primary care physicians-distribution and population to...

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Wisconsin AHEC Health Workforce Data Brief www.ahec.wisc.edu/workforce 1 June 2015 Primary Care Physicians Distribution This map shows the distribution of Wisconsin primary care physicians under age 65 as of 112012 and licensed in Wisconsin as of 3152012. The map locates physicians in the zip code of their address of record with the Department of Safety and Professional Services (DSPS). For physicians under age 65, this is most likely to be within the service area of the physician’s practice, if not the specific practice location. Comparison to information provided in the 2011/12 Wisconsin Physician Survey and linked to the licensure data supports this assumption for rural areas and most other parts of the state. In the subareas of central Milwaukee, however, there is more variation between a physician’s address of record and primary practice location. The Wisconsin Health Service Area (HSA) geography overlays the zip code information on the map. The Health Service Areas were developed by Wisconsin AHEC for health workforce data analysis. They also provide a useful geography for monitoring local program outcomes related to health workforce development and population health status. Each Wisconsin HSA consists of a hub city with healthcare services and surrounding municipalities. With some exceptions (in northern Wisconsin and border communities) each service area has a population of at least 10,000, with most of the service area population within 30 minutes travel time of the hub city. While most hubs include a hospital, inclusion of a municipality in a service area is determined by travel time to the hub, not actual hospital or clinic utilization data. A zip code version of the service areas has also been developed. For more information on the development of the service area geography, see Introduction to Wisconsin Health Service Areas, www.ahec.wisc.edu/healthserviceareas . The website also has maps and data related to the HSAs available for download. Primary Care Physicians Primary care physicians are those who listed their practice specialty as general practice, family medicine, general internal medicine, pediatrics, medpeds or geriatrics, without a medical subspecialty. Overall, about 38% of Wisconsin physicians are in primary care specialties. Trainees are excluded from the data in the attached tables, as well as physicians 65 or older. Basic physician information is from a database of all physicians drawn from the licensure records on 3152012. Additional information is from the 2011/12 Wisconsin Physician Survey. Survey results were weighted for age, sex, specialty and urbanrural location in order to arrive at an estimate for the population as a whole. The survey had a 30% response rate from the 14,722 Wisconsinbased physicians, yielding a margin of error of ±1% for all physicians and ±2% for the subgroup of 5599 primary care physicians. For details on both sources, see the October 2012 Wisconsin Physician Workforce Report (available at www.ahec.wisc.edu/workforce ). Population totals for calculation of population to physician ratios are based on the 2010 U.S. Census. Tables 1 and 2 provide information on the mix of primary care specialties by region and service area type for all physicians under 65 identified as primary care in the licensure data, including those who work as hospitalists or in urgent care or residential facility settings only, and those with administrative, teaching and research responsibilities. Information on the principal practice setting for these primary care physicians in Chart A and estimates of the number of officebased primary care physicians presented in Table 3 are based on the results of the 2011/2012 Wisconsin Physician Survey. Tables 4, 5 and 6 are based on the estimates of officebased practice presented in Table 3. Information on hours of work by work setting from the 2011/12 Wisconsin Physician Survey (Tables 4 and 5) informed estimates of patient care hours and the FTE calculation in Tables 6 and 7. The estimated population to primary care physician ratios in Tables 6 and 7 include only physicians based in Wisconsin. Residents of several border areas in Wisconsin may use physicians in neighboring states as their regular source of care. In other areas, patients may travel from an adjacent state to see physicians in Wisconsin. The net effect on the population to physician ratio will vary depending on local circumstances in these areas. Table 8 provides information on the percentage of primary care physicians who completed medical school in Wisconsin or a neighboring state, the percentage of foreign medical graduates practicing in an area, and an estimate of the percentage who completed their residency training in Wisconsin. Table 9 provides the same data for each Health Service Area and totals by region. This information may be of interest in understanding patterns of local and regional primary care physician recruitment.

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Page 1: Primary Care Physicians-Distribution and Population to ......Wisconsin’AHEC’Health’Workforce’Data’Brief! primary!care! physicians! primary!care ! ! ! ! ! ! !!!!! Primary!care!physicians!!

