Physician Workforce in Nevada

Transcription

1 Medical Education Council of Nevada Center for Education and Health Services Outreach University of Nevada School of Medicine Physician Workforce in Nevada Characteristics and Distribution 2009 Edition John Packham, PhD Tabor Griswold, MS CEHSO Health Workforce Report November 2009

2 Physician Workforce in Nevada Characteristics and Distribution, 2009 Edition The Center for Education and Health Services Outreach (CEHSO) at the University of Nevada School of Medicine is home to a number of education and outreach programs serving communities and medically underserved populations across Nevada. A wide-range of research, data collection, and policy analysis is conducted by CEHSO staff working under the auspices of several CEHSO units, including: $ Nevada State Office of Rural Health (SORH) $ Medical Education Council of Nevada (MECON) SORH coordinates a number of programs serving the health care needs of rural Nevadans, including the Nevada Health Service Corps, Nevada Rural Hospital Flexibility Program, and the Rural Obstetrical Access Program. A key function of the SORH is rural-relevant data collection and research that supports health care providers and residents in rural Nevada, including the publication of the biennial Nevada Rural and Frontier Health Data Book. MECON was established by the Nevada Legislature in 2003 to ensure that Nevada has an adequate, well-trained workforce to meet the needs of all residents of Nevada. MECON has been charged with conducting health workforce research identifying the health workforce needs for the provision of medical services in Nevada. For more information about CEHSO programs, research and policy analysis, please visit the following website For more information about this report, please contact: John Packham, PhD Director of Health Policy Research Center for Education and Health Services Outreach University of Nevada School of Medicine Reno, Nevada (775) jpackham@medicine.nevada.edu

3 Physician Workforce in Nevada Characteristics and Distribution 2009 Edition Prepared by: John Packham, PhD and Tabor Griswold, MS University of Nevada School of Medicine Prepared with support from the Medical Education Council of Nevada (MECON) and the Nevada Rural Hospital Flexibility Program November 2009

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5 Physician Workforce in Nevada Characteristics and Distribution 2009 Edition Table of Contents Contents Page Table of Contents... i Introduction: Physician Workforce in Nevada... 1 Physician Workforce in Nevada Characteristics and Distribution... 3 Figure 1: Licensed Physicians in Nevada 1997 to Figure 2: Distribution of Total Physician Population by Age and Gender in Nevada Figure 3: Total Physician Population by Major Professional Activity in Nevada Figure 4: International Medical Graduates (IMGs) by Age in Nevada Figure 5: IMGs by Major Professional Activity in Nevada 1997 to Figure 6: Specialty and Primary-Care Specialty Distribution of Physician Workforce in Nevada Figure 7: Specialty Distribution of Physician Workforce by Gender in Nevada Figure 8: Total Physicians per 100,000 Population in Nevada, Mountain Region, and United States 1997 to Figure 9: Number of Residents per Licensed Physician by County in Nevada Physician Workforce in Nevada 2009 Edition i

6 Contents Page Physician Workforce in Nevada Detailed Data Tables Table 1: Total Physicians by Age in Nevada 1997 to Table 2: Total Physicians by Gender in Nevada 1997 to Table 3: Male Physicians by Age in Nevada 1997 to Table 4: Female Physicians by Age in Nevada 1997 to Table 5: Total Physicians by Major Professional Activity in Nevada 1997 to Table 6: Male Physicians by Major Professional Activity in Nevada 1997 to Table 7: Female Physicians by Major Professional Activity in Nevada 1997 to Table 8: International Medical Graduates (IMGs) by Age and Gender in Nevada Table 9: IMGs by Major Professional Activity in Nevada 1997 to Table 10: Total Physicians by Self-Designated Specialty in Nevada 1997 to Table 11: Total Physicians per 100,000 Population by Self-Designated Specialty in Nevada 1997 to Table 12: Total Physicians per 100,000 Population by Self-Designated Specialty in Nevada, Mountain Region, and United States Table 13: Physicians in Patient Care by Self-Designated Specialty in Nevada 1997 to Table 14: Physicians in Patient Care per 100,000 Population by Self-Designated Specialty in Nevada 1997 to Table 15: Physicians in Patient Care per 100,000 Population by Self-Designated Specialty in Nevada, Mountain Region, and United States Table 16: Total Physicians by Gender and Self-Designated Specialty in Nevada Table 17: Physicians in Patient Care by Gender and Self-Designated Specialty in Nevada Table 18: Total Physicians by Self-Designated Primary Care Specialty in Nevada 1997 to Table 19: Total Physicians by Gender and Self-Designated Primary Care Specialty in Nevada Physician Workforce in Nevada 2009 Edition ii

7 Contents Page Table 20: Total Physicians by Country of Undergraduate Medical Education and Self-Designated Primary Care Specialty in Nevada Table 21: Total Physicians by County in Nevada 1997 to Table 22: Total Physicians per 100,000 Population by County in Nevada 1997 to Table 23: Physicians in Patient Care by County in Nevada 1997 to Table 24: Physicians in Patient Care per 100,000 Population by County in Nevada 1997 to Table 25: Physicians, Population, and Physician/Population Ratios in Nevada and the United States 1980 to Table 26: Number of Physicians per 100,000 Population in Nevada and Neighboring States 1980 to Table 27: Residents per One Physician in Nevada and Neighboring States 1980 to Table 28: Number of Physicians in Patient Care per 100,000 Population in Nevada and Neighboring States 1980 to Table 29: Residents per One Physician in Patient Care in Nevada and Neighboring States 1980 to Table 30: Nevada s Rank Among US States in the Number of Total Physicians per 100,000 Population 1980 to Table 31: Nevada s Rank Among US States in the Number of Physicians in Patient Care per 100,000 Population 1980 to Table 32: Graduates of the University of Nevada School of Medicine (UNSOM) Currently Practicing in the United States by Year of Graduation and Gender Table 33: Graduates of the University of Nevada School of Medicine (UNSOM) Currently Practicing in the United States by Self-Designated Primary Care Specialty 1997 to Table 34: Osteopathic Physicians (DOs) by Gender and Age in Nevada Table 35: Osteopathic Physicians (DOs) by Gender and Major Professional Activity in Nevada Table 36: Osteopathic Physicians (DOs) by Self-Designated Specialty and Major Professional Activity in Nevada Physician Workforce in Nevada 2009 Edition iii

8 Contents Page Table 37: Osteopathic Physicians (DOs) by Self-Designated Primary Care Specialty in Nevada and the United States Appendix: Definitions and Terms Used by the American Medical Association (AMA) and the AMA Division of Survey and Data Resources Physician Workforce in Nevada 2009 Edition iv

9 Introduction: Physician Workforce in Nevada, 2009 Edition Physician Workforce in Nevada: Characteristics and Distribution, 2009 Edition is the first installment of an anticipated annual profile and update of the physician workforce in Nevada. This volume contains current, historical, and comparative data on the allopathic (MD) and osteopathic (DO) physician workforce in Nevada. The principal purpose of this and future editions is to improve health workforce planning and policy development in Nevada through the preparation and dissemination of accurate information on the physician workforce. Data presented in this report are derived from multiple volumes of the American Medical Association s (AMA) annual publication, Physician Characteristics and Distribution in the US. Each of these reports utilizes data from the continuously updated Physician Masterfile, which is maintained by the AMA s Division of Survey and Data Resources. The AMA Physician Masterfile is widely considered to be the most complete and extensive source of physician-related information in the United States. Data presented for the calendar year ending December 31, 2007 represents the most current data available on the Nevada s physician workforce. The first section of the Physician Workforce in Nevada, 2009 Edition summarizes major trends and features of Nevada s physician workforce over the past decade: Characteristics of the allopathic physician workforce (MDs), Distribution of the physician workforce by major professional activity, Distribution of the physician workforce by major specialty area, Geographic distribution of the physician workforce by county and region, Comparative trends in Nevada, the mountain region, and United States, and Characteristics and distribution of the osteopathic physician workforce (DOs) Most of this report details trends for allopathic physicians (MD) only, while the last section of the narrative includes data on osteopathic physicians (DO) recently incorporated into the AMA Physician Masterfile. The report contains an appendix containing definitions and explanations of terms used by the AMA. The second section of the report contains 37 detailed tables on the characteristics, specialty distribution, and geographic distribution of the state s physician workforce. Physician Workforce in Nevada, 2009 Edition highlights the current nature and composition of the physician workforce in Nevada, as well as changes that have taken place over the past decade.

