UPDATE ON EASTERN & CENTRAL WASHINGTON GME EXPANSION COMMITTEE GME Summit March 23, 2012 John McCarthy, MD Assistant Dean for Regional Affairs University of Washington School of Medicine
EASTERN & CENTRAL WASHINGTON
- EASTERN & CENTRAL WASHINGTON --- THE CHARGE 1. Refine & update physician supply & workforce needs 2. Initiate planning for GME programs to meet physician workforce needs 3. Develop recommendations for business plans and financing for GME programs
EASTERN & CENTRAL WA ---- MEMBERS & COMMUNITIES Greater Spokane Incorporated Residencies UWSOM/WSU VA Hospitals Spokane County Medical Society
PRE WORK PHYSICIAN SUPPLY & WORKFORCE NEEDS a) Spokane County Medical Society/EWU 2009 The Challenges of Providing Primary Care in Spokane County 72% respondents - not enough primary care or physician assistants 20% of Spokane Primary Care physicians graduates of UWSOM b) WWAMI Rural Health Research Center/Mark Doescher, MD, MSPH 06/10 Current & Projected Supply of Physicians in Eastern WA: 2009 & 2030 WA relies heavily on importing physicians EWA physician/population below US Will need 150 additional FM physicians by 2030 to retain ratio c) Tripp Umbach UME Study 04/10 America s Next Great Academic Health Science Center Expand to 80-120 First Year Medical Students
GME EXPANSION PRE WORK FINDINGS PHYSICIAN SUPPLY & WORKFORCE NEEDS We have too few physicians 18.5/10K population vs. US 21.3/10K population We have proportionately fewer residents 6.8/100k population vs. US 35.7/100k population We have modest number of entering medical students 40 MS1 vs. 80-120 MS1 recommended by UME study
CURRENT RESIDENT SUPPLY GME expansion is vital for meeting physician needs in Central/Eastern Washington, given the strong correlation between where residents train and where they practice. Region currently has only seven residency programs Region currently imports 86% of its physicians to meet the region s needs Specialty Washington State Eastern Washington Spokane County Family Medicine 79% 79% 77% General Internal 84% 83% 81% General Pediatrics 85% 91% 89% Obstetrics 86% 87% 87% General Surgery 90% 91% 91% Psychiatry 84% 92% 94% Total Physicians 85% 86% 85% Recent planning by Tripp Umbach for the Academic Health Sciences Center at Riverpoint suggest that by 2030, 38%, or 46 out of 120 of WWAMI Medicine Spokane graduates are expected to choose work in communities throughout eastern Washington Source: Current and Projected Supply of Physicians in Eastern Washington: 2009 and 2030, Mark Doescher, MD June 2010 ; American s Next Great Academic Health Science Center, Tiripp Umbach; ACGME website and phone verification May 2010
RESIDENT NEEDS COMPARATIVE Based on current number of residents in the U.S. and Western Washington (W WA), Central/ Eastern Washington (C/E WA) lags behind by 253 and 172 residency positions, respectively. E/C WA Residency Targets based on US and W WA Ratios: Family Medicine Internal Medicine OB/GYN Pediatrics Surgery Emergency Medicine Psychiatry US Ratio (1) 46 109 23 40 35 24 23 300 W WA Ratio (2) 62 63 11 29 37 11 18 231 C/E WA Slots (3) 46 21 0 0 0 0 6 73 E/C WA Targeted Totals: Target Slots Current C/E WA Slots (3) Target Incremental Slots US Ratio (1) 326 73 253 W WA Ratio (2) 245 73 172 Total Notes: (1) Based on a population of 304,059,000 and the number of residents in each specialty per 100,000 population (2) Based on a population of 5,084,000 and the number of residents in each specialty per 100,000 population (3) Central / Eastern Washington slots exclude transitional and radiology residents Source: ACGME Data Resource Book 2009-2010: Western Washington based on October, 2009 data
