trends in physician supply in north carolina december, 2005 thomas c. ricketts, ph.d. erin fraher,...
Post on 19-Dec-2015
214 views
TRANSCRIPT
Trends inTrends inPhysician SupplyPhysician Supplyin North Carolinain North Carolina
Trends inTrends inPhysician SupplyPhysician Supplyin North Carolinain North Carolina
1998
1999
2000
2001
2002
Hospital Setting
Clinics
050
100
150
200
250
300
350
December, 2005
Thomas C. Ricketts, Ph.D.Thomas C. Ricketts, Ph.D.Erin Fraher, MPP; Katie Gaul, MA; Erin Fraher, MPP; Katie Gaul, MA;
Jennifer King, Hazel HadleyJennifer King, Hazel Hadley
University of North Carolina at Chapel HillUniversity of North Carolina at Chapel Hill
Thomas C. Ricketts, Ph.D.Thomas C. Ricketts, Ph.D.Erin Fraher, MPP; Katie Gaul, MA; Erin Fraher, MPP; Katie Gaul, MA;
Jennifer King, Hazel HadleyJennifer King, Hazel Hadley
University of North Carolina at Chapel HillUniversity of North Carolina at Chapel Hill
Goals for the PresentationGoals for the Presentation
Highlight emerging trends in the supply of Highlight emerging trends in the supply of physicians, nurse practitioners, and physicians, nurse practitioners, and physician assistants in the US and NC.physician assistants in the US and NC.
Closely examine the characteristics of Closely examine the characteristics of physicians who are new to practice in NC.physicians who are new to practice in NC.
Estimate the future supply of physicians Estimate the future supply of physicians for the NC under optional scenarios.for the NC under optional scenarios.
Review some medical workforce policy Review some medical workforce policy options in other states.options in other states.
Main Message: The Supply of Main Message: The Supply of Physicians Is Growing Physicians Is Growing Slower than Slower than
PopulationPopulationPopulation growth for 2002-2005 Population growth for 2002-2005
exceeds physician supply growth.exceeds physician supply growth.National estimates project an National estimates project an
emerging shortage.emerging shortage.NC reflects these trends.NC reflects these trends.This may cause access problems in This may cause access problems in
North Carolina in the near future.North Carolina in the near future.
NC Population Has GrownNC Population Has Grownand slightly faster than the USand slightly faster than the US
1
1.05
1.1
1.15
1.2
1.25
1993
1994
1995
1996 19
9719
9819
9920
0020
0120
0220
0320
04
Year
Rela
tive
gro
wth
rate
North CarolinaUnited States
Source: US Census Bureau, NC State DemographerPopworksheet.xls
North Carolina 11th inNorth Carolina 11th inPopulation total,Population total,
9th in growth rate (4 years)9th in growth rate (4 years)
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
Perc
en
t G
row
th
NC Primary Care MDs
NC Population
US Population
NC Total MDs
MD Growth Has Slowed to below MD Growth Has Slowed to below Population GrowthPopulation Growth
National ContextNational Context
Recognition of potential shortage by Recognition of potential shortage by national groups:national groups:American Association of Medical Colleges
(AAMC) reversed position in 2005 to say there is a shortage
Council on Graduate Medical Education reversed position in 2004 to say there may be a shortage coming
Family Physicians (AAFP) debating the issue
National ContextNational Context
Very slow Allopathic medical school growthVery slow Allopathic medical school growth Florida State only new allopathic school Others considered in TX, AZ, FL
Growth in small Osteopathic SchoolsGrowth in small Osteopathic Schools 2 new schools in Florida 2004-5
Lake Erie, 300 students in its 2Lake Erie, 300 students in its 2ndnd year year Northern Florida announces plansNorthern Florida announces plans
Nevada branch of Touro (CA) Osteopathic Medical School Philadelphia College of Osteopathic Medicine in Atlanta opened 2005
Kentucky (Pikeville School) opens in a consortium Virginia School (Edward Via) associated with Virginia
Tech Opens 2005.