10 Future editions of this publication will undoubtedly provide a more detailed portrait of the state s physician workforce as the range and quality of data contained the AMA Physician Masterfile improves. This volume nonetheless represents our attempt to provide a comprehensive snapshot of the physician workforce in Nevada. We would like to acknowledge the contributions of Brandon Weise and Alexandra Sigillo who assisted us immensely with data abstraction and entry tasks, as well as the preparation and editing of this report. In closing, since health care and the health care workforce in Nevada are ever-changing, our ambition is to update and distribute this volume on an annual basis. As such, we would appreciate hearing from you on how future editions can be improved. Please direct all comments and suggestions to John Packham at jpackham@medicine.nevada.edu or (775) John Packham, PhD Director of Health Policy Research University of Nevada School of Medicine Tabor Griswold, MS Health Services Research Analyst University of Nevada School of Medicine Reno, Nevada November 2009 Physician Workforce in Nevada 2009 Edition 2

11 Section One: Physician Workforce in Nevada Characteristics and Distribution The physician workforce in Nevada changed considerably over the past couple of decades. It has been characterized by growth in the proportion of female physicians and by growing percentages of older physicians nearing retirement. Figure 1 highlights changes in the distribution of actively and inactively licensed allopathic physicians (MDs) in Nevada from 1997 to During that period, the total physician population in Nevada increased by 2,405 or 75.5%. In 2007, there were 5,591 licensed physicians in Nevada. This figure includes 4,796 (85.8%) physicians with an active license to practice in the State of Nevada and 795 physicians (14.2%) with an inactive license. Since 1997, the number of actively licensed physicians increased by 1,959 or 69.0%, and the number of inactively licensed physicians increased by 446 or 127.8%. The faster growth of inactively licensed physicians is an important indicator of the state s aging physician workforce. While there are approximately three male physicians for every female physician in Nevada, the number of female physicians increased by 162.4% from 492 in 1997 to 1,291 in By contrast, the number of male physicians in Nevada increased by 1,606 or only 59.6% during the same time frame. Figure 1: Licensed Physicians in Nevada 1997 to 2007 Physician Workforce in Nevada 2009 Edition 3

12 Figure 2: Distribution of Total Physician Population by Age and Gender in Nevada 2007 Figure 2 summarizes both the age and gender distribution of the physician workforce in Nevada in Currently, there are 1,184 physicians over the age of 65. This figure represents 21.4% of the state s physician workforce. Nearly two in five physicians in Nevada (39.2%) are 55 years or older. While the number of male physicians is greater than that of female physicians in all but the youngest age category, the proportion of male to female physicians rises with each older age cohort. For instance, over half of female physicians in Nevada (53.0%) are under the age of 45 as compared to less than one third of male physicians (31.0%) in the same age grouping. Conversely, 43.5% of male physicians are over the age of 55, as compared to only 23.3% of female physicians of the same age. These data indicate that just as the demand for health care services is increasing as a result of overall population aging the number of Nevadans aged 65 and over is projected to increase by 170,000 or 52.1% between 2008 and 2018 the looming retirement of the baby boom cohort of physicians will exacerbate existing shortages in the physician workforce. Physician Workforce in Nevada 2009 Edition 4

13 Figure 3 provides a current snapshot of the major professional activity reported by physicians licensed in Nevada. In 2007, 4,442 Nevada physicians indicated that they provide patient care in an office-based practice (69.1%) or hospital-based setting (10.4%). Another 2.1% listed administration, medical research, or medical teaching as their principal professional activity. The remaining 18.4% are engaged in other non-patient care work, non classified activities or hold an inactive license. Figure 3: Total Physician Population by Major Professional Activity in Nevada 2007 Over the past decade, the number of physicians providing patient care increased by 1,779 or 66.8%. However, the number providing patient care as a percent of all licensed physicians declined from 83.6% in 1997 to 79.4% in While this trend is occurring among both male and female physicians, 83.7% of female physicians currently provide direct patient care as compared to only 78.2% male physicians. Additionally, the number of male physicians holding an inactive license is nearly seven times that of female physicians. In 2007, 7.9% of female physicians held an inactive license as compared to 16.1% of male physicians. Physician Workforce in Nevada 2009 Edition 5

14 Figure 4: International Medical Graduates (IMGs) by Age in Nevada 2007 Figures 4 and 5 highlight the distribution of International Medical Graduates (IMGs) by age and major professional activity in Nevada. In 2007, IMGs accounted for 30.3% of all licensed physicians in Nevada and 30.2% of all Nevada physicians who provide patient care in an officebased setting or hospital. Figure 5: IMGs by Major Professional Activity in Nevada 1997 to 2007 Physician Workforce in Nevada 2009 Edition 6

15 Over the past decade, the number of IMGs has increased by 1,072 or 172.6%. While the percentage of IMGs aged 55 and over parallels that of the overall physician workforce in Nevada (38.8%), 40.3% of IMGs are under the age of 45 years, as compared to 36.1% of all physicians in Nevada. In 2007, approximately one in five IMGs (20.9%) were between the ages of 45 and 54, as compared to one in four Nevada physicians (25.1%). Currently, 28.8% of IMGs are women. Within the IMG population itself, 1,343 physicians are providing patient care in office-based or hospital settings and 350 are employed in administrative, research, teaching, and other non-patient care positions. While the number of IMGs providing patient care has increased over the past decade by 152.4%, the proportion of IMGs whose principal professional activity is patient care has declined from 85.7% in 1997 to 79.3% in 2007, mirroring trends in the overall Nevada physician workforce. Figure 6: Specialty and Primary-Care Specialty Distribution of Physician Workforce in Nevada 2007 Figures 6 and 7 depict the current specialty distribution of the physician workforce in Nevada and the specialty distribution by gender. In 2007, a little over one-third (33.6%) of the physician workforce practice in the primary care specialties of pediatrics, obstetrics/gynecology, internal medicine, general practice, or family medicine. Another 6.3% practice in a wide range of primary care subspecialty areas such as pediatric endocrinology and geriatric medicine. Approximately two in five physicians in Nevada (42.1%) practice in medical and surgical specialities, while the remaining 17.9% are inactive and/or have an unknown specialty area. Physician Workforce in Nevada 2009 Edition 7