  Wisconsin  AHEC  Health  Workforce  Data  Brief    

www.ahec.wisc.edu/workforce   -­‐1-­‐   June  2015  

  Primary  Care  Physicians  Distribution  This  map  shows  the  distribution  of  Wisconsin  primary  care  physicians  under  age  65  as  of  1-­‐1-­‐2012  and  licensed  in  Wisconsin  as  of  3-­‐15-­‐2012.    The  map  locates  physicians  in  the  zip  code  of  their  address  of  record  with  the  Department  of  Safety  and  Professional  Services  (DSPS).    For  physicians  under  age  65,  this  is  most  likely  to  be  within  the  service  area  of  the  physician’s  practice,  if  not  the  specific  practice  location.  Comparison  to  information  provided  in  the  2011/12  Wisconsin  Physician  Survey  and  linked  to  the  licensure  data  supports  this  assumption  for  rural  areas  and  most  other  parts  of  the  state.    In  the  sub-­‐areas  of  central  Milwaukee,  however,  there  is  more  variation  between  a  physician’s  address  of  record  and  primary  practice  location.    The  Wisconsin  Health  Service  Area  (HSA)  geography  overlays  the  zip  code  information  on  the  map.  The  Health  Service  Areas  were  developed  by  Wisconsin  AHEC  for  health  workforce  data  analysis.    They  also  provide  a  useful  geography  for  monitoring  local  program  outcomes  related  to  health  workforce  development  and  population  health  status.    Each  Wisconsin  HSA  consists  of  a  hub  city  with  healthcare  services  and  surrounding  municipalities.    With  some  exceptions  (in  northern  Wisconsin  and  border  communities)  each  service  area  has  a  population  of  at  least  10,000,  with  most  of  the  service  area  population  within  30  minutes  travel  time  of  the  hub  city.    While  most  hubs  include  a  hospital,  inclusion  of  a  municipality  in  a  service  area  is  determined  by  travel  time  to  the  hub,  not  actual  hospital  or  clinic  utilization  data.  A  zip  code  version  of  the  service  areas  has  also  been  developed.  For  more  information  on  the  development  of  the  service  area  geography,  see  Introduction  to  Wisconsin  Health  Service  Areas,  www.ahec.wisc.edu/healthserviceareas  .  The  website  also  has  maps  and  data  related  to  the  HSAs  available  for  download.    Primary  Care  Physicians  Primary  care  physicians  are  those  who  listed  their  practice  specialty  as  general  practice,  family  medicine,  general  internal  medicine,  pediatrics,    med-­‐peds  or  geriatrics,  without  a  medical  subspecialty.    Overall,  about  38%  of  Wisconsin  physicians  are  in  primary  care  specialties.    Trainees  are  excluded  from  the  data  in  the  attached  tables,  as  well  as  physicians  65  or  older.    Basic  physician  information  is  from  a  database  of  all  physicians  drawn  from  the  licensure  records  on  3-­‐15-­‐2012.    Additional  information  is  from  the  2011/12  Wisconsin  Physician  Survey.  Survey  results  were  weighted  for  age,  sex,  specialty  and  urban-­‐rural  location  in  order  to  arrive  at  an  estimate  for  the  population  as  a  whole.  The  survey  had  a  30%  response  rate  from  the  14,722  Wisconsin-­‐based  physicians,  yielding  a  margin  of  error  of  ±1%  for  all  physicians  and  ±2%  for  the  subgroup  of  5599  primary  care  physicians.    For  details  on  both  sources,  see  the  October  2012  Wisconsin  Physician  Workforce  Report  (available  at  www.ahec.wisc.edu/workforce).  Population  totals  for  calculation  of  population  to  physician  ratios  are  based  on  the  2010  U.S.  Census.      Tables  1  and  2  provide  information  on  the  mix  of  primary  care  specialties  by  region  and  service  area  type  for  all  physicians  under  65  identified  as  primary  care  in  the  licensure  data,  including  those  who  work  as  hospitalists  or  in  urgent  care  or  residential  facility  settings  only,  and  those  with  administrative,  teaching  and  research  responsibilities.    Information  on  the  principal  practice  setting  for  these  primary  care  physicians  in  Chart  A  and  estimates  of  the  number  of  office-­‐based  primary  care  physicians  presented  in  Table  3  are  based  on  the  results  of  the  2011/2012  Wisconsin  Physician  Survey.        Tables  4,  5  and  6  are  based  on  the  estimates  of  office-­‐based  practice  presented  in  Table  3.    Information  on  hours  of  work  by  work  setting  from  the  2011/12  Wisconsin  Physician  Survey  (Tables  4  and  5)  informed  estimates  of  patient  care  hours  and  the  FTE  calculation  in  Tables  6    and  7.  The  estimated  population  to  primary  care  physician  ratios  in  Tables  6  and  7  include  only  physicians  based  in  Wisconsin.    Residents  of  several  border  areas  in  Wisconsin  may  use  physicians  in  neighboring  states  as  their  regular  source  of  care.    In  other  areas,  patients  may  travel  from  an  adjacent  state  to  see  physicians  in  Wisconsin.    The  net  effect  on  the  population  to  physician  ratio  will  vary  depending  on  local  circumstances  in  these  areas.    Table  8  provides  information  on  the  percentage  of  primary  care  physicians  who  completed  medical  school  in  Wisconsin  or  a  neighboring  state,  the  percentage  of  foreign  medical  graduates  practicing  in  an  area,  and  an  estimate  of  the  percentage  who  completed  their  residency  training  in  Wisconsin.  Table  9  provides  the  same  data  for  each  Health  Service  Area  and  totals  by  region.    This  information  may  be  of  interest  in  understanding  patterns  of  local  and  regional  primary  care  physician  recruitment.

Page 2: Primary Care Physicians-Distribution and Population to ......Wisconsin’AHEC’Health’Workforce’Data’Brief! primary!care! physicians! primary!care ! ! ! ! ! ! !!!!! Primary!care!physicians!!

 Wisconsin  AHEC  Health  Workforce  Data  Brief    

www.ahec.wisc.edu/workforce   -­‐2-­‐   June  2015  

Service  Area  Regions    For  convenience  in  summarizing  certain  kinds  of  data,  service  areas  are  grouped  into  17  regions  around  the  closest  source  of  tertiary  care.    With  the  exception  of  Rhinelander  in  northern  Wisconsin,  each  region  includes  a  city  of  greater  than  50,000,  or  is  adjacent  to  a  metro-­‐politan  area  in  a  neighboring  state  (Duluth,  Minneapolis,  Dubuque).  Note  that  each  region  may  include  metro,  urban  and  rural  service  areas.    Summary  data  by  region  may  obscure  significant  within-­‐region  variation.  

Service  Area  Urban  and  Rural  Types    The  service  areas  are  identified  by  type  using  data  on  urban  density  from  the  2010  U.S.  Census.  Urban  Area  (UA)  and  Urban  Cluster  (UC)  population  data  was  used  to  classify  the  service  areas  as  "Metro"  (>  50%  of  the  population  in  UAs),  "Urban"  (<50%  UA  but  >60%  in  UAs  or  UCs),  "Mixed"  (40%  to  60%  living  in  UAs  and  UCs),  and  "Rural  (  <40%  UA  and  UC  population).  Areas  with  high  numbers  of  health  professionals  engaged  in  administration,  research  and  teaching  are  identified  for  separate  analysis.  