Doctors are Trained in Two StepsDoctors are Trained in Two Steps
75% of US Doctor Supply comes from US 75% of US Doctor Supply comes from US Medical Schools via US ResidencyMedical Schools via US Residency
25% comes from Foreign Medical Schools, 25% comes from Foreign Medical Schools, via US Residenciesvia US Residencies
Medical School(4 years)
Residency(3-7 years)
US Medical Student Enrollment
-
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
1994-1995
1995-1996
1996-1997
1997-1998
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
2003-2004
2004-2005
Medical Students
Source: Barzansky B, Jonas HS, Etzel SI. JAMA, September 1, 282(9): 840-846; JAMA, September 3, 290(9): 1190-1196.; JAMA, September 7, 294(9): 1068-1074.
US Resident Physicians, 1994-2003
-
20,000
40,000
60,000
80,000
100,000
120,000
1994-1995
1995-1996
1996-1997
1997-1998
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
Total No. of Residents
USMGs
IMGs
DOs
Canadian
Unknown
General PictureGeneral Picture
An emerging shortage?An emerging shortage?
A Growth trend that is slowingA Growth trend that is slowing
Medical School and ResidencyMedical School and ResidencyNumbers “Flat” Numbers “Flat”
…………
What is happening in North What is happening in North Carolina?Carolina?
Pathways into Practice North Pathways into Practice North CarolinaCarolina
From Medical SchoolsFrom Medical SchoolsIn North CarolinaOther US and Canadian SchoolsInternational Medical Schools
From Residency ProgramsFrom Residency ProgramsIn North CarolinaIn other US states and Canada
In-migration from other StatesIn-migration from other States
Newly Licensed Patient Care Newly Licensed Patient Care Physicians in NC 1998-2004Physicians in NC 1998-2004
0
100
200
300
400
500
600
700
1998 1999 2000 2001 2002 2003 2004
Num
ber
of M
Ds Primary Care
Emergency Medicine
Surgery
Radiology
Psychiatry
Anesthesiology
Other
Source: NC Health Professions Data System, Sheps Center from dataProvided by the North Carolina Medical Board
Newly Licensed Patient Care Newly Licensed Patient Care Primary CarePrimary Care Physicians in North Physicians in North
CarolinaCarolina
0
50
100
150
200
250
300
1998 1999 2000 2001 2002 2003 2004
Num
ber
of M
Ds Internal Medicine
Family PracticeGeneral PracticeOB/GYNPediatrics
Source: NC Health Professions Data System, Sheps Center from dataProvided by the North Carolina Medical Board
Newly Licensed Physicians Newly Licensed Physicians were….were….
More likely to be femaleMore likely to be female34% of new licensees are female vs. 25% of all
current, active NC physicians.More likely to be minorityMore likely to be minority
26% of new licensees are minority vs. 18% of all physicians.
YoungerYoungerAverage age of new licensees is 38.5 years vs.
46.4 years for all physicians.
Average Age of All and New Average Age of All and New Physicians Increasing SlowlyPhysicians Increasing Slowly
45.4 45.3 45.6 45.6 45.7 45.98 46.4
37.738.5
34.9 34.9 35.4 35.2 35.5
30
32
34
36
38
40
42
44
46
48
1998 1999 2000 2001 2002 2003 2004
Mea
n A
ge
All MDsNew MDs
Source: NC Health Professions Data System, Sheps Center from dataProvided by the North Carolina Medical Board
Age-Gender Pyramid, PhysiciansNorth Carolina, 1980
400 350 300 250 200 150 100 50 0 50 100
Under 30313335373941434547495153
55575961636567697173757779
Over 80
Ag
e
Number of Physicians
Female
Male
Note: There w ere three physicians w ith missing age.
Figures include active, instate, nonfederal, non-resident-in-training physicians licensed in North Carolina as of October 31, 1980.Source: North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, with data derived from the North Carolina Medical Board, 1980.
Age-Gender Pyramid, PhysiciansNorth Carolina, 1990
450 400 350 300 250 200 150 100 50 0 50 100 150
Under 30313335373941
434547495153
55575961636567
697173757779
Over 80
Ag
e
Number of Physicians
Female
Male
Figures include active, instate, nonfederal, non-resident-in-training physicians licensed in North Carolina as of October 31, 1990.Source: North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, with data derived from the North Carolina Medical Board, 1990.