16 Like many states, Nevada s physician workforce has been characterized by declining percentages of physicians providing patient care services (versus employment in administation, research, and other non-patient care activities) and by declining percentages of physicians in primary care versus medical and surgical specialities. Figure 7 highlights the fact that a greater proportion of female physicians in Nevada currently practice in primary care specialties or subspecialties than do male physicians. As such, it remains to be seen whether the growing proportion of women entering medicine will result in a reduction of primary care physician shortages in Nevada and other regions of the country. Figure 7: Specialty Distribution of Physician Workforce by Gender in Nevada 2007 Data contained in this report indicate that, when compared with other states in the west, Nevada possesses shortages for most medical and surgical specialties. Of 39 speciality areas tracked by the AMA, only five specialty areas possess higher numbers of licensed MDs per capita in Nevada than other states in the region: cardiovascular disease, internal medicine, thoracic surgery, anesthesiology, and forensic medicine. Only two specialty areas possess higher numbers of licensed MDs per capita in Nevada than the national per capita figure: anesthesiology and forensic medicine. Physician Workforce in Nevada 2009 Edition 8

17 The final two figures highlight features of the geographic distribution of the physician workforce in Nevada. Figure 8 indicates that, while the physician workforce has grown steadily over the past decade, the number of physicians per 100,000 residents has consistently lagged behind that of other states in the region and the nation. Figure 8: Total Physicians per 100,000 Population in Nevada, Mountain Region, and United States 1997 to 2007 While the number of physicians in Nevada grew by nearly 70% over the past decade, the expansion of the physician workforce has barely kept pace with the state s rapid population growth. Presently, there are 218 physicians per 100,000 population in Nevada a per capita increase of only 14.7% since Despite steady growth in the physician workforce, Nevada continues to have an extremely low number of physicans per capita versus other western states in the US that are also experiencing overall physician shortages and shortages across the th majority of medical and specialty areas. Nevada currently ranks 48 in the number of physicians per capita a ranking that has not changed appreciably since Physician Workforce in Nevada 2009 Edition 9

18 Figure 9 highlights the considerable variation in geographic distribution of the physician workforce across Nevada. In general, the number of physicians per capita is lower in rural versus urban areas of Nevada. Among urban counties of the state, the number of physicians per capita is lower in southern versus northwestern Nevada. For example, the ratio of county residents per licensed physician ranges from 316 to 1 in urban Washoe County to 2,941 to 1 in rural Lyon County. In Clark County, there are 509 residents per licensed physician. Figure 9: Number of Residents per Licensed Physicians by County in Nevada 2007 Physician Workforce in Nevada 2009 Edition 10

19 Section 2: Physician Workforce in Nevada Detailed Data Tables Table 1: Total Physicians by Age in Nevada 1997 to 2007 Age Category Change 1997 to 2007 Number Percent Number Percent Number Percent Number Percent < , , , , , , Total Physicians 3, , , , Note: Figures for 1997 and 2002 are for nonfederal physicians only. Figures for 2007 include both federal and nonfederal physicians. Table 2: Total Physicians by Gender in Nevada 1997 to 2007 Gender Change 1997 to 2007 Number Percent Number Percent Number Percent Number Percent Male Physicians 2, , , , Female Physicians , Total Physicians 3, , , , Note: Figures for 1997 and 2002 are for nonfederal physicians only. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 11

20 Table 3: Male Physicians by Age in Nevada 1997 to 2007 Age Category Change 1997 to 2007 Number Percent Number Percent Number Percent Number Percent < , , , Total Male Physicians 2, , , , Note: The Total Male Physicians figures for 1997 and 2002 are for nonfederal physicians only. The Total Male Physicians figures for 2007 include both federal and nonfederal physicians. Table 4: Female Physicians by Age in Nevada 1997 to 2007 Age Category Change 1997 to 2007 Number Percent Number Percent Number Percent Number Percent < Total Female Physicians , Note: The Total Female Physicians figures for 1997 and 2002 are for nonfederal physicians only. The Total Female Physicians figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 12

21 Table 5: Total Physicians by Major Professional Activity in Nevada 1997 to 2007 Major Professional Activity Change 1997 to 2007 Num ber Percent Num ber Percent Num ber Percent Num ber Percent Patient Care Office Based 2, , , , Hospital-based Residents & Fellows Hospital-based Physician Staff Subtotal Patient Care 2, , , , Other Professional Activity Administration Medical Teaching Medical Research Other Subtotal Other Prof Activity Not Classified Inactive Total Physicians 3, , , , Note: Physicians in Patient Care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. Figures for 1997 and 2002 are for nonfederal physicians only. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 13

22 Table 6: Male Physicians by Major Professional Activity in Nevada 1997 to 2007 Major Professional Activity Change 1997 to 2007 Num ber Percent Num ber Percent Num ber Percent Num ber Percent Patient Care Office Based 1, , , , Hospital-based Residents & Fellows Hospital-based Physician Staff Subtotal Patient Care 2, , , , Other Professional Activity Administration Medical Teaching Medical Research Other Subtotal Other Prof Activity Not Classified Inactive Total Male Physicians 2, , , , Note: Physicians in Patient Care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. Figures for 1997 and 2002 are for nonfederal physicians only. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 14

23 Table 7: Female Physicians by Major Professional Activity in Nevada 2004 to 2007 Major Professional Activity Change 1997 to 2007 Num ber Percent Num ber Percent Num ber Percent Num ber Percent Patient Care Office Based Hospital-based Residents & Fellows Hospital-based Physician Staff Subtotal Patient Care , Other Professional Activity Administration Medical Teaching Medical Research Other Subtotal Other Prof Activity Not Classified Inactive Total Female Physicians , Note: Physicians in Patient Care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. Figures for 1997 and 2002 are for nonfederal physicians only. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 15

24 Table 8: International Medical Graduates (IMGs) by Age and Gender in Nevada 2007 International Medical Graduates (IMGs) Age Category Male Female Total Number Percent Number Percent Number Percent < Total IMG Physicians 1, , Note: The Total IMG Physicians figures for 1997 and 2002 are for nonfederal physicians only. The Total IMG Physicians figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 16

25 Table 9: IMGs by Major Professional Activity in Nevada 1997 to 2007 Major Professional Activity Change 1997 to 2007 Num ber Percent Num ber Percent Num ber Percent Number Percent Patient Care Patient Care, Office Based , Patient Care, Hospital Based Subtotal Patient Care , Other Professional Activity Total IMG Physicians , , , Note: Physicians in Patient Care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. The Total IMG Physicians figures for 1997 and 2002 are for nonfederal physicians only. The Total IMG Physicians figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 17

26 Table 10: Total Physicians by Self-Designated Specialty in Nevada 1997 to 2007 Major Specialty Total Physicians Change 1997 to 2007 Number Percent Number Percent Number Percent Number Percent General and Family Practice Family Medicine General Practice Medical Specialties , , Allergy & Immunology Cardiovascular Disease Dermatology Gastroenterology Internal Medicine Pediatrics Pediatric Cardiology Pulmonary Disease Surgical Specialties Colon & Rectal Surgery General Surgery Neurological Surgery Obstetrics & Gynecology Ophthalmology Orthopedic Surgery Otolaryngology Plastic Surgery Thoracic Surgery ,400.0 Urology Surgery Other Specialties , , Aerospace Medicine Anesthesiology Child & Adolescent Psychiatry Physician Workforce in Nevada 2009 Edition 18

27 Major Specialty Total Physicians Change 1997 to 2007 Number Percent Number Percent Number Percent Number Percent Other Specialties, cont. Diagnostic Radiology Emergency Medicine Forensic Medicine General Preventive Medicine Medical Genetics Neurology Nuclear Medicine Occupational Medicine Psychiatry Public Health & Gen Prev Med Physical Med & Rehabilitation Anatomic & Clinical Pathology Radiology Radiation Oncology Other Unspecified Not Classified Inactive Total Physicians 3, , , , Note: See Appendix A for sub-specialty classification by major specialty categories. Physician Workforce in Nevada 2009 Edition 19