For  documentation  and  maps,  see  Introduction  to  Wisconsin  Health  Service  Areas  at  www.ahec.wisc.edu/workforce    

Table  1.  Primary  Care  Physicians  by  Specialty,  by  Region       (Wisconsin-­‐based  physicians  under  age  65  as  of  1-­‐1-­‐2012,  excluding  trainees)  Region   Service  Area  

Population1    All  Primary  Care   Family  Medicine/  

General  Practice  General  Internal  Medicine  

General  Pediatrics  

Medicine-­‐Pediatrics  

Green  Bay    428,055    301    147  (48.8%)    108  (35.9%)    43  (14.3%)    3  (1.0%)   Sheboygan    196,867    116    64  (55.2%)    35  (30.2%)    17  (14.7%)    -­‐       Appleton    293,325    244    143  (58.6%)    60  (24.6%)    41  (16.8%)    -­‐       Oshkosh    162,242    109    65  (59.6%)    29  (26.6%)    13  (11.9%)    2  (1.8%)   Fond  du  Lac    172,043    108    68  (63.0%)    27  (25.0%)    11  (10.2%)    2  (1.9%)   Milwaukee    1,328,682    1,414    511  (36.1%)    581  (41.1%)    296  (20.9%)    26  (1.8%)   Waukesha    274,040    239    106  (44.4%)    68  (28.5%)    51  (21.3%)    14  (5.9%)   Southeast    469,599    234    126  (53.8%)    71  (30.3%)    37  (15.8%)    -­‐       Madison    667,420    813    383  (47.1%)    278  (34.2%)    145  (17.8%)    7  (0.9%)   Janesville    246,150    158    83  (52.5%)    48  (30.4%)    26  (16.5%)    1  (0.6%)   Southwest    66,166    24    24  (100%)    -­‐        -­‐        -­‐       La  Crosse    290,009    328    206  (62.8%)    88  (26.8%)    34  (10.4%)    -­‐       Eau  Claire    352,965    313    202  (64.5%)    74  (23.6%)    34  (10.9%)    3  (1.0%)   West  Central    174,159    115    99  (86.1%)    10  (8.7%)    5  (4.3%)    1  (0.9%)   Superior    69,465    42    32  (76.2%)    8  (19.0%)    2  (4.8%)    -­‐       Rhinelander    114,310    87    44  (50.6%)    35  (40.2%)    8  (9.2%)    -­‐       Wausau    381,489    413    169  (40.9%)    175  (42.4%)    64  (15.5%)    5  (1.2%)   Statewide  totals   5,686,986     5,058  2,472  (48.9%)    1,695  (33.5%)    827  (16.4%)    64  (1.3%)    

Table  2.  Primary  Care  Physicians  by  Specialty,  by  Service  Area  Type     (Wisconsin-­‐based  physicians  under  age  65  as  of  1-­‐1-­‐2012,  excluding  trainees)  Service  Area  Type   Service  Area  

Population1    All  Primary  Care   Family  Medicine/  

General  Practice  General  Internal  Medicine  

General  Pediatrics  

Medicine-­‐Pediatrics  

Type  1a:    Metro,  academic   647,023   932   301  (32.3%) 391  (42.0%) 229  (24.6%) 11  (1.2%) Type  1b:    Metro,  all  other   2,990,734   2760   1271  (46.1%) 967  (35.0%) 477  (17.3%) 45  (1.6%) Type  2:    Other  Urban   555,454   339   205  (60.5%) 95  (28.0%) 37  (10.9%) 2  (0.6%) Type  3a:    Mixed-­‐L,  Marshfield*   49,163   134   14  (10.4%)   89  (66.4%)   30  (22.4%)   1  (0.7%  Type  3b:  Mixed-­‐L,  hub>10,000   183,612     135   80  (59.3%) 40  929.6%) 15  (11.1%) (0%) Type  4:    Mixed-­‐M,  hub  <10,000   211,040     175   122  (69.7%) 38  (21.7%) 14  (8.0%) 1  (0.6%) Type  5:  Rural-­‐M,  hub  >2500   775,372     430   364  (84.7%) 46  (10.7%) 18  (4.2%) 2  (0.5%) Type  6:  Rural-­‐S,  hub  <  2500   274,588     153   11  (75.2%) 29  (19.0%) 7  (4.6%) 2  (1.3%) ALL  METRO  &  URBAN  (74%  of  pop)   4,193,211    4,031    1,777  (44.1%)    1,453  (36.0%)    743  (18.4%)    58  (1.4%)   ALL  MIXED  (8%  of  pop)   443,815    444      216  (49.6%)    167  (38.6%)    59  (13.3%)    2  (0.5%)   ALL  RURAL  (18%  of  pop)   1,049,960    583    479  (82.2%)    75  (13.9%)    25  (4.3%)    4  (0.7%)   STATEWIDE  TOTAL   5,686,986      5,058    2,472  (48.9%)    1,695  (33.5%)    827  (16.4%)  64  (1.3%)   *  Marshfield  is  a  special  case  among  the  more  rural  service  areas,  with  a  high  proportion  of  physicians  engaged  in  teaching,  research  and  administration  at  the  Marshfield  Clinic.      

Page 3: Primary Care Physicians-Distribution and Population to ......Wisconsin’AHEC’Health’Workforce’Data’Brief! primary!care! physicians! primary!care ! ! ! ! ! ! !!!!! Primary!care!physicians!!

 Wisconsin  AHEC  Health  Workforce  Data  Brief    

www.ahec.wisc.edu/workforce   -­‐3-­‐   June  2015  

Chart  A    

                                           Table  3.      Estimated  Number  of  Patient  Care  Primary  Care  Physicians,  by  Service  Area  Type       (Wisconsin-­‐based  physicians  under  age  65  as  of  1-­‐1-­‐2012,  excluding  trainees)  

Service  Area  Type    

Primary  care  physicians  

under  age  65  as  of  

1-­‐1-­‐2012  

Estimated  %  primary  care  

physicians  who  do  not  have  a  patient  practice  

Estimated  number  patient  care  primary  care  

physicians  under    age  65  

Estimated  %  primary  care  pt  care  physicians  who  do  not  have  an  office-­‐based  practice  

