State Physician Workforce Studies

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State Physician Workforce Studies

• Mary Ellen Rimsza MD FAAP

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Massachusetts

• Survey of
• Practicing physicians
• Med staff presidents in community hospitals
• Department chiefs in teaching hospitals
• Medical directors
• GME program directors
• State residents
• Medical Office staff

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Practicing Physician Responses

• 83 have increased their work hours
• 70 have difficulty filling MD vacancies
• 72 say their patients have difficulty accessing
  specialists

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Filling Physician Vacancies

• 68 of teaching hospitals have difficulty filling
  physician vacancies
• 83 of community hospitals have difficulty
  filling physician vacancies
• 70 of medical directors report that it takes
  more time (median 1 yr) to fill

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Office Surveys

• Only 51 of internists accepting new patients
  (64 in 2006)
• 52 day wait for new patients (33 in 2006)

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Massachusetts Pediatricians

• 9 months to recruit new pediatrician
• Only 7 of medical directors reported
  pediatrician shortage
• 30 dissatisfied with practice compared to mean
  of 43 for other Mass docs
• 25 day wait for new patient appointments and 17
  for existing (Mean for other Mass docs 26/15)

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Colorado Physicians

• Relicensure survey of physicians
• Both MDs and DOs surveyed

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Colorado Physicians

• 15 of DOs and 11 of MDs work in rural areas
• 59 of DOs and 38 of MDs in primary care
• Same number of direct patient care hours

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National Conference of State Legislature
Practice/Education Site

• Based on AMA masterfile data 1975-1998
• Limited to Allopathic physicians
• States without medical schools excluded

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Findings

• 39 of physicians practice in same state where
  they attended medical school (range 10-63)
• 47 of physicians practice in same state where
  they completed last residency (range 14-68)

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Predictors of Physician Retention

• State characteristics
• Large population
• High median household income
• Predominantly public med schools
• Physician characteristics
• Generalist
• Practice in metro area

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Recommendations

• Support GME programs in state based on shortages
• Provide incentives for instate med students to
  attend instate residencies

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Other Thoughts

• Physician/Population ratio in Massachusetts
  highest in nation
• What will be impact of expanded insurance
  coverage on physician shortage?
• Impact of expanding osteopathic grads
• Impact of medical liability premiums as per cent
  of total operating costs