Health Sciences Education and the University of California

Transcription

1 Health Sciences Education and the University of California A Process for Planning Michael V. Drake, MD Vice President, Health Affairs March 16, 2005

2 Health Sciences Enrollment Planning Acknowledgements Context Process Findings Next Steps

3 Acknowledgements Health Sciences Committee Academic Planning Council OHA Staff Cathryn Nation MD Dena Bullard, MHS Andrea Gerstenberger, ScD Catherine Nancarrow, BA

4 Context UC operates 15 Health Sciences Schools and four longstanding programs on 7 campuses 5 hospitals, 4 academic medical centers Among the leading programs in the nation Particularly in research, but also in clinical and primary care

5 Context No significant increase in Health Sciences enrollment over past 25 years Undergraduate enrollment increased by 70,000 students State population increase ~10 million Health Sciences increased <200 Spot decreases result in no net gain

6 Goals to develop a model of the health care workforce needs of California 10 to 15 years from now, to help determine the proper role of UC in helping the State address those needs not to develop the plan, but rather to gather information that will support the planning process

7 Process Health Sciences Committee Standing sub committee of Academic Planning Council The California Endowment funded staff, consultants Extensive, serious, 3 year effort Produced 7 discipline specific reports: Dentistry, Medicine, Nursing, Optometry, Pharmacy, Public Health, Veterinary Medicine Today s example will focus on medicine

8 Process for Medicine 1. To create a demographic profile of California s population in 2002 and To compile a current profile of physicians practicing in California 3. To identify and discuss factors affecting the California s physician supply in the coming decade

9 Process 4. To identify and discuss the factors affecting demand for physicians services in California through To forecast and compare future physician workforce supply and needs (under 2 scenarios) in California through To advise on the steps necessary to better ensure an adequate supply of physicians in California through 2015 and beyond

10 California Population 34.7 million (as of 2000) California population increased by 15.7% between 1990 and 2000 (compared to 13% for U.S.) The population of California is projected to increase by 7.5 million (22%) between 2000 and 2015

11 Projected Population Growth by Region, Region 2000 Population 2015 Population % Change Bay Area 7,199,291 8,308, % Central Coast 1,874,448 2,370, % Central Valley/Sierra 1,149,033 1,591, % Inland Empire 3,298,337 4,859, % Los Angeles 8,838,861 10,978, % North Valley/Sierra 2,085,706 2,736, % Northern California 904,963 1,149, % Orange County 2,833,190 3,277, % San Diego 3,097,190 3,900, % South Valley/Sierra 2,372,133 3,198, % Total 34,653,395 42,370, %

12 Number of Physicians in California by Activity, ,000 70,000 69,252 60,000 50,000 40,000 30,000 20,000 10,000 0 Office/Hospital Based Patient Care 9,452 Residents/ Fellows 7,290 1, ,819 Research Teaching Administration Other Source: AMA Physician Masterfile, 12/2002

13 Race/Ethnicity of Active Patient Care Physicians in California Compared to California Population, % 66% CA Physicians CA Population 60% 50% 50% 40% 30% 20% 10% 0% White, non- Hispanic 3% 7% Black, non- Hispanic 22% 12% Asian/Pacific Islander < 1% 1% Native American/Alaskan 4% 31% Hispanic/Latino

14 Location of Medical School of Active Patient Care Physicians in California, 2002 Other Foreign County 22.4% Non-UC Osteopathic 3.4% Non-UC Allopathic 34.3% California 25.5% UC Allopathic 62.3% Other US/ Canada 52.1%

15 California s s Physician Workforce California ranks 38th among 46 states with medical schools in # medical school grads per 100,000 population California trains 15.8 medical students per 100,000 National average 28/100,000

16 Workforce Contribution Workforce Contribution Medical Students/100, DC Nebraska Pennsylvania West Virginia New York US Average Texas California

17 Workforce Contribution Residents/100, New York Pennsylvania US Average West Virginia Texas California

18 Medical Education Pipeline Pre Med UG Med Students Internship Specialty Fellowship

19 Training Science and math initiative Crucial for the future, but we need to create the next step as well California imports trained scientists for tech industries >50% of California s pre-med students attend medical school outside the state Committee work

20 California Physician Supply and Demand Forecasting: General Approach Develop simple forecasting model for physician supply Use existing forecasting model for physician demand Use historical data to inform forecasting models Develop alternative scenarios to supplement baseline forecasts Assumes supply equals demand in base year

21 California Physician Demand Forecasting Insurance Environments Physician demand was forecast in two distinct insurance environments: 1. Constant Insurance Environment: current levels of health insurance remain over forecast period 2. Expanded Insurance Environment: universal health insurance/other barriers to care removed; historically uninsured use physician services similarly as historically insured