Est.  number  office-­‐based  primary  care  physicians  

under  age  65  

Academic*   1066   9.0%   970   34.8%   633  

Type  1:    Metro,  all  other   2760   7.1%   2564   23.5%   1961  

Type  2:    Other  Urban   339   5.3%   321   13.4%   278  

Type  3:    Mixed-­‐L,  hub  >  10,000   135   4.6%   129   30.8%   89  

Type  4:    Mixed-­‐M,  hub  <10,000   175   16.5%   146   10.7%   131  

Type  5:    Rural-­‐M,  hub  >2500     430   6.7%   401   10.6%   359  

Type  6:  Rural-­‐S,  hub  <  2500   153   14.5%   131   19.9%   105  

STATEWIDE   5058   7.8%   4662   23.8%   3555  *Includes  Marshfield,  a  Mixed  type  service  area  with  a  hub  city  >10,000  which  shares  many  of  the  characteristics  of  an  academic  hub.    Survey  response  rate  for  the  Marshfield  service  area  was  too  low  to  permit  estimation  of  this  data  for  Marshfield  alone,  but  the  pattern  can  be  presumed  to  be  similar  to  that  for  an  Academic  service  area      Primary  care  physicians  providing  care  available  to  the  general  public  are  supplemented  by  physicians  in  other  office-­‐based  specialties  who  report  providing  a  significant  amount  of  primary  care.    These  specialties  include  OB/Gyn  (26%  of  patient  care  time  providing  primary  care),  occupational  medicine  (38%  of  time  in  primary  care)  and  other  specialties  such  as  addiction  medicine,  pain  medicine,  sleep  medicine  and  sports  medicine  (25%  primary  care).    Subspecialists  in  medicine  and  pediatrics,  as  well  as  psychiatrists  and  other  specialties  also  report  some  primary  care  hours,  but  generally  no  more  than  10%.    Overall,  counting  the  office-­‐based  patient  care  hours  of  primary  care  physicians  (both  those  based  in  Wisconsin  and  those  from  neighboring  states  practicing  in  Wisconsin  on  a  regular  basis)  and  the  primary  care  hours  reported  by  subspecialty  physicians  provides  an  estimate  of  about  3800  FTE  physicians  providing  care  to  the  general  public  in  Wisconsin  in  2012,  or  an  effective  statewide  population  to  physician  ratio  of  about  1500:1.      However,  primary  care  physician  shortages  are  well  documented  in  rural  areas  and  in  central  city  Milwaukee,  Beloit,  Kenosha  and  several  other  cities.    As  of  July  2012,  the  Health  Resources  and  Services  Administration  (HRSA)  estimated  that  Wis  consin  needed  at  least  228  additional  primary  care  physicians  in  rural  and  urban  areas  where  shortages  had  been  documented,  in  order  to  reach  a  population  to  provider  ratio  of  2000:1  in  those  areas.      

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 Wisconsin  AHEC  Health  Workforce  Data  Brief    

www.ahec.wisc.edu/workforce   -­‐4-­‐   June  2015  

 Office-­‐based  primary  care  physicians  have  a  variety  of  other  patient  care  and  administrative  responsibilities.    Note  that  the  amount  of  time  these  physicians  spend  in  non-­‐office  based  settings  (see  Table  4,  below)  rises  for  those  in  small  communities,  reflecting  the  fact  that  they  are  the  only  specialists  available  to  fill  these  essential  roles.    Although  these  physicians  work  longer  hours  overall,  these  other  responsibilities  still  reduce  the  average  amount  of  time  each  physician  is  available  for  office-­‐based  primary  care  practice.    .  In  addition,  there  are  very  few  other  specialists  in  these  small  communities  who  may  be  providing  some  primary  care  for  their  patients.    Thus,  very  rural  areas  require  a  somewhat  higher  number  of  primary  care  physicians  relative  to  the  population  to  provide  access  equivalent  to  that  in  larger  communities  with  more  specialists.    Table  4.  Office-­‐Based  Patient  Care  Primary  Care  Physicians:    Hours  of  Work  in  various  Work  Settings    

Est.  number  office-­‐based  primary  care  physicians  

Total  average  hrs/wk

Office-­‐based  primary  care

Long-­‐term  care,  home  visits,  corrections

Inpatient  &  ER

Specialty  &  other  patient  care

Admin,  research,  teaching,  other  non-­‐patient  care

Service  Area  Type                Academic*   633  52.6  hrs 33.0  hrs 0.9  hrs 4.5  hrs 3.4  hrs 10.9  hrs Type  1:    Metro,  all  other   1961 50.6  hrs 38.4  hrs 1.0  hrs 3.9  hrs 2.7  hrs 4.5  hrs Type  2:    Other  Urban   278 52.5  hrs 38.4  hrs 1.0  hrs 7.0  hrs 2.3  hrs 3.9  hrs Type  3:    Mixed-­‐L,  hub  >  10,000   89 51.2  hrs 38.2  hrs 0.7  hrs 3.9  hrs 1.5  hrs 6.8  hrs Type  4:    Mixed-­‐M,  hub  <10,000   131 51.0  hrs 37.3  hrs 1.2  hrs 6.5  hrs 2.5  hrs 3.5  hrs Type  5:  Rural-­‐M,  hub  >2500     359 54.0  hrs 36.2  hrs 3.3  hrs 8.3  hrs 2.6  hrs 3.6  hrs Type  6:  Rural-­‐S,  hub  <  2500   105 57.3  hrs 34.9  hrs 1.1  hrs 15.7  hrs 1.0  hrs 4.6  hrs STATEWIDE  AVERAGE   3555 51.7  hrs 37.0  hrs 1.1  hrs 5.1  hrs 2.7  hrs 5.6  hrs *Includes  Marshfield,  a  Mixed  type  service  area  with  a  hub  city  >10,000  which  shares  many  of  the  characteristics  of  an  academic  hub.          Since  patterns  of  work  vary  considerably  by  service  area  type,  adjustment  factors  were  determined  for  each  service  area  type  in  order  to  estimate  the  effective  FTE  of  office-­‐based  care  for  physicians  under  age  65.    This  primary  care  patient  care  FTE  calculation  excludes  the  estimated  number  of  physicians  not  providing  any  patient  care,  along  with  those  who  work  only  in  hospital-­‐based  practice  (hospitalists),  emergency  room,  or  other  facility–based  practice  (nursing  homes,  prisons).    The  estimate  was  further  adjusted  for  the  patterns  of  time  spent  in  administration,  teaching  and  research  characteristic  of  each  service  area  type.        Table  5.    Number  of  primary  care  physicians  needed  to  produce  one  FTE  (40  hours/week)  of  office-­‐based  primary  care     (Wisconsin-­‐based  physicians  under  age  65  as  of  1-­‐1-­‐2012,  excluding  trainees)  

   

All  primary  care  physicians  under  age  65  as  of  1-­‐1-­‐2012  

Estimated  #  primary  care  physicians  with  office-­‐based  primary  care  practice  

