The State of the Physician Workforce - AAMC · Primary Care Specialties Non-Primary Care Medical...

The State of the Physician Workforce

Michael J. Dill

Director, Workforce Studies, AAMC

November 3, 2018

• Da’Shia Davis, BS

• Kara Fisher, MPH

• Sarah Hampton, BA

• Xiaochu Hu, PhD

• Karen Jones, MApStat

• Scott Shipman, MD, MPH

• Preeti Iyer, BSE

• Camille Moeckel

• Michelle Ogunwole, MD

• Laura Ostapenko, MD, MPP

The AAMC Workforce Studies Team

The State of the Physician Workforce

Projections

Trends

Diversity

People Who Need Care

Overview

How it all fits together

Projections

Trends

Diversity

People Who Need Care

Will we meet our need?

Pipeline growth & limits

Workforce changes

Pipeline growth & limits

Workforce changes

Access growth & limits

Population changes

Projections

Projections

The State of the Physician Workforce

Projections inform policy, and updates inform projections

For the fourth time,

projections show

shortages of

physicians in both

primary and

specialty care, with

a large shortage

among critical

surgical specialties.

Projections based on key trends, current utilization, most likely scenarios

• Begin with 2016 “level of care” as status quo

• Key trends modeled as supply and demand scenarios

• Focus on most likely 25th-75th percentiles of paired projections

We model multiple scenarios

Supply scenarios Demand scenarios

Status quo Status quo

Work hours Managed care

GME Retail clinics

Retirement – earlier APRNs/PAs – moderate

Retirement - later APRNs/PAs - high

Population health

We look at all possible pairings of scenarios

700,000

750,000

800,000

850,000

900,000

950,000

1,000,000

2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030

Demand (Status Quo)

Demand (Managed Care)

Demand (Retail Clinics)

Demand (APRN/PA High)

Demand (APRN/PA Moderate)

Demand (Population Health)

Supply (Declining Hours)

Supply (GME Expansion)

Supply (Retire 2 Years Earlier)

Supply (Retire 2 Years Later)

Supply (Status Quo)

Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.

Growing shortage of physicians projected from 2015 to 2030

42,600

121,300

-50,000

0

50,000

100,000

150,000

200,000

2016 2030

Projected Physician Shortfall Range, 2015-2030

2030Range

Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.

The size and range of projected physician shortages varies by specialty group

14,800

33,800

-700

20,700

20,300

49,300

72,700

9,600

30,500

31,800

Primary Care Specialties

Non-Primary Care

Medical Specialties

Surgical Specialties

Other Specialties

Projected physician specialty group shortfall ranges, 2030

Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.

Projections - Summary

• Most recent report consistent with past• Shortages

• Surgical specialties

Trends

Trends

The State of the Physician Workforce

Trends

• UME

We have 26 27 new medical schools since 2006

Central Michigan

UC Riverside

Western Michigan

Cooper Rowan

South Carolina

Greenville

Quinnipiac-Netter

Florida Atlantic-

Schmidt

Arizona Phoenix

California Northstate

University

Oakland Beaumont

Hofstra

Northwell

Geisinger

Commonwealth

Virginia Tech

Carilion

Texas Tech-Foster

Central Florida

FIU-Wertheim

San Juan Bautista

(Puerto Rico)

Dell Medical School

at UT-Austin

College of

Henricopolis

Roseman University

of Health Sciences

Seton Hall-

Hackensack

UT-Rio Grande

Valley

Applicant or

Candidate

School

Preliminarily

Accredited

Provisionally

Accredited

Fully

Accredited

University of

Nevada, Las Vegas

CUNY

CA University of

Science and

Medicine

TCU and UNTHSC

WA State University

Kaiser Permanente

Nova

Southeastern

Carle Illinois

New York– Long Island

US MD enrollment expected to exceed 30% increase

Source: Results of the 2017 AAMC Medical School Enrollment Survey

0

5,000

10,000

15,000

20,000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Original schools

(n=125)

All Schools (n=149)

Actual Enrollment Survey data Projections

30% over 2002

Medical schools’ concern about clinical training opportunities for their students continues to grow

73%77%

54%

85%89%

67%

0%

20%

40%

60%

80%

100%

Number of clinical training sites Supply of qualified primary care preceptors Supply of qualified specialty preceptors

Pe

rce

nta

ge o

f sc

ho

ols

co

nce

rne

d a

bo

ut

clin

ical

tra

inin

g o

pp

ort

un

itie

s

2010 2017

Source: AAMC 2017 Medical School Enrollment Survey Report

Pressure from sites regarding payment for student rotations on the rise

32%

46%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Pressure from existing clinical training sites regarding payment(s) for student rotations

Perc

enta

ge o

f sc

ho

ols

exp

erie

nci

ng

dif

ficu

ltie

s w

ith

exi

stin

g cl

inic

al t

rain

ing

site

s

Source: AAMC 2017 Medical School Enrollment Survey Report

2009 2017

Turnover and difficulties with replacement of physician volunteers are growing problems