Age-Gender Pyramid, PhysiciansNorth Carolina, 2000
550 500 450 400 350 300 250 200 150 100 50 0 50 100 150 200 250
Under 30
32
35
38
41
44
47
50
53
56
59
62
65
68
71
74
77
80
Ag
e
Number of Physicians
Female
Male
Note: There w ere three physicians w ith missing age.
Figures include active, instate, nonfederal, non-resident-in-training physicians licensed in North Carolina as of October 31, 2000.Source: North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, with data derived from the North Carolina Medical Board, 2000.
Age-Gender Pyramid, PhysiciansNorth Carolina, 2004
550 500 450 400 350 300 250 200 150 100 50 0 50 100 150 200 250 300
Under 303133353739414345
474951535557596163
6567697173757779
Over 80
Ag
e
Number of Physicians
Female
Male
Figures include active, instate, nonfederal, non-resident-in-training physicians licensed in North Carolina as of October 31, 2004.Source: North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, with data derived from the North Carolina Medical Board, 2004.
Gender Converging Slowly forGender Converging Slowly forNew MDsNew MDs
0100200300400500600700800900
1000
Num
ber
of M
Ds
1998 1999 2000 2001 2002 2003 2004
MaleFemale
Source: NC Health Professions Data System, Sheps Center from dataProvided by the North Carolina Medical Board
Many, but Not Most New Patient Many, but Not Most New Patient Care MDs Go to NC Medical Care MDs Go to NC Medical
Schools Schools
8457 40 49
659
87
0
100
200
300
400
500
600
700
Medical School
UNC-CHBowman GrayDukeECUOther US
International
Majority of New Patient Care MDs Majority of New Patient Care MDs Do Residency in NCDo Residency in NC
0
100
200
300
400
500
600
Residency
NCOther US
InternationalUnknown
Osteopaths, relatively few, but Osteopaths, relatively few, but growing fast in numbersgrowing fast in numbers
0
50
100
150
200
250
300
350
400
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Nu
mb
er
of
DO
s
379 practicing in NC2.2% of Total Physician Supply
Growth rate of >10% per year
Trends in Physicians Delivering Trends in Physicians Delivering BabiesBabies
20002000 20012001 20022002 20032003 20042004
OBGsOBGs 919919 937937 954954 960960 981981
OBGs OBGs DeliveringDelivering
651651 701701 742742 750750 748748
% OBGs% OBGs 70.8%70.8% 74.8%74.8% 77.8%77.8% 78.1%78.1% 76.2%76.2%
FPsFPs 2,1732,173 2,2242,224 2,2932,293 2,3272,327 2,0402,040
FPs FPs DeliveringDelivering 212212 227227 228228 232232 205205
% FPs% FPs 9.8%9.8% 10.2%10.2% 9.9%9.9% 9.9%9.9% 10%10%
Delivery DynamicsDelivery Dynamics
Of the 101 physicians who stopped Of the 101 physicians who stopped providing obstetric deliveries providing obstetric deliveries between 2003 and 2004, 56 (56%) between 2003 and 2004, 56 (56%) were Family Docs. were Family Docs.
This is a disproportionate share This is a disproportionate share since family docs are just 13% of since family docs are just 13% of total physicians and 10% of total physicians and 10% of physicians delivering babies.physicians delivering babies.
IMGS—slight Increase;IMGS—slight Increase;NC IMGs Stable in Recent Years.NC IMGs Stable in Recent Years.
165 153 143 172 164 1630%
10%20%30%40%50%60%70%80%90%
100%
Perc
ent
of
New
MD
s
1997 1998 1999 2000 2001 2003
NC MGsUS/CDN MGsIMGs
Source: NC Health Professions Data System, Sheps Center.As reported on NC Medical Board license renewal and registration
NC TOTAL IMG = 13%NC TOTAL IMG = 13%US Avg = 24%US Avg = 24%
Components of Change, 2001-4Components of Change, 2001-4
New to file1,681
(status change 480newly licensed 1201)
2001 Supply16,392
Left File1,304
2002 total16,769
Net gain 377
New to file1,563
(status change 508newly licensed 1055)
2002 Supply16,769
Left File1,242
2003 total17,090
Net gain 384
Source: NC Health Professions Data System, Sheps Center from dataProvided by the North Carolina Medical Board
New to file1,413
(status change 480newly licensed 933)
2003 Supply17,090
Left File1,163
2003 total17,340
Net gain 250
What do we know about those who What do we know about those who left North Carolina or Practice?left North Carolina or Practice?
