140,000
Mountain 151,000
West Central 160,000
Pacific 165,000
Mid- Atlantic 173,000
Source Integrated Healthcare Report
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MEDIAN U.S. PHYSICIAN INCOME
( In Thousands)
NOMINAL REAL (1998 )
Source American Hospital Association
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Current Status
NOW
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FUTURE VARIABLES

• Experts have been wrong in the past
• Market adjusts
• Technology
• New Pathologies
• Demographic changes
• Consumerism

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PRACTICE CHOICES
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EMPLOYMENT STATUS AND EMPLOYER
1997 DISTRIBUTION OF PHYSICIANS BY PRACTICE TYPE
AND EMPLOYER

• Self-employed solo 25.9
• Self-employed group 30.7
• Employee
• Health maintenance organization 2.7
• Group practice, free-standing center
  11.1
• Private hospital 7.3
• Medical schools, universities, colleges
  7.0
• State and local government 9.6
• Unknown 1.1
• Independent contractor 4.7

Percentages do not sum to 100 because of rounding

Source AMA Center for Health Policy Research
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UNIONS
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Its just what the doctors ordered
The AMA votes to organize a union
Source AMA Center for Health Policy Research
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CASE AT A GLANCE
National Labor Relations Board v. Kentucky River
Community Care, Inc. Venue U. S. Supreme
Court At Issue The court said a professional
who uses independent judgment to direct the
work of others is a supervisor who is unable to
collectively bargain. Potential Impact The
decision is expected to make it more difficult
for privately employed physicians to unionize.
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Status of State Physician Antitrust Exemption
Legislation
Pending legislation Legislation enacted
Source National Conference of State Legislatures
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MALPRACTICE CRISIS
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What is your single greatest source of personal
frustration?
Medicare/Medicaid regulation/billing
15 Patient attitudes 8 Malpractice worries
6 Pressure of running a business
6 Long hours 4 Other 5
Managed Care 56
Source Merritt, Hawkins Associates
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In the next one to three years, do you plan to
...?
Continue as you are 18 Close your practice to
new patients or significantly
reduce work load 16 Work locum
tenens 12 Seek employment in
non-clinical or non-medical setting
10 Other 4
Retire 38
Source Merritt, Hawkins Associates
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A SYMPTOM OF DISCONTENT
N.E.J.M., Vol. .344, No. 3 January 18, 2001
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SUMMARY PHYSICIANS IN THE NEW ENVIRONMENT
Understanding the health care system
Clinical knowledge and skill
Stewardship Appropriate allocation of health
care resources for quality care and cost
effectiveness
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• Outlined the program and its goals and objectives

CONCLUSION
CONCLUSION

• Offered trend data on

• numbers of M.D.s

• market forces at play

• compensation trend

• forces impacting choice

• current and future opportunities and concerns

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ANY QUESTIONS