22 California Physician Supply and Demand Forecasting: Findings

23 California Physician Demand: (Constant Insurance Environment) Total Physicians per 100,000 Population % Change 1. Baseline % 2. Economic Expansion % 3. Changing Physician Use Rates % 4. Eliminate Unnecessary Marginal Services % 5. Econ Expans & Unnecessary Services Reduction Hybrid % 6. Changing MD Use Rates Services Reduction Hybrid %

24 California Physician Demand: (Expanded Insurance Environment) Total Physicians per 100,000 Population % Change 1. Baseline % 2. Economic Expansion % 3. Changing Use Rates % 4. Eliminate Unnecessary Marginal Services % 5. Econ Expans & Unnecessary Services Reduction Hybrid % 6. Changing Use Rates & Un Services Reduction %

25 Physician Supply and Demand in California, 2015: Supply Scenario 4: Lifestyle Changes/Productivity Increases Hybrid 140, , , , , , , , ,000 95,000 90, ,904 Supply Scenario 4 119, , , , , ,988 Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Scenario 6 Constant Insurance Environment

26 Physician Supply and Demand in California, 2015: Supply Scenario 4: Lifestyle Changes/Productivity Increases Hybrid 140, , , , , , , , ,000 95,000 90, ,904 Supply Scenario 4 131, , , , , ,855 Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Scenario 6 Expanded Insurance Environment

27 Findings Californian s population is growing, aging, becoming increasingly diverse Twice national average in growth by 2025 Aging at twice the rate of total state population By 2015 more than half Hispanic/Asian Statewide shortages in major health professions; regional shortages will become more severe

28 Findings Demand for culturally, linguistically competent care growing due to increasing diversity of population California s health workforce does not reflect the diversity of the population Latinos, African-Americans, Native Americans significantly under-represented among students, faculty, and health care providers

29 Profession-specific Findings ~15% shortfall of physicians (i.e., 10,000-15,000) by 2015 Rapid population growth, aging physician workforce, no growth in medical education programs for over a quarter century California 49 th in nurses per capita Shortage of 60,000 by 2015 Shortage of nursing faculty a barrier to increasing enrollments

30 Profession-specific Findings Public health workforce deficient in preparation, size California 48 th in pharmacists per capita, 49 th in vets per capita Optometry, dentistry will need to continue to train to keep pace with population growth

31 Options for Addressing Physician Shortages Increase the Supply of Physicians in State Increase medical school capacity (MD output) Increase GME capacity Incentive in-migration (?, 20 th century)

32 Other Policy Options for California to Address Workforce Needs Programs and policies to increase diversity Programs and policies to address major geographic mal-distribution of physicians Develop systems to assess and monitor physician workforce supply, demand and need

33 Next Steps Begin by increasing capacity at our existing schools Replace some of the losses sustained in the early 80s New, creative programs aimed at addressing the State s compelling needs

34 PRIME-LC PRogram In Medical Education in the Complement to current curriculum Produce culturally and linguistically competent physicians to address needs in underserved communities. (Planning initiated for 3 additional PRIME sites: Davis, San Diego, SF)

35 Next Steps Forward Committee Report to the Long Range Guidance and Planning Team appointed by President Dynes One of a series of white papers the Planning Team will consider Engage University Leadership and Faculty in planning activity

36 Health Sciences Committee ANTHONY J. ADAMS, OD, Ph.D, UCB School of Optometry PHILIP J. DISAIA, MD, School of Medicine, UC Irvine KATHLEEN A. DRACUP, RN, DNS, Dean, UCSF School of Nursing KATHERINE FLORES, MD, UCSF/Fresno Medical Education Program EDWARD H. HOLMES, MD, Vice Chancellor, Dean, UCSD School of Medicine CATHRYN L. NATION, MD, Director, Academic Health Sciences, UCOP BENNIE I. OSBURN, DVM, Ph.D. Dean, UCD School of Veterinary Medicine STEPHEN SHORTELL, Ph.D.Dean, UCB School of Public Health NEIL PARKER, M.D., CHAIR; Sr. Associate Dean, UCLA Geffen SOM LAWRENCE H. PITTS, MD UCSF School of Medicine LINDA SARNA, RN, DNSc, FAAN, UCLA School of Nursing PALMER TAYLOR, Ph.D, Dean, UCSD School of Pharmacy MICHAEL E. WINTER, Pharm.D, UCSF School of Pharmacy MICHAEL V. DRAKE, MD (Ex Officio), Vice President--Health Affairs UCOP

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38 Product Available as PDF file on UCOP OHA website as of 3/14/05 Printed version available 3/21/05 Findings presented here today