Between 2002 and 2003Between 2002 and 2003 143 physicians retired from practice. Average retirement
age was 66 years of age. 90% of retiring physicians were men. Only 2% did obstetric
deliveries. 303 physicians moved out of state but maintained an active
license 138 went inactive 658 dropped out of physician file (presumably moved)
51% of the 138 physicians who went inactive were 51% of the 138 physicians who went inactive were women. The average age of inactive females was 42 women. The average age of inactive females was 42 compared to 59 for inactive males.compared to 59 for inactive males.
Dynamics and ChangeDynamics and Change
The supply is dynamic with up to 20% of The supply is dynamic with up to 20% of all physicians moving either into or out of all physicians moving either into or out of active practice in NC.active practice in NC.
Many physicians move into and out of Many physicians move into and out of active practice during their careers.active practice during their careers.
The “net” supply is a “snapshot” of The “net” supply is a “snapshot” of changechange
There are other practitioners who can do There are other practitioners who can do what doctors do what doctors do —Nurse Practitioners —Nurse Practitioners and Physician Assistantsand Physician Assistants
Cumulative Growth of Nurse Cumulative Growth of Nurse Practitioners, Physician Assistants and Practitioners, Physician Assistants and Physicians, North Carolina, 1990-2004Physicians, North Carolina, 1990-2004
Cumulative rate of growth since 1990
231%
26.3
0
50
100
150
200
250
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
% r
ate
of
gro
wth
(cu
mu
lati
ve)
sin
ce
1990
Nurse Practitioners
Physician Assistants
Physicians
140%
QuestionsQuestions
Do NPs and PAs fill the gap left by Do NPs and PAs fill the gap left by the slowdown in physician growth?the slowdown in physician growth?
Do NPs and PAs expand demand for Do NPs and PAs expand demand for physician services?physician services?
Do NPs and Pas meet different Do NPs and Pas meet different patient care needs than physicians?patient care needs than physicians?
The Geography of Physician The Geography of Physician Supply in NCSupply in NC
Very uneven distribution of MDs in Very uneven distribution of MDs in North CarolinaNorth Carolina
Selected areas have recognized Selected areas have recognized “shortages” designated by the “shortages” designated by the federal government as Primary care federal government as Primary care Health Professional Shortage Areas Health Professional Shortage Areas (HPSAs)(HPSAs)
Primary Care Physicians per 10,000 Population*(# of Counties)
9.17 to 33.12 (19)7.41 to 9.16 (20)5.48 to 7.40 (20)4.28 to 5.47 (20)1.69 to 4.27 (21)
Primary Care Physicians per 10,000 PopulationNorth Carolina, 2004
AHEC Region Boundary
Source: North Carolina Health Professions Data System, with data derived from the North Carolina Medical Board, 2004.Produced by: North Carolina Health Professions Data System, and the Southeast Regional Center for Health Workforce Studies, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
*Primary Care Physicians include active or unknown activity status, instate, nonfederal, non-resident-in-training MDs and DOs indicating a primary specialty of Family Practice, General Practice, Internal Medicine, Ob/Gyn or Pediatrics.
Surgeons per 10,000 Population*(# of Counties)
2.46 to 7.80 (21)1.58 to 2.45 (20)1.07 to 1.57 (20)0.01 to 1.06 (21)No Surgeons (18)
Surgeons per 10,000 PopulationNorth Carolina, 2004
AHEC Region Boundary
Source: North Carolina Health Professions Data System, with data derived from the North Carolina Medical Board, 2004.Produced by: North Carolina Health Professions Data System, and the Southeast Regional Center for Health Workforce Studies, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
*Physicians included are active or have unknown activity status, instate, nonfederal, non-resident-in-training MDs and DOs. Surgeons include physicians who reported a primary specialty in any type of surgery.
