Health Workforce Now and Tomorrow Urgent Matters Delaware

Health Workforce Now and Tomorrow Urgent Matters Delaware Health Care Commission December 1, 2011 1

International Comparison of Spending on Health, 1980– 2008 Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP 2 Source: OECD Health Data 2010 (June 2010).

Number of Practicing Physicians per 1, 000 Population, 2006 *2005 Source: OECD Health Data 2008, “June 2008. ” 3

Federal Snapshot • AAMC projects 91, 500 physician shortage by 2020 • COGME projects 85, 000 shortage by 2020 • HRSA: demand will outstrip supply • Nearly 40% doctors over 55 – economists say 1/3 could retire in next 10 years • More women physicians – work fewer hours 4

Federal Snapshot • RN’s over 50: – % total RN’s 2000 33% 2008 44. 7% • 157, 000 pharmacy shortage -2020* • Faculty shortages: nursing & pharmacy • Demographics do not reflect population • *Health Resources and Services Administration 5

Delaware Snapshot • 2, 255 Est. physicians active practice • 863 Est. pcp: 1 pcp to 1187 people • Federally designated shortage areas: all Kent & Sussex & portions NCC – Meet or exceed 3500 to 1 ratio – COGME low end of acceptable – 1250 to 1 6

Delaware Snapshot • DE Healthcare Assn – 7900 nurses and allied professional between 2009 2014 • 1 to 9582 - Psychiatrist to population ratio • 80% bachelor’s program report faculty shortage • Average faculty age (2006) – 46 – diploma, certificate, associates – 53 – bachelor and graduate 7

PCP – DE Age Distribution PCP ‘ 08 Under 40 19% 40 -49 29. 2% DE ‘ 08 DE 2020 19% DE 2030 17% 14. 9% 11% 12% 50 – 64 35. 4% 19% 20% 17% Over 65 16. 3% 14% 19% 24% 8

PCP – DE Race Distribution • Caucasian – PCP ’ 08 73% DE 2030 72% • Asian – PCP ’ 08 20. %% DE 2030. 04%* • African American – PCP ’ 08 4. 5% DE 2030 23. 5% • Other – PCP ’ 08 1. 2% DE 2030. 04% – * Population Consortium does not separate Asian from “other” 9

Hispanic & Non-Hispanic • PCP ’ 08 4. 2% 95. 8% • DE ’ 08 6% 94% • DE 2020 10% 90% • DE 2030 12. 5% 87. 5% 10

Primary Care: WHY IT MATTERS • Aging “Boomers” will create more demand for services • Increased insured from ACA • Increased rates of chronic illness • Proven efficiency; cost effective; better outcomes • Adequate supply critical to insuring access and maintain healthy populations 11

Primary Care Challenges • Medical School Debt $145, 000 - $180, 000 • Annual Compensation: – Orthopedics – Radiology – Dermatology – Pediatrics – Family Medicine – Geriatrics $473, 770 $468, 594 $385, 088 $192, 000 $183, 999 $179, 950 • “ROAD” to success 12

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DHCC Strategies • DIMER DE Institute Medical Education & Research – 20 slots – 6 slots Jefferson Medical College Phil. College Osteopathic Medicine • DIDER – Delaware Institute Dental Education & Research – Dental residency support – CCHS – 5 slots Temple Univ. Kornberg School of Dentistry • Loan Repayment – Repay undergraduate and graduate education debt – Must locate in federally designated under-served area • Workforce Development 17

SLRP Gets Results! • • • 78 46 12 20 5 total physicians nurses dentists left after service 18

Looking Ahead • Patient Centered Medical Home – Payment Reform – Scope of Practice • Accountable Care Organizations – Team approach – best care, less spending – Evidence based medicine • Technology – health information exchanges and electronic medical records • Incentives – Loan Repayment 19

CONTACT INFORMATION Paula K. Roy Executive Director Delaware Health Care Commission Margaret O’Neil Building 410 Federal St. Suite 7 Dover, DE 19901 302 -739 -2730 302 -739 -6927 fax Paula. roy@state. de. us www. dhcc. delaware. gov 20