28 Table 11: Total Physicians per 100,000 Population by Self-Designated Specialty in Nevada 1997 to 2007 Major Specialty Total Physicians per 100,000 Population Change 1997 to Number Percent General and Family Practice Family Medicine General Practice Medical Specialties Allergy & Immunology Cardiovascular Disease Dermatology Gastroenterology Internal Medicine Pediatrics Pediatric Cardiology Pulmonary Disease Surgical Specialties Colon & Rectal Surgery General Surgery Neurological Surgery Obstetrics & Gynecology Ophthalmology Orthopedic Surgery Otolaryngology Plastic Surgery Thoracic Surgery ,177.4 Urology Surgery Other Specialties Aerospace Medicine Anesthesiology Child & Adolescent Psychology Physician Workforce in Nevada 2009 Edition 20

29 Major Specialty Total Physicians per 100,000 Population Change 1997 to Number Percent Other Specialties, cont. Diagnostic Radiology Emergency Medicine Forensic Medicine General Prev Medicine Medical Genetics Neurology Nuclear Medicine Occupational Medicine Psychiatry Public Health & Gen Prev Med Physical Med & Rehabilitation Anatomic/Clinical Pathology Radiology Radiation Oncology Other Unspecified Not Classified Inactive Total Physicians Note: See Appendix A for sub-specialty classification by major specialty categories. Figures for 1997 and 2002 are for nonfederal physicians only. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 21

30 Table 12: Total Physicians per 100,000 Population by Self-Designated Specialty in Nevada, Mountain Region, and United States 2007 Major Specialty Total Physicians per 100,000 Population Nevada Mountain Region United States Nevada per Capita Difference Versus Mountain Region United States General and Family Practice Family Medicine General Practice Medical Specialties Allergy & Immunology Cardiovascular Disease Dermatology Gastroenterology Internal Medicine Pediatrics Pediatric Cardiology Pulmonary Disease Surgical Specialties Colon & Rectal Surgery General Surgery Neurological Surgery Obstetrics & Gynecology Ophthalmology Orthopedic Surgery Otolaryngology Plastic Surgery Thoracic Surgery Urology Surgery Other Specialties Aerospace Medicine Anesthesiology Child & Adolescent Psychology Physician Workforce in Nevada 2009 Edition 22

31 Major Specialty Other Specialties, cont. Total Physicians per 100,000 Population Nevada Mountain Region United States Nevada per Capita Difference Versus Mountain Region United States Diagnostic Radiology Emergency Medicine Forensic Medicine General Preventive Medicine Medical Genetics Neurology Nuclear Medicine Occupational Medicine Psychiatry Public Health & Gen Prev Medicine Physical Med & Rehabilitation Anatomic/Clinical Pathology Radiology Radiation Oncology Transplant Surgery Other Unspecified Vascular Medicine Not Classified Inactive Total Physicians Note: See Appendix A for sub-specialty classification by major specialty categories. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 23

32 Table 13: Physicians in Patient Care by Self-Designated Specialty in Nevada 1997 to 2007 Major Specialty Physicians in Patient Care Change 1997 to 2007 Number Percent Number Percent Number Percent Number Percent General and Family Practice Family Medicine General Practice Medical Specialties Allergy & Immunology Cardiovascular Disease Dermatology Gastroenterology Internal Medicine Pediatrics Pediatric Cardiology Pulmonary Disease Surgical Specialties Colon & Rectal Surgery General Surgery Neurological Surgery Obstetrics & Gynecology Ophthalmology Orthopedic Surgery Otolaryngology Plastic Surgery Thoracic Surgery N/A Urology Surgery Other Specialties , Aerospace Medicine Anesthesiology Child & Adolescent Psychology Physician Workforce in Nevada 2009 Edition 24

33 Major Specialty Physicians in Patient Care Change 1997 to 2007 Number Percent Number Percent Number Percent Number Percent Other Specialties, cont. Diagnostic Radiology Emergency Medicine Forensic Medicine General Preventive Medicine Medical Genetics Neurology Nuclear Medicine Occupational Medicine Psychiatry Public Health & Gen Prev Med Physical Med & Rehab Anatomic & Clinical Path Radiology Radiation Oncology Transplant Surgery Other Unspecified Vascular Medicine Active MDs Patient Care 2, , , , Active MDs Non Patient Care Not Classified Inactive Total Physicians 3, , , , Physician Workforce in Nevada 2009 Edition 25

34 Table 14: Physicians in Patient Care per 100,000 Population by Self-Designated Specialty in Nevada 1997 to 2007 Major Specialty Number of Physicians in Patient Care per 100,000 Population Change 1997 to Number Percent General and Family Practice Family Medicine General Practice Medical Specialties Allergy & Immunology Cardiovascular Disease Dermatology Gastroenterology Internal Medicine Pediatrics Pediatric Cardiology Pulmonary Disease Surgical Specialties Colon & Rectal Surgery General Surgery Neurological Surgery Obstetrics & Gynecology Ophthalmology Orthopedic Surgery Otolaryngology Plastic Surgery Thoracic Surgery Urology Surgery Other Specialties Aerospace Medicine Anesthesiology Child & Adolescent Psychology Physician Workforce in Nevada 2009 Edition 26

35 Major Specialty Number of Physicians in Patient Care per 100,000 Population Change 1997 to Number Percent Other Specialties, cont. Diagnostic Radiology Emergency Medicine Forensic Medicine General Prev Medicine Medical Genetics Neurology Nuclear Medicine Occupational Medicine Psychiatry Pub Health & Gen Prev Medicine Physical Med & Rehabilitation Anatomic/Clinical Pathology Radiology Radiation Oncology Transplant Surgery Other Unspecified Vascular Medicine Not Classified Inactive Total Physicians Note: See Appendix A for sub-specialty classification by major specialty categories. Physicians in Patient Care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. Figures for 1997 and 2002 are for nonfederal physicians only. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 27

36 Table 15: Physicians in Patient Care per 100,000 Population by Self-Designated Specialty in Nevada, Mountain Region, and United States 2007 Major Specialty Physicians in Patient Care per 100,000 Population Nevada Mountain Region United States Nevada per Capita Difference Versus Mountain Region United States General and Family Practice Family Medicine General Practice Medical Specialties Allergy & Immunology Cardiovascular Disease Dermatology Gastroenterology Internal Medicine Pediatrics Pediatric Cardiology Pulmonary Disease Surgical Specialties Colon & Rectal Surgery General Surgery Neurological Surgery Obstetrics & Gynecology Ophthalmology Orthopedic Surgery Otolaryngology Plastic Surgery Thoracic Surgery Urology Surgery Other Specialties Aerospace Medicine Anesthesiology Child & Adolescent Psychology Physician Workforce in Nevada 2009 Edition 28

37 Major Specialty Other Specialties, cont. Physicians in Patient Care per 100,000 Population Nevada Mountain Region United States Nevada per Capita Difference Versus Mountain Region United States Diagnostic Radiology Emergency Medicine Forensic Medicine General Prev Medicine Medical Genetics Neurology Nuclear Medicine Occupational Medicine Psychiatry Pub Health & Gen Prev Med Physical Med & Rehabilitation Anatomic/Clinical Pathology Radiology Radiation Oncology Transplant Surgery Other Unspecified Vascular Medicine Active MDs Patient Care Active MDs Non Patient Care Not Classified Inactive Total Physicians in Patient Care Note: See Appendix A for sub-specialty classification by major specialty categories. Physicians in Patient Care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 29