Other Specialists per 10,000 Population*(# of Counties)
7.73 to 49.20 (23)3.90 to 7.72 (23)1.50 to 3.89 (23)0.01 to 1.49 (24)No Other Specialists (7)
Source: North Carolina Health Professions Data System, with data derived from the North Carolina Medical Board, 2004.Produced by: North Carolina Health Professions Data System, and the Southeast Regional Center for Health Workforce Studies, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
Other Physician Specialists per 10,000 PopulationNorth Carolina, 2004
*Physicians included are active or have unknown activity status, instate, nonfederal, non-resident-in-training MDs and DOs.Other specialists include physicians who reported something otherthan primary specialties in primary care or any type of surgery.
AHEC Region Boundary
Percent Change, 1995-1999(# of Counties)
20.0% or More (48)10.0% to 19.9% (19)
0.01% to 9.9% (19)No Active Physicians in 1994 (1)-0.01% to -9.9% (8)
-10.0% to -19.9% (0)-20.0% or More (5)
Percent Change in Physicians per 10,000 PopulationNorth Carolina, 1995-1999
Source: North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, with data derived from the North Carolina Medical Board, 1995-2004.
*There were no active physicians in 1995; there were 3 active physicians in 1999.Counts include active, instate, nonfederal, non-resident-in-training physicians.
Percent Change, 1999-2004(# of Counties)
20.0% or More (10)10.0% to 19.9% (19)
0.01% to 9.9% (28)-0.01% to -9.9% (20)
-10.0% to -19.9% (10)-20% or More (13)
Percent Change in Physicians per 10,000 PopulationNorth Carolina, 1999-2004
Source: North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, with data derived from the North Carolina Medical Board, 1995-2004. Counts include active, instate, nonfederal, non-resident-in-training physicians.
Percent Change, 1995-1999(# of Counties)
20.0% or More (44)10.0% to 19.9% (14)
0.01% to 9.9% (20)No Active Physicians in 1995 (1)-0.01% to -9.9% (11)
-10.0% to -19.9% (5)-20.0% or More (5)
Percent Change in Primary Care Physicians per 10,000 PopulationNorth Carolina, 1995-1999
Source: North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, with data derived from the North Carolina Medical Board, 1995-2004.
Counts include active, instate, nonfederal, non-resident-in-training physicians who indicated aprimary specialty of family practice, internal medicine, general practice, OB/GYN or pediatrics.
*There were no active physicians in 1995; there was 1 active physician in 1999.
Percent Change, 1999-2004(# of Counties)
20.0% or More (24)10.0% to 19.9% (22)
0.01% to 9.9% (17)-0.01% to -9.9% (21)
-10.0% to -19.9% (4)-20.0% or More (12)
Percent Change in Primary Care Physicians per 10,000 PopulationNorth Carolina, 1999-2004
Source: North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, with data derived from the North Carolina Medical Board, 1995-2004.
Counts include active, instate, nonfederal, non-resident-in-training physicians who indicated aprimary specialty of family practice, internal medicine, general practice, OB/GYN or pediatrics.
Persistent HPSA Designation Status(# of Counties)
Whole County is PHPSA (21)Part of County is PHPSA (23)Not HPSA Designated (56)
Persistent Health Professional Shortage Areas* (PHPSAs)North Carolina Counties
*Persistent HPSAs are those designated as HPSAs by the Health Resources and Services Administration (HRSA) from 1993 to 1997, or in 6 of the last 7 releases of HPSA definition.Source: Area Resource File, HRSA, DHHS, 1998.Produced By: North Carolina Rural Health Research and Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
How to Change the Future Supply How to Change the Future Supply of Physiciansof Physicians
Factors in the SupplyFactors in the Supply
Medical School
Residency
INMigration
OUTMigration
Retirement
Death
Career Change
AccessibleSupply
Increase Entry the SupplyIncrease Entry the Supply
Medical School
Residency
INMigration
OUTMigration
Retirement
Death
Career Change
AccessibleSupply
Reduce Exit from the SupplyReduce Exit from the Supply
Medical School
Residency
INMigration
OUTMigration
Retirement
Death
Career Change
AccessibleSupply
NC Medical Schools, IN-State YieldNC Medical Schools, IN-State Yield(percent of graduates in active practice, in (percent of graduates in active practice, in
North Carolina)North Carolina)
Bowman-Gray-WFU..Bowman-Gray-WFU.. 39.4%39.4%Duke…………………..Duke………………….. 24.1%24.1%East Carolina………..East Carolina……….. 59.0%59.0%UNC-Chapel Hill…….UNC-Chapel Hill……. 48.7%48.7%
Yield from NC SuppliersYield from NC Suppliers
NC Medical Schools 40 year trend: NC Medical Schools 40 year trend: 39.3% of graduates practice in NC Current annual graduates: 441 2X graduates yields net increase of 171, after 7 years
NC Residencies 40 year trendNC Residencies 40 year trend 42% of those trained in NC stay in NC Current total Residents 2,640; 633 are in their 1st year 2X residencies yields net increase of 316, after 3.5 yrs
Birth States of Birth States of NC PhysiciansNC Physicians
n=17,000n=17,000
SC579
GA539
OH817
IL550
CA525
VA708
NY1691
NJ581
PA1000
Source: AMA Masterfile, December 31, 2003.