Average  office-­‐based  primary  care  patient  care  hours  per  week    

Primary  care  physicians  per  40  hr  FTE  office-­‐based  primary  care  

Service  Area  Type          

Academic*   1066   633   33.0  hrs/wk   2.0  

Type  1:    Metro,  all  other   2760   1961   38.4  hrs/wk   1.5  

Type  2:    Other  Urban   339   278   38.4  hrs/wk   1.3  

Type  3:    Mixed-­‐L,  hub  >  10,000   135   89   38.2  hrs/wk   1.6  

Type  4:    Mixed-­‐M,  hub  <10,000   175   131   37.3  hrs/wk   1.4  

Type  5:  Rural-­‐M,  hub  >2500     430   359   36.2  hrs/wk   1.3  

Type  6:  Rural-­‐S,  hub  <  2500   153   105   34.9  hrs/wk   1.7  

STATEWIDE   5058   3555   37.0  hrs/wk   1.5  *Marshfield,  a  Mixed  type  service  area  with  a  hub  city  >10,000  which  shares  many  of  the  characteristics  of  an  academic  hub,  is  included  in  the  Academic  group  for  this  calculation.  

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 Wisconsin  AHEC  Health  Workforce  Data  Brief    

www.ahec.wisc.edu/workforce   -­‐5-­‐   June  2015  

Table  6.    Estimated  Population  to  Primary  Care  Physician  Ratio       (Wisconsin-­‐based  physicians  under  age  65  as  of  1-­‐1-­‐2012,  excluding  trainees)     Total  

Population  All  Primary  Care  

Physicians  Office-­‐Based  Patient  Care  Primary  Care  Physicians  Only  

40  hr/wk  Patient  Care  FTE  

Service  Area  Type          Type  1a:    Metro,  academic   647,017   694:1 1170:1 1416:1 Type  1b:    Metro,  all  other   2,990,740   1084:1 1525:1 1587:1 Type  2:    Other  Urban   555,454   1639:1 1998:1 2080:1 Type  3a:    Mixed-­‐L  Marshfield*   49,163   367:1   618:1   748:1  Type  3b:  Mixed-­‐L**,  hub  >  10,000   183,612   1360:1 2059:1 2150:1 Type  4:    Mixed-­‐M,  hub  <10,000   211,040     1206:1 1617:1 1735:1 Type  5:  Rural-­‐M,  hub  >2500     775,372     1803:1 2161:1 2391:1 Type  6:  Rural-­‐S,  hub  <  2500   274,588     1795:1 2622:1 3005:1 ALL  METRO  &  URBAN  (74%  of  pop)   4,193,211   1040:1 1502:1 1607:1 ALL  MIXED  (8%  of  pop)   443,815   1000:1 1483:1 1627:1 ALL  RURAL  (18%  of  pop)   1,049,960   1801:1 2265:1 2526:1 STATEWIDE  TOTAL   5,686,986     1124:1 1600:1 1725:1 *Marshfield  is  a  special  case  among  rural  service  areas,  with  a  high  proportion  of  physicians  engaged  in  teaching,  research  and  administration  at  the  Marshfield  Clinic.    It  is  also  possible  that  the  licensure  record  does  not  reflect  subspecialty  practice  for  some  Marshfield  Clinic  physicians  in  internal  medicine  and  pediatrics,  resulting  in  their  being  counted  as  primary  care;  or  that  some  of  their  patient  care  time  is  in  other  service  areas  in  the  region.    It  is  not  possible  to  determine  this  from  the  licensure  record  alone.    The  pattern  for  academic  service  areas  (Tables  4,  5  and  6)  was  used  to  estimate  the  population  to  primary  care  physician  ratio  for  Marshfield.    **Note  that  the  Mixed,  hub  >10,000  group  includes  the  Platteville  service  area,  an  area  with  a  relatively  high  population  to  primary  care  physician  ratio  (3769:1).    This  area  is  served  in  part  by  physicians  in  Dubuque  IA  who  are  not  included  in  the  ratio.    The  ratios  for  the  other  Type  3  service  areas    (Menomonie,  Marinette  and  Portage  are  more    similar  to  the  ratio  for  Type  2  and  Type  4  service  areas  .    The  population  to  provider  ratios  in  other    border  areas  do  not  take  into  account  activity  that  crosses  state  borders:  physicians  residing  in  other  states  who  practice  in  Wisconsin  on  a  regular  basis,  and  patients  whose  primary  care  physician  is  located  in  another  state.  Ratios  for  these  service  areas  could  be  higher  or  lower  depending  upon  the  local  circumstances.    All  primary  care  physicians           FTE  Office-­‐Based  Patient  Care  only  standardized  to  40  hr/wk=1  FTE  

                                                       

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 Wisconsin  AHEC  Health  Workforce  Data  Brief    

www.ahec.wisc.edu/workforce   -­‐6-­‐   June  2015  

 Table  7.    Estimated  Population  to  Primary  Care  Physician  Ratio,  by  region         (Wisconsin-­‐based  physicians  under  age  65  as  of  1-­‐1-­‐2012,  excluding  trainees)     Total  