RESIDENTS NEEDS ASSESSMENT Central/Eastern Washington ratio of 6.8 residents per 100K population falls significantly below the United States average of 35.7 residents Region Residents Population Residents per 100K population United States 108,488 304.059 million 35.7 Western Washington 1,517 5.084 million 29.8 Central/Eastern Washington 100 1.465 million 6.8 Alaska 34.689 million 4.87 Idaho 56 1.545 million 3.62 Montana 20.974 million 2.05 Wyoming 40.544 million 7.35 Source: 2009 State Physician Workforce Data Book: Center For Workforce Studies, AAMC November 2009; WWAMI Clinical Medical Education E&C WA
RESIDENTS NEEDS ASSESSMENT Central & Eastern Washington Programs 100 Slots Region City Central Washington Family Medicine 18 Central Yakima Family Medicine Spokane 22 Eastern Spokane Family Medicine Spokane RTT 3 Eastern Colville Internal Medicine Residency Spokane 21 Eastern Spokane Sacred Heart Transitional Program 18 Eastern Spokane Radiology Residency 9 Eastern Spokane UW Psychiatry 6 Eastern Spokane Source: 2009 State Physician Workforce Data Book: Center For Workforce Studies, AAMC November 2009; WWAMI Clinical Medical Education E&C WA
MEMBER SURVEY GOAL Expansion Committee survey - most agreed the GME expansion target should be based on current Western Washington ratios Goal of next 10 years = 144 COGME recommendations - primary care training will exceed 40% overall Family Medicine goal should be considered a minimum target
MEMBER SURVEY GOAL Program Family Medicine Internal Medicine Current Incremental Total GME # % # # % 46 46% 15 61 25% 21 21% 27 48 20% OB/GYN - - 18 18 7% Pediatrics - - 23 23 9% Surgery - - 23 23 9% Emergency Med - - 14 14 6% Psychiatry 6 6% 13 19 8% Radiology 9 9% - 9 4% Transitional Year 18 18% - 18 7% Fellowships - - 11 11 5% Total 100 100% 144 * 244 100% Note: (*) With an incremental goal of 144 residency positions, the total slots for C/E Washington of 244 almost equals the total for W Washington of 245.
WHERE GROWTH CAN OCCUR Wenatchee FQHC Tri-Cities Hospitals Ellensburg FQHC Rural Training Tracks Moses Lake, Colville, Colfax? Coeur d Alene Kootenai Medical Center Spokane Providence Holy Family Hospital Spokane s IM & FM Residencies
SURVEY GOAL Most agreed GME expansion target should be based on current Western Washington ratios GME expansion alone won t meet the region s needs How to meet the requirements of evolving delivery models Changes in GME funding will influence the scope and timing of expansion
10 YEAR TIMELINE The proposed schedule below would exceed the minimum 2020 goal of 144 new residency positions through a combination of new, expanded, and WWAMI opportunities. KEY New Program Incremental Growth of Existing Program Potential WWAMI Regional Rotation/Track 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Total Goal C/WA 2 C/WA 2 FAMILY MED 24 15 6 6 6 INTERNAL MED WWAMI 5 5 5 5 5 5 32 27 2 C/WA 2 PEDIATRICS * 8 8 8 24 23 OB/GYN * WWAMI 2 4 4 4 4 18 18 SURGERY * WWAMI 22 23 2 4 4 4 4 4 WWAMI EMER MED 6 6 6 20 14 PSYCHIATRY * 3 4 4 4 4 19 13 FELLOWSHIPS 11 11 Cardio 1 1 1 GI 2 1 1 1 SM 2 Pulm 1 1 1 CUMULATIVE SLOTS 2 6 22 49 81 109 129 146 158 170 Note: (*) Size of new residency program reflected on the 10 year timeline is different from the minimum RRC program requirements used for financial modeling purposes.
BUSINESS PLAN & FINANCING Business Plan Template Review of Funding Mechanisms Review of Legislative Initiatives
COMPLEXITIES Staging Implementation Funding Health Systems ACGME/RRC Faculty Development
OUTCOME THEMES Be Prepared - Shovel Ready Cooperative Infrastructure Think Creatively Out of the Box Think Bigger Accept Incremental Growth UWSOM Commitment to GME
Updates? Next steps? Questions