The Allergy/Immunology Physician Workforce Presented To: The American Academy of Allergy Asthma & Immunology Chrysalis/NREP Programs San Francisco, CA March 20, 2004 Gaetano Forte School of Public Health (518) 402-0250 http://chws.albany.edu
Overview of Presentation Current National Physician Workforce Debates and Developments A/I Workforce Studies Overview A/I Graduate Medical Education Surveys, 1999-2002
at the Dedicated to studying the supply, demand, use, and education of the health workforce Committed to collecting and analyzing data to understand workforce dynamics and trends Goal to inform public policies, the health and education sectors, and the public One of six regional centers with a cooperative agreement with HRSA/Bureau of Health Professions
: Current Physician Workforce Projects Re-assessment of physician workforce goals for 2020 for national Council on Graduate Medical Education (COGME) Tracking physician workforce in New York State Assessment of supply, demand, and need for physicians in California in 2015 Specialty-specific studies Allergy and Immunology Urology Neurosurgery Medical Geneticists Hospice and Palliative Care
Current National Physician Workforce Debates and Developments
The Current Debate: The Four Major Positions 1. The total supply of physicians is adequate: No need to do anything now 2. The total supply is adequate but we rely too heavily on IMGs: Increase US medical school slots but not GME slots (or funding)
The Current Debate: The Four Major Positions, cont. 3. The contribution of additional physicians is marginal and/or a significant percent of physician services are unnecessary or of marginal benefit. Therefore, the nation has more than enough physicians: reduce the supply of physicians 4. The nation will be facing a major shortage of physicians: Begin to increase US medical school capacity as soon as possible
The 2003/04 COGME Report Forecast supply, demand, and need for the nation for 2020 Council endorsed preliminary findings and recommendations in September 2003 Report awaiting final approval and dissemination
Projections of Physician Supply, Demand, and Need in 2020 Projections of supply, demand, and need based on historical rates of production and use of physicians Employed historical practice patterns such as physician retirement rates, use of physician services by age and setting, insurance status of the population Applied historical practice pattern rates to population projections
Projections of Physician Supply, Demand, and Need, 2020 1,400,000 1,350,000 1,300,000 1,250,000 1,240,000 1,200,000 1,173,000 FTEs 1,150,000 1,100,000 1,050,000 1,000,000 1,076,000 1,027,000 1,086,000 950,000 900,000 972,000 850,000 800,000 Supply Demand Need
Factors Affecting Demand/Need Not Included in Projections Increasing use due to new interventions and treatment protocols Increasing average length of visit time Increase in use of services generated by use of human genome diagnostic screening Changes in reimbursement policies (Medicare, Medicaid, coverage for the uninsured) Changes in the health services delivery system Mal-distribution of physicians
COGME Recommendations #1 1. Increase number of new physicians produced each year from 24,000 per year to 27,000 2. Increase in US medical school graduates by 3000 per year (15%) by 2015 3. Gradually increase the number of training positions and begin to raise Medicare cap on GME positions to match increase in US medical school graduations 4. Track physician supply, demand and need and conduct a comprehensive re-assessment within next 4 years
COGME Recommendations #2 5. Assess supply, demand, and need by specialty on a systematic basis to guide medical student and physician decision making on specialty mix rather than set a specific target for the nation 6. Promote efforts to increase physician productivity, including investing in new technologies, such as information systems 7. Expansion of national health service corps (NHSC) and other federal programs that address access problems created by shortages
A/I Workforce Studies Overview
A/I Workforce Studies: Timeline 1998 Analysis of historical A/I workforce data: AMA and AAAAI 1999 Survey of physicians providing A/I services A/I training program director survey A/I fellows completing training survey 2000 Report on the A/I physician workforce A/I training program director survey A/I fellows completing training survey
A/I Workforce Studies: Timeline (cont.) 2001 Internal medicine and pediatric PGY-2 resident survey A/I training program director survey A/I fellows completing training survey 2002 A/I training program director survey A/I fellows completing training survey Internet Based Information System (IBIS Survey #1) 2003 IBIS Survey #2 2004 Census Survey (May August)
Selected Findings: Characteristics of Patient Care A/I Physicians, 1999 Characteristic Female 65 years of age and above Under-represented minority International Medical School Graduate Pediatric Training Internal Medicine Training % of A/I Physicians 19% 10% 6% 22% 54% 41% % of All US Physicians 22% 13% 6% 24% n/a n/a Sources: Survey of A/I Physicians 1999; AMA Physician Characteristics and Distribution in the US 2001-2002 Ed.