Population  All  Primary  Care  

Physicians  Office-­‐Based  Patient  Care  Primary  Care  Physicians  Only  

40  hr/wk  Patient  Care  FTE  

Green  Bay   428,055 1422:1   1938:1   2044:1  Sheboygan   196,867 1697:1   2259:1   2362:1  Appleton   293,325 1202:1   1672:1   1748:1  Oshkosh   162,242 1488:1   2002:1   2131:1  Fond  du  Lac   172,043 1593:1   2084:1   2189:1  Milwaukee   1,328,682 940:1   1384:1   1490:1  Waukesha   274,040 1147:1   1591:1   1656:1  Southeast   469,599 2007:1   2695:1   2804:1  Madison   667,420 821:1   1269:1   1459:1  Janesville   246,150 1558:1   2118:1   2206:1  Southwest   66,166 2757:1   3460:1   3856:1  La  Crosse   290,009 884:1   1185:1   1259:1  Eau  Claire   352,965 1128:1   1558:1   1659:1  West  Central   174,159 1514:1   2004:1   2181:1  Superior   69,465 1654:1   2086:1   2264:1  Rhinelander   114,310 1314:1   1846:1   2069:1  Wausau   381,489 924:1   1330:1   1457:1  Statewide  totals   5,686,986   1124:1   1600:1   1725:1    Information  available  for  all  physicians  in  the  Wisconsin  licensure  data  includes  medical  school  location  and  date  of  initial  licensure  in  Wisconsin.    When  broken  down  by  service  area  type  and  region,  this  provides  insight  into  patterns  of  physician  recruitment  in  different  areas  of  the  state.    Newly  graduated  physicians  must  complete  one  year  of  post-­‐graduate  training  in  order  to  be  eligible  for  a  license  in  Wisconsin.    Residency  training  programs  (also  know  as  graduate  medical  education,  or  GME)  generally  require  their  trainees  to  obtain  the  license  in  their  second  post-­‐graduate  year.    Thus,  the  license  granted  data  relative  to  a  physician’s  MD  granted  date  provides  an  estimate  of  physicians  currently  practicing  in  Wisconsin  who  completed  the  first  three  years  of  their  post-­‐graduate  training  in  the  state.    Table  8.  All  Primary  Care  Physicians:    Medical  School  and  Date  of  First  Licensure  in  Wisconsin    (Physicians  under  age  65  as  of  1-­‐1-­‐2012)       Medical  school  location   When  WI  license  issued              

Primary  Care  Physicians  under  age  65  as  of    1-­‐1-­‐2012  

UW  &  MCW  

graduates

MN,  IA,  IL,  MI  

graduates

US  citizen  graduates  of  offshore  medical  schools  

(USFMGs)

International  Medical  

Graduates  (IMGs)

<  3    yrs  after  degree:   Likely  to  have  

completed  PG1-­‐3  in  WI

3-­‐10  years  after  degree  

>10  years  after  degree  

Service  Area  Type                  Type  1a:    Metro,  academic   932   33% 20% 1% 15% 48% 40% 11% Type  1b:    Metro,  all  other   2,760   34% 25% 3% 19% 47% 40% 12% Type  2:    Other  Urban   339   32% 28% 4% 11% 51% 40% 9% Type  3:    Mixed-­‐L,  hub  >  10,000*   269   17% 21% 2% 33% 30% 55% 15% Type  4:    Mixed-­‐M,  hub  <10,000   175   33% 34% 2% 10% 55% 35% 10% Type  5:    Rural-­‐M,  hub  >2500     430   28% 34% 2% 11% 47% 41% 11% Type  6:    Rural-­‐S,  hub  <  2500   153   29% 31% 3% 8% 44% 41% 13% ALL  METRO  &  URBAN   4,031   33% 24% 3% 18% 48% 40% 11% ALL  MIXED   444   24% 26% 2% 24% 40% 47% 13% ALL  RURAL   583   28% 34% 2% 10% 46% 41% 11% STATEWIDE  TOTAL-­‐  PRIMARY  CARE  

 5,058   32% 25% 3% 17% 47% 41% 12%

STATEWIDE  TOTAL-­‐  ALL  PHYSICIANS  

 14,722   31% 25% 2% 16% 37% 46% 16%

*Note  that  service  area  type  3  (Mixed,  hub  >10,000)  includes  Marshfield,  which  shares  many  of  the  workforce  characteristics  of  an  academic  hub.      

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 Wisconsin  AHEC  Health  Workforce  Data  Brief    

www.ahec.wisc.edu/workforce   -­‐7-­‐   June  2015  

 

Table  9.  Individual  Service  Area  Data:    Primary  Care  Physicians  by  Discipline  (Physicians  under  age  65  as  of  1-­‐1-­‐2012)       Medical  school  location   When  WI  license  issued  

 

Primary  Care  Physicians  under  age  65  

UW  &  MCW  

graduates

MN,  IA,  IL,  MI  

graduates

US  citizen  graduates  of  

offshore  medical  schools  (USFMGs)

International  Medical  Graduates  (IMGs)

<  3    yrs  after  degree:  

Likely  to  have  completed  PG1-­‐3  in  WI

3-­‐10  years  after  degree  

>10  years  after  degree  

  GREEN  BAY  REGION 301   35% 23% 2% 21% 38% 49% 13% 1   Green  Bay    148   43% 22% 1% 18% 41% 50% 9% 2   De  Pere-­‐Hobart  47   32% 28% 2% 23% 26% 57% 15% 3   Pulaski    3   33% 0% 0% 67% 33% 0% 0% 4   Shawano    22   41% 18% 0% 14% 55% 41% 5% 5   Keshena/Menominee    2   0% 0% 0% 0% 50% 50% 0% 6   Oconto    4   0% 25% 25% 25% 75% 0% 25% 7   Oconto  Falls    5   20% 40% 0% 40% 40% 20% 40% 8   Marinette    30   13% 17% 3% 40% 20% 60% 20% 9   Sturgeon  Bay    17   12% 59% 6% 24% 53% 29% 18% 10   Kewaunee    7   71% 0% 0% 0% 57% 14% 29% 11   Two  Rivers    16   38% 13% 0% 13% 25% 56% 19%   SHEBOYGAN  REGION 116   40% 25% 4% 11% 48% 46% 5% 12   Sheboygan    74   42% 24% 4% 14% 50% 45% 5% 13   Manitowoc    34   32% 24% 6% 9% 38% 56% 6% 14   Chilton    8   50% 38% 0% 0% 75% 13% 0%   APPLETON  REGION 244 34% 26% 2% 13% 52% 40% 8% 15   Appleton    140   37% 24% 1% 16% 51% 42% 7% 16   Kaukauna    24   29% 38% 0% 4% 79% 17% 4% 17   Neenah    63   27% 27% 3% 11% 46% 46% 8% 18   New  London    13   46% 31% 0% 8% 54% 23% 23% 19   Seymour    4   25% 25% 0% 0% 50% 50% 0%   OSHKOSH  REGION 109   39% 28% 0% 16% 41% 40% 17% 20   Oshkosh    74   34% 28% 0% 20% 32% 43% 22% 21   Waupaca    20   50% 25% 0% 10% 70% 25% 5% 22   Berlin    10   40% 40% 0% 0% 50% 50% 0% 23   Wautoma-­‐Wild  Rose  5   80% 20% 0% 0% 40% 40% 20%   FOND  DU  LAC  REGION 108   28% 25% 1% 14% 40% 43% 17% 24   Fond  du  Lac    57   28% 32% 2% 11% 37% 44% 19% 25   Waupun    6   17% 0% 0% 33% 50% 33% 17% 26   Beaver  Dam    30   33% 20% 0% 13% 50% 33% 13% 27   Ripon    15   20% 20% 0% 20% 27% 60% 13%   MILWAUKEE  REGION 1414 34% 20% 4% 25% 49% 38% 12% 28   Milwaukee  -­‐  downtown,  

