Anticipated Shortages of Physicians Comparisons between Family Medicine and Ob-Gyn William F. Rayburn MD, MBA Professor and Chair, Dept. of Obstetrics & Gynecology University of New Mexico Consultant, Workforce Studies and Planning American Congress of Obstetricians & Gynecologists
Objectives After today s session, the participant will gain more knowledge in comparing between family medicine and general ob-gyn for: Pursuit of residencies Resident demographics Residency graduates Demographics of practitioners Access to care Consequences of shortages
American College of Surgeons General surgery Obstetrics and gynecology Orthopedics Otolaryngology Opthalmology Neurosurgery Urology Plastic surgery
Data Sets AAMC Association of American Medical Colleges ACOG American College of Obstetricians and Gynecologists AHA American Hospital Association Merritt Hawkins Search Firm NRMP National Resident Matching Program U.S. Census Bureau
Percent U.S. Medical Graduates and Specialty Salary AAMC
Residency Programs, 2011 Programs Positions Family medicine 453 2,708 General surgery 296 1,179 Ob-gyn 237 1,205 NRMP
Ob-Gyn Residents and Programs NRMP
Female Residents in Accredited Programs Average 46.0% Family medicine 55.6% Ob-gyn 79.7% General surgery 35.0% NRMP
African American, American Indian or Alaska Native, or Native Hawaiian or Pacific Islander Residents in Accredited Programs Average 6.3% Family medicine 8.0% Ob-gyn 11.2% General surgery 7.2% NRMP
Hispanic Residents in Accredited Programs Average 8.0% Family medicine 9.7% Ob-gyn 9.0% General surgery 8.3% NRMP
Gyn Procedures Performed by Residents Abdominal hysterectomy Vaginal hysterectomy Laparoscopic hysterectomy Treatment of incontinence/pelvic floor repair Laparoscopy Operative hysterectomy Abortion Treatment on invasive cancer ACOG
Active Physicians Practicing in Same State as Residency Training Average 47.4% Family medicine 55.6% Ob-gyn 47.4% General surgery 44.4% AAMC
Trends in Graduates from Residency Programs in Ob-Gyn Year Graduates (N) U.S. Population (100,000) Graduates per 100,000 Population (n) 1995 1,248 2,670 4.7 2000 1,234 2,820 4.4 2005 1,107 2,960 3.7 2010 1,168 3,100 3.8 AAMC
Patients in the General Population Per Active Physician Internal medicine 2,875 Family medicine 2,919 Pediatrics 5,579 Ob-Gyn 7,600 Psychiatry 7,661
Specialties With the Largest Numbers of Active Physicians Internal medicine 104,904 Family medicine 103,315 Pediatrics 54,061 Ob-Gyn 39,689 Psychiatry 39,371
per 10,000 women ACOG
Densities of Ob-Gyns per 10,000 women ACOG
Active Female Physicians by Medical Specialty, 2007 Average 28.3% Family medicine 31.3% Ob-gyn 43.2% General surgery 13.6% AAMC
Average Age at Which Fellows Stop Practicing Obstetrics Year All Fellows (Years) Males (Years) Females (Years) 1985 49.4 No data No data 1987 49.3 No data No data 1990 49.8 No data No data 1992 48.9 50.2 39.5 1996 46.6 48.4 39.2 1999 48.2 51.2 40.8 2003 48.0 51.0 42.0 2006 48.0 51.7 43.1 2009 48.0 51.9 43.8 ACOG
Hospitals with Maternity Services AHA
Hospitals with Maternity Services 60-Minute Drive AHA USCB
Hospitals with Maternity Services 30-Minute Drive AHA USCB
Mean Ages of Male/Female Fellows at ACOG ACOG
Age Intervals of the Fellows of ACOG ACOG
Active Physicians Aged 55 Years or Older Categorized by Medical Specialty, 2007 Average 37.6% Family medicine 36.7% Ob-gyn 38.5% General surgery 42.4% AAMC
Change in Number of Active Physicians 1996-2006 General surgery -1.0% Ob-gyn 10.2% Family medicine 33.0% AAMC
Physician Revenue by Payment Source Medical Specialty Medicare (%) Medicaid (%) Insurance (%) Self-pay (%) Other (%) All physicians 29 12 43 12 4 Family practice 23 12 44 17 4 Surgery 35 8 43 12 2 Obstetrics and gynecology 11 20 54 13 2 MH
Topics Assessed at a Typical Women s Annual Visit Cervical cytology Breast examination Pelvic examination Alcohol, tobacco, or drug use Sexuality concerns Fitness and nutrition Psychologic well-being Cardiovascular risk factors Immunizations ACOG
Wait Times Before Next Well-Woman Gynecologic Examination Year Shortest Time Longest Time Average Time Accepting Medicaid (%) 2004 3.0 days 65.1 days 23.3 days 60 2009 2.5 days 98.7 days 27.5 days 41 15 cities, 17 offices per city MH
Ten Most Sought After Physicians 1. Family practice 2. Internal medicine 3. Hospitalist 4. Radiology 5. Orthopedic surgery 6. Obstetrics and gynecology 7. Cardiology 8. General surgery 9. Emergency medicine 10. Psychiatry MH
ACOG
Advanced Ob-Gyn Training Maternal-Child health fellowship Women s Health training in internal medicine Re-entry of Ob-Gyns in the workforce
Nonphysician Practitioners Types of Nonphysician Practitioners Training Programs in the United States (N) Estimated Nonphysician Practitioners (N) Certified nursemidwives 38 11,546 Nurse practitioners 350 135,000 Physician assistants 140 85,345 ACOG
Visits to Retail Clinics URI, sinusitis 32% Immunizations 24% Pharyngitis 16% Otitis 8% UTI 5% Conjunctivitis 4% BP check 2% Other 10% Claims: National Ambulatory Medical Care Survey National Hospital Ambulatory Medical Care Survey, 2007