38 Table 16: Total Physicians by Gender and Self-Designated Specialty in Nevada 2007 Total Physicians Major Specialty Male Female Total Number Percent Number Percent Number Percent General and Family Practice Family Medicine General Practice Medical Specialties 1, , Allergy & Immunology Cardiovascular Disease Dermatology Gastroenterology Internal Medicine Pediatrics Pediatric Cardiology Pulmonary Disease Surgical Specialties Colon & Rectal Surgery General Surgery Neurological Surgery Obstetrics & Gynecology Ophthalmology Orthopedic Surgery Otolaryngology Plastic Surgery Thoracic Surgery Urology Surgery Other Specialties 1, , Aerospace Medicine Anesthesiology Child & Adolescent Psychology Physician Workforce in Nevada 2009 Edition 30

39 Total Physicians Major Specialty Male Female Total Number Percent Number Percent Number Percent Other Specialties, cont. Diagnostic Radiology Emergency Medicine Forensic Medicine General Prev Medicine Medical Genetics Neurology Nuclear Medicine Occupational Medicine Psychiatry Public Health & Gen Prev Med Physical Med & Rehabilitation Anatomic/Clinical Pathology Radiology Radiation Oncology Transplant Surgery Other Unspecified Vascular Medicine Not Classified Inactive Total Physicians 4, , , Note: See Appendix A for sub-specialty classification by major specialty categories. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 31

40 Table 17: Physicians in Patient Care by Gender and Self-Designated Specialty in Nevada 2007 Physicians in Patient Care Major Specialty Male Female Total Number Percent Number Percent Number Percent General and Family Practice Family Medicine General Practice Medical Specialties 1, , Allergy & Immunology Cardiovascular Disease Dermatology Gastroenterology Internal Medicine Pediatrics Pediatric Cardiology Pulmonary Disease Surgical Specialties Colon & Rectal Surgery General Surgery Neurological Surgery Obstetrics & Gynecology Ophthalmology Orthopedic Surgery Otolaryngology Plastic Surgery Thoracic Surgery Urology Surgery Other Specialties , Aerospace Medicine Anesthesiology Child & Adolescent Psychology Physician Workforce in Nevada 2009 Edition 32

41 Physicians in Patient Care Major Specialty Male Female Total Number Percent Number Percent Number Percent Other Specialties, cont. Diagnostic Radiology Emergency Medicine Forensic Medicine General Prev Medicine Medical Genetics Neurology Nuclear Medicine Occupational Medicine Psychiatry Public Health & Gen Prev Med Physical Med & Rehabilitation Anatomic/Clinical Pathology Radiology Radiation Oncology Transplant Surgery Other Unspecified Vascular Medicine Active MDs Patient Care 3, ,081 1, , Active MDs Non Patient Care Not Classified Inactive Total Physicians 4, ,291 1, , Note: See Appendix A for sub-specialty classification by major specialty categories. Physicians in Patient Care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 33

42 Table 18: Total Physicians by Self-Designated Primary Care Specialty in Nevada 1997 to 2007 Specialty Total Physicians Change 1997 to 2007 Number Percent Number Percent Number Percent Number Percent Primary Care Specialties Family Medicine General Practice Internal Medicine Obstetrics/Gynecology Pediatrics Total Primary Care Physicians 1, , , Primary Care Subspecialties All Other Specialties 1, , , Not Classified Inactive or Address Unknown Total Physicians 3, , , , Note: See Appendix A for sub-specialty classifications. Physician Workforce in Nevada 2009 Edition 34

43 Table 19: Total Physicians by Gender and Self-Designated Primary Care Specialty in Nevada 2007 Total Physicians Specialty Male Female Total Number Percent Number Percent Number Percent Primary Care Specialties Family Medicine General Practice Internal Medicine Obstetrics/Gynecology Pediatrics Total Primary Care Physicians 1, , Primary Care Subspecialties All Other Specialties 1, , Not Classified Inactive or Address Unknown Total Physicians 4, , , Note: See Appendix A for sub-specialty classifications. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 35

44 Table 20: Total Physicians by Country of Undergraduate Medical Education and Self-Designated Primary Care Specialty in Nevada 2007 Total Physicians Specialty US Medical Graduates International Medical Graduates (IMGs) Total Number Percent Number Percent Number Percent Primary Care Specialties Family Medicine General Practice Internal Medicine Obstetrics/Gynecology Pediatrics Total Primary Care Physicians 1, , Primary Care Subspecialties All Other Specialties 1, , Not Classified Inactive or Address Unknown Total Physicians 3, , , Note: See Appendix A for sub-specialty classifications. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 36

45 Table 21: Total Physicians by County in Nevada 1997 to 2007 Region/County Total Physicians Change 1997 to Number Percent Rural Counties Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Rural Subtotal Urban Counties Carson City Clark County 2,003 2,819 3,836 1, Washoe County 896 1,087 1, Urban Subtotal 3,020 4,052 5,311 2, Nevada Total 3,186 4,284 5,591 2, Note: Figures for 1997 and 2002 are for nonfederal physicians only. The Total Physicians figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 37

46 Table 22: Total Physicians per 100,000 Population by County in Nevada 1997 to 2007 Region/County Total Physicians per 100,000 Population Change 1997 to Number Percent Rural Counties Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Rural Subtotal Urban Counties Carson City Clark County Washoe County Urban Subtotal Nevada Total Note: Figures for 1997 and 2002 are for nonfederal physicians only. The Total Physicians figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 38

47 Table 23: Physicians in Patient Care by County in Nevada 1997 to 2007 Region/County Physicians in Patient Care Change 1997 to Number Percent Rural Counties Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Rural Subtotal Urban Counties Carson City Clark County 1,691 2,314 3,052 1, Washoe County , Urban Subtotal 2,522 3,311 4,225 1, Nevada Total 2,663 3,493 4,442 1, Note: Physicians in Patient Care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. Figures for 1997 and 2002 are for nonfederal physicians only. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 39

48 Table 24: Physicians in Patient Care per 100,000 Population by County in Nevada 1997 to 2007 Region/County Physicians in Patient Care per 100,000 Population Change 1997 to Number Percent Rural Counties Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Rural Subtotal Urban Counties Carson City Clark County Washoe County Urban Subtotal Nevada Total Note: Physicians in Patient Care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. Figures for 1997 and 2002 are for nonfederal physicians only. Figures for 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 40

49 Table 25: Physicians, Population, and Physician/Population Ratios in Nevada and the United States 1980 to 2007 Year Change 1980 to 2007 Category Number Percent United States Total Population (Millions) Total Physicians (Thousands) Total Physicians per 100,000 Population Individuals per One Physician Nevada Total Population (Thousands) 797 1,219 2,018 2,565 1, Total Physicians 1,171 2,006 4,025 5,591 4, Total Physicians per 100,000 Population Individuals per One Physician Nevada Rank Among US States Note: Figures for 1980 are for nonfederal physicians only. Figures for 1990 to 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 41

50 Table 26: Number of Physicians per 100,000 Population in Nevada and Neighboring States 1980 to 2007 State Number of Physicians per 100,000 Population Change 1980 to Number Percent Arizona California Idaho Nevada Oregon Utah United States Note: Figures for 1980 are for nonfederal physicians only. Figures for 1990 to 2007 include both federal and nonfederal physicians. Table 27: Residents per One Physician in Nevada and Neighboring States 1980 to 2007 State Number of Residents per One Physician Change 1980 to Number Percent Arizona California Idaho Nevada Oregon Utah United States Note: Figures for 1980 are for nonfederal physicians only. Figures for 1990 to 2007 include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 42