NC335420%
NC335420%
Where Graduates of NC Where Graduates of NC Medical Schools PracticeMedical Schools Practice
2003 data,2003 data, n=14,400n=14,400
NC510039%
NC510039%
SC577GA
579
FL719
TX411
CA803
TN419
VA779
NY412
Source: AMA Masterfile, December 31, 2003.
Where NC Physicians Where NC Physicians went to Medical Schoolwent to Medical School
2003 data n = 17,0902003 data n = 17,090
Source: AMA Masterfile, December 31, 2003.
SC640
GA658
OH817
IL566
VA984
NY1111
PA1036 NJ
581
TX606
NC456527%
NC456527%
Where physicians Where physicians who trained in NC who trained in NC
Residencies PracticeResidencies Practice 2003 data2003 data n=14,591n=14,591
TX491
CA469
Source: AMA Masterfile, December 31, 2003.
NC856342%
NC856342%
SC515GA
550
FL692
TN397
VA673
PA328
MD319
Where NC Physicians Where NC Physicians Received Specialty Received Specialty
TrainingTrainingn=17,090n=17,090
NC617636%
NC617636%
SC628GA
563
OH789
VA1005
NY1424
PA1016
FL555
TX659
CA633
Source: AMA Masterfile, December 31, 2003.
GY-1 Residency Fill Rate in North Carolina, 1995 - 2005
0%
20%
40%
60%
80%
100%
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Number of GY-1 Residencies in North Carolina,1995 - 2005
633
0
100
200
300
400
500
600
700
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
National - State Policy ContextNational - State Policy ContextPresident cuts Title VII, AHEC from President cuts Title VII, AHEC from
BudgetBudgetCongress not mobilized to support Congress not mobilized to support
training programstraining programsStates facing need to expand States facing need to expand
residenciesresidenciesUtah: University-Intermountain System
Consortium to add state-funded residencies
State/Federal InitiativesState/Federal Initiatives
Kentucky-study shows need for 600 Kentucky-study shows need for 600 primary care physiciansprimary care physicians
Texas ,Georgia, Maryland: Texas ,Georgia, Maryland: Study/Analysis Groups, shortages Study/Analysis Groups, shortages notednoted
J-1 Visa program extended, J-1 Visa program extended, expanded PL 108-441.expanded PL 108-441.
Medical Schools Expanding ClassesMedical Schools Expanding Classes
Projections of Future SupplyProjections of Future Supply
Physician-Population Trends and Physician-Population Trends and ProjectionsProjections
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Total Active Physicians Population Primary Physicians
Focus on Short Term Future Focus on Short Term Future Population “Crosses” Physician Population “Crosses” Physician
GrowthGrowth
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
2004 2005 2006 2007 2008 2009 2010
Total Active Physicians Population Primary Physicians
Projection with 20% increase in Med. Projection with 20% increase in Med. School, Residency, In-migrationSchool, Residency, In-migration
physicians/10 000physicians/10 000
18
18.5
19
19.5
20
20.5
21
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Baseline Med Sch+20% + Res+20% Inmigration +20%