Selected Findings: Supply and Demand for A/I Physicians The supply and demand for A/I physicians are currently roughly balanced in the US Supply appears to slightly exceed demand in communities with hospitals that train A/I physicians, but there appear to be many practice opportunities in other communities There is significant competition between allergists and between A/I physicians and non-a/i physicians in many communities There are significant variations in the A/I physician-topopulation ratio across country Demand is likely to exceed supply for A/I physicians in the future due to an expected to rise in demand and steady or declining per capita supply
Perceptions of Supply/Demand Relationship among A/I Physicians, 1999, 2002, 2003 100% 1999 2002 2003 80% 60% 40% 36% 31% 37% 54% 41% 46% 29% 20% 10% 18% 0% Supply Greater than Supply Balanced with Supply Less than Demand Demand Demand Sources: Survey of A/I Physicians 1999; IBIS Survey #1 2002; IBIS Survey #2 2003
Intentions to Retire or Significantly Reduce Time Spent in Patient Care, 1999, 2002 100% 1999 2002 80% 60% 63% 65% 40% 20% 0% 4% 2% 13% 10% Less than 3 Years 3-5 Years 6-10 Years More than 10 Years Sources: Survey of A/I Physicians 1999; IBIS Survey #1 2002 20% 23%
Selected Findings: The Practice Environment for A/I Physicians Managed care did not reduce demand or income of most A/I physicians New technologies, medical interventions, and medications have not reduced demand for formally-trained A/I physicians Case complexity is increasing
A/I Graduate Medical Education Surveys, 1999-2002
Selected Findings: GME Surveys Interest in the specialty of A/I has increased significantly An increasing number of US medical school graduates are applying for and entering A/I fellowship programs While the total number of A/I fellows completing training is no longer falling it has not risen significantly despite the increase in US medical school graduates Shortages of faculty and limits on institutional funding may be limiting expansion of fellowship positions The vast majority of physicians completing A/I training are very satisfied with the specialty
Number of USMG and IMG Fellows in A/I Training, 1985-2002 IMG USMG 300 250 200 150 100 50 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Source: JAMA Med Ed Theme Issues, 1986-2003
Number of Graduates of A/I Fellowship Programs, 1993-2002 180 160 140 120 100 80 60 40 20 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Source: JAMA Med Ed Theme Issues, 1994-2003
Finding A Practice Position in Patient Care After A/I Training 1999-2002 100% 80% 1999 2000 2001 2002 88% 83% 77% 74% 60% 40% 20% 26% 23% 17% 12% 0% Secured Position Had Not Secured Position Source: Fellows Completing Training Surveys, 1999-2002
Planned Activities After Completing A/I Training, 1999-2002 1999 2000 2001 2002 Patient Care / Clinical Practice 83% 89% 91% 95% Research 35% 23% 22% 28% Teaching 31% 40% 31% 36% Temp. Inactive in Medicine 4% 0% 0% 4% Additional Training 2% 10% 7% 1% Other 2% 2% 9% 1% Multiple answers possible, columns may add to greater than 100% Source: Fellows Completing Training Surveys, 1999-2002