51 Table 28: Number of Physicians in Patient Care per 100,000 Population in Nevada and Neighboring States 1990 to 2007 State Number of Physicians in Patient Care per 100,000 Population Change 1980 to Number Percent Arizona California Idaho Nevada Oregon Utah United States Note: All figures include both federal and nonfederal physicians. Table 29: Residents per One Physician in Patient Care in Nevada and Neighboring States 1990 to 2007 State Number of Residents per One Physician in Patient Care Change 1980 to Number Percent Arizona California Idaho Nevada Oregon Utah United States Note: All figures include both federal and nonfederal physicians. Physician Workforce in Nevada 2009 Edition 43

52 Table 30: Nevada s Rank Among US States in the Number of Total Physicians per 100,000 Population 1980 to 2007 State Rank in the Number of Total Physicians per 100,000 Population Change in Rank 1980 to 2007 Alabam a Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana M aine M aryland M assachusetts M ichigan M innesota M ississippi M issouri M ontana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Verm ont Virginia W ashington W est Virginia W isconsin W yom ing Physician Workforce in Nevada 2009 Edition 44

53 Table 31: Nevada s Rank Among US States in the Number of Physicians in Patient Care per 100,000 Population 1980 to 2007 State Rank in the Number of Physicians in Patient Care per 100,000 Population Change in Rank 1980 to 2007 Alabam a Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana M aine M aryland M assachusetts M ichigan M innesota M ississippi M issouri M ontana Nebraska Nevada New Ham pshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Verm ont Virginia W ashington W est Virginia W isconsin W yom ing Physician Workforce in Nevada 2009 Edition 45

54 Table 32: Graduates of the University of Nevada School of Medicine (UNSOM) Currently Practicing in the United States by Year of Graduation and Gender 2007 UNSOM Physicians Practicing in the United States 2007 Year of Graduation Men Women Total Number Percent Number Percent Number Percent Present Total , Table 33: Graduates of the University of Nevada School of Medicine (UNSOM) Currently Practicing in the United States by Self-Designated Primary Care Speciality 1997 to 2007 Specialty Total UNSOM Graduates Change 1997 to 2007 Number Percent Number Percent Number Percent Number Percent Primary Care Specialties Family Medicine General Practice Internal Medicine Obstetrics/Gynecology Pediatrics Total Primary Care Physicians Primary Care Subspecialties All Other Specialties Not Classified Inactive or Address Unknown Total Physicians , , Physician Workforce in Nevada 2009 Edition 46

55 Table 34: Osteopathic Physicians (DOs) by Gender and Age in Nevada 2007 Osteopathic Physicians (DO) Age Category Male Female Total Number Percent Number Percent Number Percent < Total DO Physicians Table 35: Osteopathic Physicians (DOs) by Gender and Major Professional Activity in Nevada 2007 Osteopathic Physicians (DO) Major Professional Activity Male Female Total Number Percent Number Percent Number Percent Patient Care Office Based Hospital-based Residents & Fellows Hospital-based Physician Staff Subtotal Patient Care Other Professional Activity Administration Medical Teaching Medical Research Other Subtotal Other Prof Activity Total DO Physicians Note: Physicians in patient care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. Physician Workforce in Nevada 2009 Edition 47

56 Table 36: Osteopathic Physicians (DOs) by Self-Designated Specialty and Major Professional Activity in Nevada 2007 Osteopathic Physicians (DO) Major Specialty Patient Care Non-Patient Care Total Number Percent Number Percent Number Percent General and Family Practice Family Medicine General Practice Medical Specialties Allergy & Immunology Cardiovascular Disease Dermatology Gastroenterology Internal Medicine Pediatrics Pediatric Cardiology Pulmonary Disease Surgical Specialties Colon & Rectal Surgery General Surgery Neurological Surgery Obstetrics & Gynecology Ophthalmology Orthopedic Surgery Otolaryngology Plastic Surgery Thoracic Surgery Urology Surgery Other Specialties Aerospace Medicine Anesthesiology Child & Adolescent Psychology Physician Workforce in Nevada 2009 Edition 48

57 Osteopathic Physicians (DO) Major Specialty Patient Care Non-Patient Care Total Number Percent Number Percent Number Percent Other Specialties, cont. Diagnostic Radiology Emergency Medicine Forensic Medicine General Prev Medicine Medical Genetics Neurology Nuclear Medicine Occupational Medicine Psychiatry Public Health & Gen Prev Med Physical Med & Rehabilitation Anatomic/Clinical Pathology Radiology Radiation Oncology Transplant Surgery Other Unspecified Vascular Medicine Active DO Physicians Not Classified Inactive Total DO Physicians Note: Physicians in patient care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. Physician Workforce in Nevada 2009 Edition 49

58 Table 37: Osteopathic Physicians (DOs) by Self-Designated Primary Care Specialty in Nevada and the United States 2007 Specialty DO Physicians in Nevada DO Physicians in United States Number Percent Number Percent Primary Care Specialties Family Medicine , General Practice , Internal Medicine , Obstetrics/Gynecology , Pediatrics , Total Primary Care DO Physicians , Primary Care Subspecialties , All Other Specialties , Not Classified , Inactive or Address Unknown , Total DO Physicians , Physician Workforce in Nevada 2009 Edition 50

59 Appendix: Definitions and Explanation of Terms Used by the American Medical Association (AMA) and the AMA Division of Survey and Data Resources The AMA Physician Masterfile The Physician Workforce in Nevada: Current Characteristics and Distribution 2009 Edition utilizes information from the American Medical Association s (AMA) Physician Masterfile. The Physician Masterfile is maintained by the AMA s Division of Survey and Data Resources, and is recognized as the definitive source of information on the physician workforce in the United States. These reports contain historical and current data on the US physician population that provide a basis for comparison essential for health services research, program planning, and policy development. All of the state-level data contained in this report were derived from annual reports generated by the AMA on physician workforce characteristics, including the recently published Physician Characteristics and Distributions in the US, 2009 Edition, which contains summary and detailed data on physicians in Nevada and the United States as of December 31, The 2009 edition represents the latest in a series beginning in 1963 as the Distribution of Physicians. This Appendix summarizes key elements of the AMA Physician Masterfile and definitions and terms used by the AMA in the annual Physician Characteristics and Distribution in the US reports that have been incorporated in this report. The AMA has continued to develop a unique and comprehensive database of physician and medical student information since the establishment of the Masterfile in Although initially the Masterfile was primarily used by the Association as a record-keeping device for membership and mailing purposes, today the Masterfile is widely considered to be the most complete and extensive source of physician-related information in the United States. The Masterfile contains current and historical data on all physicians, including members and nonmembers of the AMA and graduates of foreign medical schools who are in the United States and meet educational standards for recognitions as physicians. International Medical Graduates (IMGs), who are graduates of foreign medical schools residing in the United States, are included in the Masterfile, generally upon entry into graduate medical training programs accredited by the Accreditation Council on Graduate Medical Education (ACGME). Included also in the Masterfile are IMGs who have been granted a state license to practice medicine but who may not have entered ACGME training programs. The Masterfile also includes physicians licensed to practice in the United States but temporarily located abroad. Physician Workforce in Nevada 2009 Edition 51

