National Physician Workforce Trends ACEP Town Hall Meeting

National Physician Workforce Trends ACEP Town Hall Meeting Edward Salsberg Director, Center for Workforce Studies Washington DC April 22, 2009

Key Points • The nation is very likely to face a significant shortage of physicians • We will not be able (or willing) to meet all of the likely needs with more physicians; systems redesign is essential • Emergency medicine is growing and has become one of the most popular specialties for US medical school graduates

Overall Physician Workforce: Recent Findings and Developments (1) • AAMC analysis confirms likely significant shortage in coming years across a broad range of specialties • Population growth, aging and medical advances are increasing demand • Aging of physicians and work patterns of younger physicians will limit growth of supply • Shortages are already apparent and competition for physicians is increasing

Overall Physician Workforce: Recent Findings and Developments (2) • MD and DO 1 st year enrollment will rise by nearly 6, 000 per year between 2002 and 2013 • GME is unlikely to keep pace. This will probably lead to a reduction in IMGs and limit the supply of physicians and a peaking of the physician to population ratio in the next few years • The recession is slowing the growing shortage but health care reform will increase it • Increasing physician supply has to be part of a multifaceted effort to assure access including increased use of non-physician clinicians and innovations in service delivery

The Number of Active Physicians Approaching Retirement Age is Increasing Sharply: At the Current Level of GME, the US pop. Will Grow Faster Than the Physician Supply by 2015 26, 000 Physicians Entering Training Each Year Sources: AMA Physician Masterfile (January 2007); AAMC CWS GME Analysis March 2009

Time for family and personal life very important to young physicians, especially women physicians Percent “Very Important” to Physicians Under 50 BALANCE Male Female Time for family/personal life 66 82 Flexible scheduling 26 54 No / limited on call 25 44 Minimal practice mgmt resp 10 18 Practice income 43 33 Long term income potential 45 36 Opportunity to advance professionally 29 27 CAREER/INCOME Source: AAMC/AMA 2006 Survey of Physicians Under 50

Drivers of Future Demand for Physicians • Population growth § US Pop Growing by 25 million/decade • Aging of the population § Over 65 will double 2000 -2030 § Major illness/chronic illness far more prevalent among the elderly § Over 65 make twice as many physician visits as under 65 • Public expectations § Baby boom generation: high resources and expectations • Life Style factors § Rates of obesity, diabetes, etc. rising rapidly • Economic growth of the nation • Medical advances

Recent AAMC Report Projecting Physician Supply and Demand Through 2025

Most Plausible Scenario • Utilization rates will rise; • Shift in work schedules; • Moderate growth in GME (27, 600 new residents per year); and • Increase in productivity. Most plausible demand Shortage: 159, 300 Most plausible supply

Expansion of UME and GME Will Not Meet All of Future Demand: Still Need System Improvements Shortfall Addt’l supply from robust GME growth Baseline supply Reflects Impact of Full Growth of GME to 32, 000 Entrants Per Year

Emergency Medicine: Increasing in Size and Popularity

Emergency Medicine’s Share of Positions Offered in NRMP Has Risen Sharply 1999 -2009 6. 6% 4. 5% Source: NRMP Data; Prepared by Center for Workforce Studies 4 -09

Number US Seniors Matching in Emergency Medicine in NRMP Up 60. 5% in Past Decade 1, 146 714 Source: NRMP Data; Prepared by Center for Workforce Studies 4 -09

Top Specialties Filled by U. S. Seniors in NRMP in 2009 Specialty # U. S. Seniors % of U. S. Seniors Internal Medicine 2632 18% Pediatrics 1680 12% Medicine - Preliminary 1504 10% Emergency Medicine 1146 8% Family Medicine 1071 7% Obstetrics - Gynecology 879 6% Transitional 840 6% Surgery 824 6% Psychiatry 656 5% Anesthesiology 612 4% 14, 566 100% Total U. S. Seniors Matched Source: NRMP Data; Prepared by Center for Workforce Studies 4 -09

Growing Competition for Physicians: Recent Reports Related to Specialty Shortages Allergy & Immunology (2006) Anesthesia (2003) Cardiology (2004) Child Psychiatry (2006) Critical Care Workforce (2006) Dermatology (2004) Emergency Medicine (2006) Endocrinology (2003) Family Medicine (2006) Geriatric Medicine (2008) General Surgery (2007) Generalist Physicians (2008) Medical Genetics (2004) Neurosurgery (2005) Oncology (2007) Pediatric Subspecialty (2007) Psychiatry (2003) Public Health (2007) Rheumatology (2007)

What Can be Done to Help Assure Access to Care in the Future? Ø Continue to increase medical school enrollment Ø Increase GME positions Ø Assure that we are using our physicians wisely and effectively Ø Increase use of teams including non-physician clinicians (This will require inter-disciplinary education and practice) Ø Improve efficiency and effectiveness, including through evidence based medicine, comparative effectiveness studies, improved IT and EMR Ø Design service delivery responsive to needs of younger and older physicians, such as flexible scheduling and part time work