Location of Planned Activities After Completing A/I Training, 1999-2002 100% 1999 2000 2001 2002 80% 60% 53% 40% 36% 43% 40% 38% 20% 23% 24% 23% 19% 18% 17% 14% 23% 14% 9% 7% 0% Same City/County Where Trained Same State - Different Other State Other Country City/County Source: Fellows Completing Training Surveys, 1999-2002
Expected Weekly Direct Patient Care Hours, 1999-2002 100% 1999 2000 2001 2002 80% 60% 58% 58% 40% 44% 39% 45% 37% 30% 30% 20% 0% 16% 11% 6% 5% 3% 5% 6% 7% 19 or Fewer Hours 20-39 Hours 40-49 Hours 50 or More Hours Source: Fellows Completing Training Surveys, 1999-2002
Mean Expected Compensation Level After Completing Training, 1999-2002 1999 2000 2001 2002 Total Compensation $118,300 $116,000 $128,300 $134,000 Base Salary $103,300 $103,900 113,300 $117,000 Incentive Salary $15,000 $12,100 $15,000 $17,000 Source: Fellows Completing Training Surveys, 1999-2002
Satisfaction with Anticipated Compensation, 1999-2002 100% 1999 2000 2001 2002 80% 67% 60% 40% 20% 0% 33% 26% 24% 43% 58% 53% 48% 6% 13% 10% 6% 5% 6% 5% Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied 3% Source: Fellows Completing Training Surveys, 1999-2002
Willingness to Recommend A/I to Other Physicians in Training, 1999-2002 1999 2000 2001 2002 100% 97% 96% 94% 98% 80% 60% 40% 20% 0% Yes 3% 4% 6% 2% No Source: Fellows Completing Training Surveys, 1999-2002
Practice Position Search Experiences, 1999-2002 1999 2000 2001 2002 100% 80% 75% 60% 56% 55% 58% 40% 35% 27% 27% 20% 19% 17% 18% 7% 7% 0% Experienced Difficulties Experienced No Difficulties Had Not Begun Search Source: Fellows Completing Training Surveys, 1999-2002
Reasons for Difficulty Finding a Practice Position, 1999-2002 1999 2000 2001 2002 Lack of Positions in Desired Locations 62% 77% 67% 71% Lack of Positions in Desired Practice Settings 38% 23% 40% 21% Limited Opportunities due to Visa Status 38% 32% 33% 14% Family Considerations 38% 14% 27% 43% Inadequate Salary/Compensation Offered 23% 9% 33% 29% Overall Lack of Positions/Practice Opportunities 15% 5% 20% 7% Multiple answers possible, columns may add to greater than 100% Source: Fellows Completing Training Surveys, 1999-2002
Assessment of A/I Practice Opportunities within 50 Miles of Training Site, 1999-2002 100% 1999 2000 2001 2002 80% 60% 40% 20% 0% 13% 9% 9% 4% No Practice Opportunities 37% 33% 32% 29% Few Practice Opportunities 46% 40% 28% 27% 24% 16% 13% 12% 10% 9% 7% 3% Some Practice A Good Number of Many Practice Opportunities Practice Opportunities Opportunities Source: Fellows Completing Training Surveys, 1999-2002
Assessment of National A/I Practice Opportunities, 1999-2002 100% 1999 2000 2001 2002 80% 60% 40% 20% 0% 2% 4% 5% 0% 0% 0% 0% 0% No Practice Opportunities Few Practice Opportunities 60% 44% 46% 39% 29% 31% 32% 26% 21% 19% 28% 14% Some Practice A Good Number of Many Practice Opportunities Practice Opportunities Opportunities Source: Fellows Completing Training Surveys, 1999-2002
Assessment of National A/I Academic Opportunities, 1999-2002 100% 1999 2000 2001 2002 80% 60% 40% 20% 27% 28% 21% 17% 53% 43% 42% 30% 30% 20% 20% 19% 14% 16% 14% 0% 2% 1% 0% 0% No Academic Opportunities Few Academic Opportunities 4% Some Academic A Good Number of Many Academic Opportunities Academic Opportunities Opportunities Source: Fellows Completing Training Surveys, 1999-2002
A/I Workforce Reports All of the data and findings presented today are available at the Center s website: http://chws.albany.edu