11%

17%

19%

24%

0%

5%

10%

15%

20%

25%

30%

High turnover among volunteer physicians Difficulty in replacing retired physician volunteers

Perc

enta

ge o

f sc

ho

ols

exp

erie

nci

ng

dif

ficu

ltie

s w

ith

ex

isti

ng

clin

ical

tra

inin

g si

tes

Source: AAMC 2017 Medical School Enrollment Survey Report

2009 2017 2009 2017

Overall MD & DO first year enrollment is projected to grow 59% between 2002 and 2021

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Firs

t ye

ar e

nro

llmen

t

Projected MD and DO first year enrollment through 2021

DO - 196%

MD - 35%

Source: AAMC 2016 Medical School Enrollment Survey Report

30 new DO programs, including remote sites and branch campuses

PAs & NPs are growing their pipelines rapidly

2007 2008 2016

PA programs 134 209

PA enrollment 10,920 21,585

DNP programs 53 313

DNP enrollment 3,415 25,289

Source: PAEA Program Reports; AACN Correspondence.

Competition, especially from DO, NP & PA programs, rising rapidly

26%24% 24%

54%

31%

58%

0%

10%

20%

30%

40%

50%

60%

70%

Competition from osteopathic medicalschools for clinical training sites

Competition from offshore medicalschools for clinical training sites

Competition from other health careprofessionals (e.g., NPs, PAs)

Perc

enta

ge o

f sc

ho

ols

exp

erie

nci

ng

dif

ficu

ltie

s w

ith

ex

isti

ng

clin

ical

tra

inin

g si

tes

Source: AAMC 2017 Medical School Enrollment Survey Report

2009 2017 2009 2017 2009 2017

The Economics of Supply and Demand for Year 3 and 4 Clinical Clerkships

• Create an understanding of current situation

• Highlight contributing factors

• Focus on challenges and options moving forward with innovative solutions

• Hilton: Austin Grand Salon FG

• Today: 3:15-4:30 pm

• Anne Barnes

• Raymond Curry

• Tim Johnson

Trends

• GME

Medical schools concerned about students’ ability to find a residency training position

2012 2012 20122013 2013 20132014 2014 20142015 2015 20152016 2016 20162017 2017 20170%

25%

50%

75%

100%

For my incoming students In my state Nationally

Percent of schools reporting major or moderate concern

Source: AAMC 2017 Medical School Enrollment Survey Report

Residents entering pipeline rising, but slowly

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Residents entering ACGME

+ 1.2% per year

Sources: ACGME Data Resource Books.

+ 3.4% per year

Recent growth in DO residents and fellows may reflect shift to a single GME accreditation system

Source: ACGME Data Resource Books.

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Residents entering ACGME pipeline by school type

USMD

IMG

DO

Average annual growth rate

2005-2015 2015-2017

USMD 1% 2%

IMG 0% 3%

DO 5% 14%

Trends

• GME Retention

11 years after

residency37,818

Clinically Active Physicians

30% Practicing

in same HRR as Residency

• Higher retention for• Female physicians

• Physicians with 3+ gap years before med school

• Primary care physicians

• Physicians with ties to state of residency

How far does the apple fall from the tree?

Source: Ostapenko & Fisher. Forthcoming. “How far does the apple fall from the tree? Factors Associated with Physician Retention in the Geographic Location of their Residency”.

HRR RetentionNumber of

Physicians

Birth State

Same as residency 9,212

Different than residency 28,606

Undergraduate State

Same as residency 10,912

Different than residency 23,130

Medical School State

Same as residency 14,568

Different than residency 22,472

Previous times in Residency State

None 19,373

One 6,857

Two 6,929

Three 4,659

43%

26%

43%

25%

42%

23%

21%

34%

43%

47%

Ties to location have the strongest effect

Source: Ostapenko & Fisher. Forthcoming. “How far does the apple fall from the tree? Factors Associated with Physician Retention in the Geographic Location of their Residency”.

Trends

• Practicing physicians

Physicians are working fewer hours, especially male physicians

2005-07 2005-072008-12 2008-122012-16 2012-160

10

20

30

40

50

60

Male Female

Average hours worked per week

- 17,700 FTE physicians in 8 years

Source: Census Bureau, American Community Survey 2005-7 3-year estimates, 2008-12 and 2012-16 5-year estimates. Accessed via IPUMS-USA.

0

2,000

4,000

6,000

8,000

10,000

12,000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Physicians retiring

Post-recession, physician retirements are rising

Source: AMA Masterfile year end 2004-year end 2016. Notes: Figures are three-year rolling averages. Only counts those who move to fully retired TOP='071’.