60 A record is started on each individual upon entry into medical school or, the case of international or Canadian medical graduates, upon entry into the United States. A physician s record includes medical school and year of graduation, sex, and birth date. As the physician s training and career develop, additional information is added, such as residency training, state licensure data, and board certification. This information, which comprises the historical portion of the Masterfile, facilitates studies of trends in geographic mobility and medical education. In addition, the current professional activities portion of each physician s record identifies geographical location and current address, type of practice (Patient Care or Nonpatient Care), specialties (primary and secondary), and present employment (solo, partnership, group practice, medical schools, hospitals, government, and other organizations). These data are particularly useful in staffing needs planning and research. By definition, the current portion of the record is subject to constant change and must be updated continually through extensive monitoring and data collection activities. Over time, the objectives, collection techniques, and need assessments undergo regular review and change. Quality control, Masterfile expansion, and upgrading of the information collected and analyzed continue to be the major focus of the AMA s Division of Survey and Data Resources. A major source of data collection is the Census of Physicians (PPA Questionnaire), which the AMA designed in 1968 in order to collect data under a new classification of physician activities based on hours worked criteria. The PPA Questionnaire was sent every four years between 1969 and 1985 to all physicians residing in the United States, as well as to US physicians residing temporarily overseas. Since 1985, the PPA Questionnaire has evolved into a rotating census in which approximately one-fourth of all physicians are surveyed each year. New methodologies are periodically tested and implemented to enhance data collection; examples include telephone follow-ups and multi-packet mailings. Each physician is asked to choose among the categories in each of the following items: (1) Professional Activity Direct Patient Care or Nonpatient Care activities (i.e., Administrative Activities, Medical Education, Medical Research, Other Medical Activities); (2) Specialization primary and secondary activities; and (3) Present Employment type of employer (i.e., Self- Employed, Solo Practice, Two-Physician Practice, Group Practice, HMO, Medical School, Non- Government Hospital, City/County/State Government, US Government, Locum Tenens, Other Patient Care, and Other Nonpatient Care). All completed questionnaires are passed through a series of computer editing procedures that assign major professional activity, specialty, and employment classifications to each physician s record. Physician Workforce in Nevada 2009 Edition 52

61 Over the past decade, the PPA Questionnaire has undergone continuous expansion. In addition to the professional activity, specialty, and employment categories, the PPA Questionnaire now includes information about office addresses, principle hospital affiliations, group affiliations, telephone numbers, and other data. While the data collected from the PPA Questionnaire represent a major source of information to the Masterfile, data also are obtained from several organizations and institutions. These primary sources and the data they provide include the following: (1) Medical schools name, address, birth date, birthplace, school, and year of graduation; (2) Hospitals physicians in graduate medical training, including IMGs entering US training; (3) Medical societies address and membership information; (4) State licensing agencies licensure status of physicians; (5) Educational Commission for the Foreign Medical Graduates (ECFMG) IMGs who are certified or have applied for certification by the ECFMG; (6) Surgeons general of the US government physicians in government services; and (7) American Board of Medical Specialties physicians certified by American Specialty Boards Data are also extracted from the Masterfile for use by these agencies. In addition, the Masterfile is used by various state and county societies, publishers, and several addressing companies. Definitions and Explanation of Terms Used by the AMA This section provides definitions of specific physician attributes and an explanation of terms used by the AMA in its annual physician workforce reports and replicated in the Physician Workforce in Nevada. Major Professional Activity Major professional activity (MPA) classifications are reported by physicians in the Physicians Practice Arrangements (PPA) questionnaire. The physician s professional activity is shown in the two categories of Patient Care and Nonpatient Care, the latter category being referred to as Other Professional Activity. Patient Care activities include Office-Based practice and Hospital-Based practice. Physicians in Residency training (including Clinical Fellows) and fulltime members of Hospitals Staffs comprise Hospital-Based practice. Other Professional Activity includes Administration, Medical Teaching, Research, and Other Activities. The subcategory Clinical Fellows is not longer tabulated; physicians formerly counted as Clinical Fellows are now in the category Residents/Fellows and are tabulated as Residents. Physician Workforce in Nevada 2009 Edition 53

62 Physicians who are retired, semiretired, working part-time, temporarily not in practice, or not active for other reasons are classified as Inactive. Physicians are categorized as Not Classified if the AMA has not received any recent information as to their type of practice and present employment. Following are definitions of each of the MPA categories. Office-Based Practice includes physicians engaged in seeing patients. Physicians may be in solo practice, group practice, two-physician practice, or other patient care employment. This category also includes physicians in patient services, such as those provided by pathologists and radiologists. Hospital-Based Practice includes physicians employed under contract with hospitals to provide direct patient care. Residents includes any physician in supervised practice of medicine among patients in a hospital or in its outpatient departments, with continued instruction in the science and art of medicine by the staff of the facility. This category also includes clinical fellows in advanced training in the clinical divisions of medicine, surgery, and other specialty fields preparing for practice in a given specialty. These physicians are engaged primarily in patient care. Medical Teaching includes physicians with teaching appointments in medical schools, hospitals, nursing schools, or other institutions of higher learning. Medical Research includes physicians in activities (funded or nonfunded) performed to develop new medical knowledge, potentially leading to publication. This category also includes physicians in research fellowship programs distinct from an accredited residency program and those primarily engaged in nonpatient care. Administration includes physicians in administrative activities in a hospital, health facility, health agency, clinic, group, or any similar organization. Other Activity includes physicians employed by insurance carriers, pharmaceutical companies, corporations, voluntary organizations, medical societies, associations, grants, foreign countries, and the like. Inactives include physicians who are retired, semiretired, working part-time, temporarily not in practice, or not active for other reasons and who indicated they worked 20 hours or less per week. Not Classified includes physicians who did not provide information on their type of practice or their present employment. Physician Workforce in Nevada 2009 Edition 54

63 Self-Designated Practice Specialty Like major professional activity, a physician s self-designated practice specialty (SDPS) is determined by the physician from a list of codes included with the PPA Questionnaire. A number of tables contained in the Physician Workforce in Nevada aggregate data according to specialties listed on the PPA Questionnaire and maintained on the Masterfile for which there is at least one physician designating it as their area of practice. Specialty classifications based on the 40 specialties used by the AMA for statistical purposes are listed below. Allergy & Immunology (AI) Allergy (A) Allergy & Immunology/Clinical & Laboratory Immunology (ALI) Immunology (IG) Aerospace Medicine (AM) Anesthesiology (AN) Adult Cardiothoracic Anesthesiology (ACA) Pain Medicine (Anesthesiology) (APM) Critical Care (Anesthesiology) (CCA) Pain Management (PME) Cardiovascular Disease (CD) Child & Adolescent Psychiatry (CHP) Colon & Rectal Surgery (CRS) Proctology (PRO) Dermatology (D) Clinical & Laboratory Dermatological Immunology (DDL) Procedural Dermatology (PRD) Diagnostic Radiology (DR) Cardiothoracic Radiology (CTR) Emergency Medicine (EM) Sports Medicine (Emergency Medicine) (ESM) Medical Toxicology (Emergency Medicine) (ETX) Pediatric Emergency Medicine (Emergency Medicine) (PE) Urgent Care Medicine (UCM) Underseas Medicine (Emergency Medicine) (UME) Forensic Pathology (FOP) Family Medicine (FM) Adolescent Medicine for Family Practice (AMF) Geriatric Medicine (Family Medicine) (FPG) Sports Medicine (Family Medicine) (FSM) Gastroenterology (GE) General Practice (GP) General Preventative Medicine (GPM) Medical Toxicology (Preventative Medicine) (PTX) Underseas Medicine (Preventative Medicine (UM) General Surgery (GS) Abdominal Surgery (AS) Surgical Critical Care (Surgery) (CCS) Craniofacial Surgery (CFS) Dermatologic Surgery (DS) Head & Neck Surgery (HNS) Hand Surgery (HS) Hand Surgery (Surgery) (HSS) Oral & Maxillofacial Surgery (OMF) Pediatric Cardiothoracic Surgery (PCS) Pediatric Surgery (Surgery) (PDS) Surgical Oncology (SO) Trauma Surgery (TRS) Vascular Surgery (VS) Physician Workforce in Nevada 2009 Edition 55

