THE FUTURE OF THE PHYSICIAN WORKFORCE

IN WISCONSIN

DEMAND FACTORS: Influencing Physician Supply

Increased Population Aging population Increased utilization of Medical

Services Advances in medical technology

SUPPLY FACTORS: Influencing physician supply

Production of physicians has been stable (flat) for two decades

Aging of the physician workforce—particularly the primary care segment

Change in physician work/lifestyle preferences

Increasing specialization in medical practice

US Response to Predictions of Physician Shortage

Increase the supply of physicians– Increased enrollment in existing medical schools– New medical schools: allopathic and osteopathic

Increase the supply and utilization of other independent professionals: e.g., advanced practice nurses

Encourage more efficient use of existing resources

Reengineer health care systems to substitute the use of non-professionals where appropriate

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2004 Joint WHA/WMS Task Force on Physician Supply

Physician Workforce in Wisconsin(WCMEW)

Projected shortfalls in physician supply particularly in rural and urban underserved areas.

Shortfall: 2020– Physicians overall: 20%– Primary Care physicians: 28%

Shortfall: 2030– Physicians overall: 44%– Primary Care Physicians: 57%

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What is WCMEW?

Wisconsin Council on Medical Education and Workforce

• 2004 WHA Task Force Recommendation: “Develop an infrastructure to guide medical education policy”

• Membership– WHA and WMS– UW and MCW Med Schools– WAFM and WAPA

• Acts as a forum, convener and voice for WI workforce issues

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2008 WCMEW Report

Progress Towards 2004 Goals• Develop an infrastructure to guide medical

education policy– WHA, WMS, med schools established Wisconsin

Council on Medical Education and Workforce

• Recruit, enroll and train in Wisconsin individuals likely to practice in Wisconsin– UW established WARM

• Encourage physicians to relocate to Wisconsin– WCMEW created WisconsinPhysicianCareers.org

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2008 WCMEW Report

Progress Towards 2004 Goals

• Develop care delivery models that leverage physician resources– WCMEW survey of medical groups on APPs

• Provide adequate and targeted funding for medical education– WCMEW advocated for increased Medicaid GME

funding

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2008 WCMEW Report

2008 Workforce Environment

• Shortage of Primary Care Physicians in Rural and Inner City– Expert opinion

– Physician recruitment trends

– WMS CMO survey

– WCMEW web site shows 94 family medicine, 6 pediatrician, and 24 internist open positions in rural towns

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2008 WCMEW Report

2008 Workforce Environment

• WMS Physician Workforce Survey– High level of dissatisfaction with practice environment, hours, or

incomes.

– About one-fourth either planning on or considering retirement or relocating – either inside our outside of Wisconsin. 46% are at least considering reducing clinical hours.

– 42% modify the way they practice medicine based on fear of being sued.

– 35% of physicians indicating wait times have increased over the past three years. 50% of primary care physicians report increased wait time for referring to a specialist.

– Greatest concerns are over income security, the malpractice environment, and administrative burden.

13

2008 WCMEW Report

2008 Workforce Environment• Medical Education in Wisconsin

– UW and MCW graduate 336 physicians per year.

– 38% stay and practice in Wisconsin.

– WARM increases UW grads by 25.

– Decreasing number of graduates choosing primary care.

– 127 accredited residency programs involving 26 specialties and 1,632 positions.

– Almost all residency positions filled – lowest percentage in family medicine at 81% (also fewer positions than in 2002).

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2008 WCMEW ReportWisconsin Future Physician Supply

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Current Physician

Supply

Add Medical School

Grads Who Stay in WI

Add In-Migration of Practicing Physicians

Subtract Physicians

Leaving Practice or

Dying

Factor in Lifestyle Changes

Subtract Physicians

Leaving Wisconsin

Projected Physician

Supply

Wisconsin Future Physician Supply – Surplus or Shortfall

2008 WCMEW Report

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Projection Year Increase in

DemandIncrease in Supply

Surplus or (Shortfall)

2020 Base Estimate 13% 13% 0%

2020 High Estimate 33% 13% (20%)

2030 Base Estimate 22% 21% (1%)

2030 High Estimate 65% 21% (44%)

Wisconsin’s Future Needs – Primary Care

2008 WCMEW Report

16

Wisconsin’s Future Needs – Primary Care

2008 WCMEW Report

17

Projection Year Increase in

DemandIncrease in

SupplySurplus or (Shortfall)

2020 Base Estimate 13% 5% (8%)

2020 High Estimate 33% 5% (28%)

2030 Base Estimate 22% 8% (14%)

2030 High Estimate 65% 8% (57%)

Wisconsin’s Future Needs – Changes in Care Delivery

2008 WCMEW Report

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• Hospitalists– 15,000 nationwide, growing to 30,000 by 2010 (25 openings on web

site).

– Helps physician retention, enhances quality of care.

• Advanced Practice Providers– Increasingly important in care delivery.

– APPs have raised requirements for training and credentialing.

• Medical Home Model– Comprehensive, coordinated care centered on patients needs.

– Need for primary physicians would increase; need for specialists would decrease.

Recommendations For Wisconsin

Increase enrollment in Wisconsin Medical Schools to encourage careers in primary care in underserved areas. (WARM, TRIUMPH)

Increase enrollment in programs training Advanced Practice Providers

Increase opportunities for post-graduate medical education (residencies) in Wisconsin

Assure appropriate reimbursement for physician/APP services in rural and urban underserved areas.