north  &  northwest    114   26% 23% 3% 28% 41% 49% 8% 29   Milwaukee/West  Allis  -­‐

central  south  of  I-­‐94  109   33% 17% 4% 27% 50% 35% 15% 30   Milwaukee-­‐Greenfield,  

Franklin  &  south  suburbs  180   28% 20% 6% 34% 53% 34% 13% 31   Milwaukee-­‐Wauwatosa    201   34% 16% 2% 26% 46% 44% 9% 32   Milwaukee-­‐Shorewood,  

Brown  Deer,  Glendale  167   43% 28% 1% 13% 49% 39% 11% 33   Milwaukee-­‐Whitefish  By,  

Fox  Pt,  Bayside,  Rvr  Hills  68   34% 16% 3% 15% 46% 31% 21% 34   Brookfield    259   29% 17% 4% 38% 41% 44% 15% 35   Menomonee  Falls    117   43% 18% 5% 17% 64% 30% 5% 36   Mequon    106   34% 24% 4% 16% 55% 31% 13% 37   Grafton    27   44% 22% 7% 7% 56% 41% 0% 38   West  Bend    52   42% 23% 8% 15% 67% 27% 4% 39   Hartford    14   43% 7% 7% 21% 50% 43% 7%

   

Page 8: Primary Care Physicians-Distribution and Population to ......Wisconsin’AHEC’Health’Workforce’Data’Brief! primary!care! physicians! primary!care ! ! ! ! ! ! !!!!! Primary!care!physicians!!

 Wisconsin  AHEC  Health  Workforce  Data  Brief    

www.ahec.wisc.edu/workforce   -­‐8-­‐   June  2015  

    Medical  school  location   When  WI  license  issued  

 

Primary  Care  Physicians  under  age  65  

UW  &  MCW  graduates

MN,  IA,  IL,  MI  

graduates

US  citizen  graduates  of  

offshore  medical  schools  (USFMGs)

International  Medical  

Graduates  (IMGs)

<  3    yrs  after  degree:  

Likely  to  have  completed  PG1-­‐3  in  WI

3-­‐10  years  after  degree  

>10  years  after  degree  

  WAUKESHA  REGION  239 45% 24% 3% 8% 55% 36% 8% 40   Waukesha    131   47% 21% 2% 11% 53% 38% 8% 41   Oconomowoc    61   43% 25% 5% 10% 52% 38% 10% 42   Delafield-­‐Summit  25   48% 28% 4% 0% 72% 20% 8% 43   Watertown    22   41% 32% 5% 0% 59% 41% 0%   SOUTHEAST  WI  REGION 234   26% 30% 6% 21% 43% 47% 10% 44   Racine    79   23% 37% 4% 14% 35% 57% 8% 45   Kenosha    82   21% 26% 7% 33% 37% 49% 13% 46   Burlington    18   39% 28% 11% 6% 67% 22% 11% 47   Elkhorn    31   42% 32% 0% 13% 61% 29% 6% 48   Lake  Geneva    24   25% 25% 13% 25% 46% 46% 8%   MADISON  REGION 813   35% 23% 1% 7% 51% 38% 10% 49   Madison    549   34% 21% 1% 8% 50% 38% 11% 50   Cottage  Grove  10   30% 40% 0% 0% 70% 30% 0% 51   De  Forest  9   44% 33% 0% 0% 67% 11% 11% 52   Sun  Prairie  29   48% 34% 0% 0% 28% 72% 0% 53   Verona  38   34% 26% 3% 11% 42% 39% 18% 54   Waunakee  8   50% 13% 0% 0% 63% 38% 0% 55   Cross  Plains-­‐Arena  7   57% 43% 0% 0% 57% 29% 14% 56   Oregon    19   42% 26% 0% 0% 79% 16% 5% 57   Stoughton    13   46% 23% 0% 15% 46% 31% 23% 58   Portage    21   19% 29% 0% 19% 29% 52% 19% 59   Mt.  Horeb    7   29% 14% 0% 0% 71% 29% 0% 60   Dodgeville    17   29% 29% 6% 0% 76% 24% 0% 61   Baraboo    25   36% 32% 0% 0% 56% 40% 4% 62   Wis  Dells-­‐Lake  Delton  8   13% 13% 0% 13% 50% 25% 25% 63   Sauk  City-­‐Prairie  du  Sac  26   42% 31% 8% 0% 65% 35% 0% 64   Reedsburg    13   62% 38% 0% 0% 69% 23% 8% 65   New  Glarus    6   0% 33% 0% 0% 17% 67% 17% 66   Columbus    8   50% 25% 0% 13% 38% 50% 13%   JANESVILLE  REGION 158   25% 23% 10% 18% 45% 39% 15% 67   Janesville  59   22% 17% 12% 15% 41% 37% 20% 68   Edgerton    9   11% 11% 33% 22% 56% 22% 22% 69   Fort  Atkinson    36   36% 33% 3% 8% 67% 33% 0% 70   Monroe    20   20% 25% 0% 25% 30% 60% 10% 71   Beloit    34   24% 24% 15% 29% 35% 41% 21%   SOUTHWEST  WI  REGION 24   29% 21% 4% 0% 54% 38% 8% 72   Platteville    8   38% 13% 13% 0% 50% 50% 0% 73   Lancaster  5   40% 0% 0% 0% 40% 60% 0% 74   Darlington    6   33% 17% 0% 0% 83% 0% 17% 75   Boscobel    5   0% 60% 0% 0% 40% 40% 20%   LA  CROSSE  REGION  325 33% 35% 2% 8% 52% 38% 10% 76   La  Crosse    174   31% 33% 2% 10% 53% 32% 14% 77   Onalaska    40   50% 38% 0% 5% 50% 45% 5% 78   Mauston    18   50% 33% 0% 0% 50% 44% 6% 79   Viroqua    18   22% 61% 0% 0% 39% 61% 0% 80   Tomah    16   25% 31% 6% 19% 25% 50% 25% 81   Sparta    11   45% 36% 0% 0% 82% 18% 0% 82   Black  River  Falls    19   16% 16% 5% 5% 42% 58% 0% 83   Richland  Center    14   29% 36% 7% 0% 64% 36% 0% 84   Prairie  du  Chien    12   33% 42% 0% 8% 67% 17% 17% 85   Hillsboro    3   0% 67% 0% 0% 33% 67% 0% 86   Arcadia      3   67% 0% 0% 0% 33% 33% 33% 87   Alma   0       na na na na na na na