64 Internal Medicine (IM) Adolescent Medicine (AMI) Critical Care Medicine (Internal Medicine) (CCM) Diabetes (DIA) Endocrinology, Diabetes & Metabolism (END) Hematology (Internal Medicine) (HEM) Hepatology (HEP) Hematology/Oncology (HO) Hospitalist (HOS) Interventional Cardiology (IC) Cardiac Electrophysiology (ICE) Infectious Diseases (ID) Clinical & Laboratory Immunology (Internal Medicine) (ILI) Geriatric Medicine (IMG) Sports Medicine (Internal Medicine) (ISM) Nuclear Cardiology (NC) Nutrition (NTR) Medical Oncology (ON) Rheumatology (RHU) Sleep Medicine (Internal Medicine) (SMI) Transplant Hepatology (Internal Medicine) (THP) Medical Genetics (MG) Clinical Biochemical Genetics (CBG) Clinical Cytogenetics (CCG) Clinical Genetics (CG) Clinical Molecular Genetics (CMG) Neurology (N) Child Neurology (CHN) Clinical Neurophysiology (CN) Vascular Neurology (VN) Nuclear Medicine (NM) Neurological Surgery (NS) Endovascular Surgical Neuroradiology (ESN) Pediatric Surgery (Neurology) (NSP) Obstetrics & Gynecology (OBG) Gynecological Oncology (GO) Gynecology (GYN) Maternal & Fetal Medicine (MFM) Obstetrics (OBS) Critical Care Medicine (Obstetrics & Gynecology) (OCC) Reproductive Endocrinology (REN) Occupational Medicine (OM) Ophthalmology (OPH) Pediatric Ophthalmology (PO) Orthopedic Surgery (ORS) Hand Surgery (Orthopedic Surgery) ((HSO) Adult Reconstructive Orthopedics (OAR) Orthopedics, Foot & Ankle (OFA) Musculoskeletal Oncology (OMO) Pediatric Orthopedics (OP) Sports Medicine (Orthopedic Surgery) (OSM) Orthopedic Surgery of the Spine (OSS) Orthopedic Trauma (OTR) Other Specialty (OS) Addiction Medicine (ADM) Pediatric Psychiatry/Child Psychiatry (CCP) Emergency Medicine/Family Medicine (EFM) Pediatrics/Emergency Medicine (EMP) Epidemiology (EP) Family Medicine/Psychiatry (FPP) Internal Medicine/Family Medicine (IFP) Internal Medicine/Dermatology (IMD) Internal Medicine (Preventative Medicine) (IPM) Legal Medicine (LM) Internal Medicine/Medical Genetics (MDG) Medical Management (MDM) Internal Medicine (Emergency Medicine) (MEM) Internal Medicine & Neurology (MN) Internal Medicine/Psychiatry (MP) Internal Medicine/Physical Medicine & Rehabilitation (MPM) Neurology/Nuclear Medicine (NNM) Neurology/Diagnostic Radiology/Neuroradiology (NRN) Clinical Pharmacology (PA) Pediatrics/Dermatology (PDM) Phlebology (PHL) Pharmaceutical Medicine (PHM) Palliative Medicine (PLM) Pediatrics/Medical Genetics (PMG) Pediatrics/Physical Medicine & Rehabilitation (PPM) Psychiatry/Neurology (PYN) Sleep Medicine (SME) Otolaryngology (OTO) Otology/Neurotology (NO) Pediatric Otolaryngology (PDO) Psychiatry (P) Addiction Psychiatry (ADP) Neurodevelopmental Disabilities (Psychiatry & Neurology) (NDN) Neuropsychiatry (NUP) Forensic Psychiatry (PFP) Pain Medicine (Psychiatry) (PPN) Psychoanalysis (PYA) Geriatric Psychiatry (PYG) Psychosomatic Medicine (PYM) Physician Workforce in Nevada 2009 Edition 56

65 Pediatrics (PD) Adolescent Medicine (ADL) Pediatric Critical Care Medicine (CCP) Developmental/Behavioral Pediatrics (DBP) Internal Medicine/Pediatrics (MPD) Neurodevelopmental Disabilities (Pediatrics) (NDP) Neonatal-Perinatal Medicine (NPM) Pediatric Anesthesiology (PAN) Pediatric Allergy (PDA) Pediatric Dermatology (PDD) Pediatric Endocrinology (PDE) Pediatric Infectious Disease (PDI) Pediatric Pulmonary (PDP) Medical Toxicology (Pediatrics) (PDT) Pediatric Emergency Medicine (Pediatrics) (PEM) Pediatric Gastroenterology (PG) Pediatric Hematology/Oncology (PHO) Clinical & Laboratory Immunology (Pediatrics) (PLI) Pain Management (Physical Medicine & Rehabilitation) (PMP) Pediatric Nephrology (PN) Pediatric Rheumatology (PPR) Sports Medicine (Pediatrics) (PSM) Pediatric Rehabilitative Medicine (PRM) Pediatric Cardiology (PDC) Public Health & General Preventative Medicine (PHP) Physical Medicine & Rehabilitation (PM) Neuromuscular Medicine (NMN) Pain Medicine (PMM) Sports Medicine (Physical Medicine & Rehabilitation) (PRS) Spinal Cord Injury (SCI) Plastic Surgery (PS) Cosmetic Surgery (CS) Facial Plastic Surgery (FPS) Surgery of the Hand (Plastic Surgery) (HSP) Plastic Surgery within the Head & Neck (PSH) Anatomic/Clinical Pathology (PTH) Anatomic Pathology (ATP) Blood Banking/Transfusion Medicine (BBK) Clinical Pathology (CLP) Dermatopathology (DMP) Hematology (HMP) Molecular Genetic Pathology (MGP) Medical Microbiology (MM) Neuropathology (NP) Chemical Pathology (PCH) Cytopathology (PCP) Pediatric Pathology (PP) Selective Pathology (SP) Pulmonary Disease (PUD) Pulmonary Critical Care Medicine (PCC) Radiology (R) Abdominal Radiology (AR) Musculoskeletal Radiology (MSR) Nuclear Radiology (NR) Pediatric Radiology (PDR) Neuroradiology (RNR) Radiological Physics (RP) Vascular & Interventional Radiology (VIR) Radiation Oncology (RO) Thoracic Surgery (TS) Transplant Surgery (TTS) Urology (U) Pediatric Urology (UP) Vascular Medicine (VM) Unspecified (US) Primary Care Specialties and Primary Care Subspecialty Areas In the specialty tabulations presented in the Physician Workforce in Nevada and annual AMA physician workforce reports, the specialties of Family Medicine (FM), General Practice (GP), Internal Medicine (IM), Obstetrics/Gynecology (OBG), and Pediatrics (PD) include both the general primary care specialties and their respective subspecialties as listed in the specialty Physician Workforce in Nevada 2009 Edition 57

66 abbreviations appearing in the list above. However, in the tables detailing the distribution of the primary care physician workforce, the data are presented separately for the general primary care specialties and the primary care subspecialties, where the general primary care specialties are Family Medicine, General Practice, Internal Medicine, Obstetrics and Gynecology, and Pediatrics excluding the subspecialties associated with these general specialties. Geographic Region In some of the tables contained in this report, physician workforce data for Nevada is compared with data for the Mountain Region. States in the Mountain Region include Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming. Physician Workforce in Nevada 2009 Edition 58

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