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Primary Care Workforce Atul Grover, MD, PhD, FCCP Center for Workforce Studies Academy Health

Primary Care Workforce Atul Grover, MD, PhD, FCCP Center for Workforce Studies Academy Health June 3, 2007. Specialty and Geographic Distribution Are Important Workforce Issues.

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Primary Care Workforce Atul Grover, MD, PhD, FCCP Center for Workforce Studies Academy Health

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  1. Primary Care Workforce Atul Grover, MD, PhD, FCCP Center for Workforce Studies Academy Health June 3, 2007

  2. Specialty and Geographic Distribution Are Important Workforce Issues • “Specialism has developed so extensively in the larger communities mainly because it is easier, more satisfying, more highly regarded by the public, and more profitable than general practice. • These and other factors have been responsible for the concentration of specialists in the cities, but the increase in their numbers beyond what is necessary to care for the people in any community is unsound and costly in the long run.” …But Not New (AAMC Rappleye Report, 1932)

  3. Specialties Reporting Shortages(relative to “need” or “demand”) • Family Medicine, 2006 • Allergy and Immunology, 2004 • Cardiology, 2004 • Dermatology, 2004 • Medical Genetics, 2004 • Radiology, 2004 • Geriatric Medicine, 2003 • Neurosurgery, 2003 • Psychiatry, 2003 • Critical Care, 2006 • Pediatric Subspecialties, 2000 • Endocrinology, 2002

  4. Physician Supply per Capita Blumenthal, NEJM 2004. 350;17

  5. Proportion of Total Physicians in Primary Care Remains Stable (33%) Non-Primary Care Physicians AMA Data Primary Care Physicians

  6. IMGs Account for One-Third of IM Physicians Source: 2005 AMA Masterfile

  7. Source: Physician Characteristics and Distribution in the US, 2007 Edition

  8. Internal Medicine Family Medicine Pediatrics Source: GME Census (AAMC/AMA)

  9. % US MDs & DOs Currently Practicing as Generalists By Year of UME Graduation Graduation Year Source: 2005 AMA Masterfile Data

  10. US MDs Entering Family Practice Training Through the NRMP Source: NRMP

  11. Percent of New PAs Entering Family Medicine Parallels the Rise and Fall of MDs Going into Family Practice 1991-2005 Family Medicine *PAs graduating in year immediately preceding the census reference year are considered New Graduates. Sources: AAPA Membership Census Survey, 1991-1995; AAPA Physician Assistant Census Survey, 1996-2005.

  12. Number and Percentages of Graduates Practicing as Family Practitioners, by Graduation Year and Degree AMA Masterfile Data

  13. IMGs as a Percent of Residents in FM Rising Percent of PGY 1 Positions Filled by IMGs Source: Annual JAMA Medical Education Issues

  14. Subspecialization Rates Going Up Source: JAMA Medical Education Issues

  15. Internal Medicine Fellows by Year of Training Percentage of First-Year Internal Medicine Fellows who are Female ABIM Data

  16. Fewer Than One-Fourth of IM Residents Plan to Practice as Generalists or Hospitalists Generalist Hospitalist Internal Medicine In-Training Examination (ACP, APM, and APDIM), Ibrahim

  17. Internal Medicine In-Training Examination (ACP, APM, and APDIM), Ibrahim

  18. HRSA Report—Primary Care in Balance …but doesn’t account for increasing specialization

  19. Okay, We Built It… • Why haven’t they come? • Money? • Lifestyle? • Prestige? • Educational bias?

  20. Med Students Have Better Experiences in Primary Care AAMC, NRMP, and Ibrahim

  21. Time for Family/Personal Life Most Important Factor in Desirable Position For Physicians Under 50 Source: 2006 AAMC Survey of Physicians Under 50 (preliminary data)

  22. Not interested in working more hours to earn more money • Willing to work longer hours for more pay • 66% NO • Would reduce hours if could afford to • 80% YES • Currently working/interested in part-time hours • 43% YES Source: 2006 AAMC Survey of Physicians Under 50 (preliminary data)

  23. Specialists are More Likely to be “Very Satisfied” with Their Specialty Than Primary Care Physicians Results of the AAMC Survey of Physicians Over Age 50

  24. Primary Care Income Less Than Most Other SpecialtiesMedian Salary by Specialty in thousands of dollars Source: MGMA Physician Compensation and Production Survey 2001-2006

  25. There Will be Primary Care and Specialty Physician Shortages in the Next 20 Years • Primary care shortages may be greater if different models of care adopted, increased sub-specialization • Reimbursement a major factor in specialty choice but how is patient demand linked to physician payment? • US Medical Schools are likely to expand enrollment 18% by 2012 • Osteopathic schools report 45% expansion likely over same time period • What will the expanded workforce look like? Will they abandon generalism?

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