Page 9: Primary Care Physicians-Distribution and Population to ......Wisconsin’AHEC’Health’Workforce’Data’Brief! primary!care! physicians! primary!care ! ! ! ! ! ! !!!!! Primary!care!physicians!!

 Wisconsin  AHEC  Health  Workforce  Data  Brief    

www.ahec.wisc.edu/workforce   -­‐9-­‐   June  2015  

    Medical  school  location   When  WI  license  issued  

 

Primary  Care  Physicians  under  age  65  

Number  of  UW  &  MCW  

graduates

Number  of    MN,  IA,  IL,  

MI  graduates

US  citizen  graduates  of  

offshore  medical  schools  (USFMGs)

Number  of  International  

Medical  Graduates  (IMGs)

<  3    yrs  after  degree:  

Likely  to  have  completed  PG1-­‐3  in  WI

3-­‐10  years  after  degree  

>10  years  after  degree  

  EAU  CLAIRE  REGION  313 21% 36% 2% 17% 42% 44% 13% 88   Eau  Claire    131   20% 27% 4% 27% 36% 44% 20% 89   Chippewa  Falls    39   23% 38% 3% 10% 62% 33% 5% 90   Bloomer    8   50% 0% 0% 13% 25% 63% 13% 91   Stanley    5   0% 40% 0% 40% 40% 60% 0% 92   Menomonie    22   14% 59% 0% 5% 50% 50% 0% 93   Barron    10   20% 50% 0% 0% 40% 40% 20% 94   Rice  Lake    33   30% 45% 0% 15% 39% 45% 15% 95   Cornell    2   50% 0% 0% 0% 100% 0% 0% 96   Ladysmith      13     31% 38% 0% 15% 54% 46% 0% 97   Cumberland      6     33% 50% 0% 0% 50% 33% 17% 98   Durand      3     33% 33% 0% 0% 33% 67% 0% 99   Whitehall      2     0% 0% 0% 50% 0% 50% 50% 100   Osseo    9     33% 33% 0% 0% 67% 22% 11% 101   Shell  Lake      3     0% 33% 0% 33% 33% 67% 0% 102   Spooner      13     0% 62% 0% 0% 31% 54% 0% 103   Hayward      14     14% 43% 0% 7% 29% 57% 7%   WEST  CENTRAL  REGION   115     18% 54% 2% 3% 43% 45% 12% 104   Hudson        28     18% 39% 0% 4% 43% 46% 11% 105   River  Falls      15     20% 67% 0% 0% 33% 67% 0% 106   Baldwin      8     0% 75% 0% 13% 25% 50% 25% 107   New  Richmond      14     50% 36% 0% 0% 57% 29% 14% 108   Prescott      4     0% 100% 0% 0% 50% 25% 25% 109   Osceola      9     0% 78% 0% 11% 22% 56% 22% 110   St.  Croix  Falls      21     10% 52% 10% 5% 33% 57% 10% 111   Amery      11     27% 55% 0% 0% 82% 9% 9% 112   Grantsburg      5     20% 40% 0% 0% 40% 40% 20% 113   Bay  City     0       na   na na na na na na   SUPERIOR  WI  REGION   42     10% 52% 0% 10% 48% 38% 12% 114   Superior      14     7% 43% 0% 21% 36% 50% 14% 115   Ashland      28     11% 57% 0% 4% 54% 32% 11%   RHINELANDER  REGION   87     34% 22% 2% 17% 48% 34% 14% 116   Rhinelander      24     17% 21% 0% 29% 42% 46% 8% 117   Tomahawk      6     17% 33% 0% 17% 67% 33% 0% 118   Park  Falls      8     25% 25% 0% 38% 25% 38% 25% 119   Phillips      4     100% 0% 0% 0% 75% 25% 0% 120   Eagle  River      8     25% 50% 0% 0% 38% 25% 38% 121   Woodruff  &  Minocqua      28     50% 14% 7% 11% 54% 29% 18% 122   Crandon      4     50% 25% 0% 25% 0% 75% 0% 123   Alvin/Tipler/Long  Lake     0       na   na na na na na na 124   Florence/Niagara      3     33% 33% 0% 0% 100% 0% 0% 125   Hurley/Mercer      2     0% 0% 0% 0% 100% 0% 0%   WAUSAU  REGION   413     23% 21% 3% 30% 36% 48% 16% 126   Wausau      76     36% 29% 4% 12% 47% 38% 14% 127   Weston      50     20% 24% 4% 36% 36% 44% 20% 128   Antigo      13     31% 38% 0% 23% 31% 54% 15% 129   Merrill      20     20% 25% 5% 15% 55% 35% 10% 130   Medford      23     26% 13% 4% 30% 35% 43% 22% 131   Neillsville      9     11% 33% 11% 22% 44% 56% 0% 132   Marshfield*      134     18% 11% 1% 47% 25% 58% 16% 133   Stevens  Point      50     26% 22% 4% 22% 36% 48% 16% 134   Wisconsin  Rapids      35     20% 23% 6% 17% 37% 43% 20% 135   Adams  -­‐Friendship    3     33% 33% 0% 33% 33% 33% 33%   STATEWIDE  TOTALS   5,058     32% 25% 3% 17% 47% 41% 12%