Some large specialties are older than others

Specialty Total active physicians Percent 55+ years

Psychiatry 38,193 61.3

Anesthesiology 41,753 51.7

Radiology and Diagnostic Radiology 27,711 51.6

General Surgery 25,026 46.4

Family Medicine/General Practice 113,283 45.7

Internal Medicine 115,476 44.2

Obstetrics and Gynecology 41,623 43.5

Pediatrics 58,406 42.2

Emergency Medicine 42,280 34.8

Psychiatry

Source: AMA Physician Masterfile; CDC Wonder Database.

General surgery

Source: AMA Physician Masterfile; CDC Wonder Database.

Trends

• Wellness

Physician wellness

matters to everyone

“Physician burnout is associated with

suboptimal patient care and professional

inefficiencies; health care organizations have

a duty to jointly improve these core and

complementary facets of their function.”

• Pangioti, Geraghty, Johnson, et al. JAMA Intern Med. 20148.

Physician Burnout

• 42% burned out

➢Male – 38%

➢Female – 48%

Source: Medscape National Physician Burnout & Depression Report, 2018.

The roots of burnout are many

Main physician-reported causes of burnout:

• Too many bureaucratic tasks (e.g., charting, paperwork)

• Spending too many hours at work

• Lack of respect from administrators/employers, colleagues, or staff

• Increasing computerization of practice

https://www.aamc.org/wellbeingSource: Medscape National Physician Burnout & Depression Report, 2018.

Sexual harassment is common in academic medicine

“Women students, trainees, and

faculty in academic medical

centers experience sexual

harassment by patients and

patients’ families in addition to the

harassment they experience from

colleagues and those in

leadership positions.”

-National Academies of Sciences,

Engineering, Medicine

Trends Summary

• Exceed enrollment goal

• Clerkships & GME

• Single accreditation

• Work hours declining

• Retirement on the rise

• Burnt out

Diversity

Diversity

The State of the Physician Workforce

Diversity

• UME

Number of schools with programs to recruit under-represented groups rising

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Minority groups currentlyunderrepresented in

medicine

Students withdisadvantaged

backgrounds (low income,low SES, recent

immigrants, etc.)

Students from ruralcommunities

Students from urbanunderserved communities

Students from localunderserved communities

Percentage of respondents who have an established program for recruiting the following populations, 2015-2017

2015 2016 2017

Source: AAMC Medical School Enrollment Survey Reports, 2015-2017.

Most medical school matriculants are now female

30

35

40

45

50

55

2008-2009 2011-2012 2014-2015 2017-2018

Applicants and Matriculants to U.S. Medical Schools, Percent Female, 2008-2009 through 2017-2018

Matriculants

Applicants

Source: AAMC Applicants and Matriculants Data.

Recent diversification of matriculants has been uneven

-21%

17%23%

12%

-48%

0%

-26%

35%

-60%

-50%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

American Indianor Alaska Native

Asian Black or AfricanAmerican

Hispanic, Latino,or of Spanish

Origin

Native Hawaiianor Other Pacific

Islander

White Other MultipleRace/Ethnicity

Change in Matriculants to U.S. Medical Schools by Race/Ethnicity, 2014-2015 through 2017-2018

Source: AAMC Applicants and Matriculants Data.

Many minorities still under-represented among medical school graduates and residents

Actual 2017 Composition

American Indian or

Alaska Native Asian

Black or African

American

Hispanic, Latino or of

Spanish Origin

Native Hawaiian or

Other Pacific

Islander White

Multiple Race/

Ethnicity

Graduates 0% 21% 6% 5% 0% 56% 8%

Residents 0% 27% 5% 8% 0% 53% 4%

Population 25-29 yrs. 1% 7% 15% 21% 0% 55% 2%

Source: AAMC FACTS Table B4 with the persons of Hispanic origin and one or more race moved out of the Multiple Race/Ethnicity into Hispanic; ACS Data from the US Census.

Black Males in Medicine

American Indians and Alaskan Natives under-represented in the physician workforce

Only 0.56% of active physicians in the US identify as American Indian or Alaskan Native (alone or in combination with another race)

Active U.S. MD physicians in 2016 who identify as American Indian or Alaska Native.

Source: American Medical Association Physician Masterfile, Dec. 31, 2016; US Census, 2012-2016 5-year ACS.

The demographics on graduating AI-AN

physicians and those represented within

the Native health care workforce are

appalling and embarrassing.

-Ronald Shaw, MD (Osage-Creek)

The AAMC is honored to co-create this

report with the AAIP, and it is our hope that

we can all assist in addressing the

challenges facing our Native communities

across America. There has never been a

better time to… remind ourselves of the

social accountability we have, as

academic medical institutions, to society.

-David A. Acosta, MD, FAAFP

Diversity

• Practicing physicians

The US physician workforce is aging

0

50,000

100,000

150,000

200,000

250,000

Age 26 to 35 Age 36 to 45 Age 46 to 55 Age 56 to 65 Age 66 or older

Physicians in the US, 1980 to 2012-16

1980 1990 2000 2008-12 2012-16

Source: Census Bureau 1980, 1990, 2000 5% state sample, American Community Survey 2005-7 3-year estimates, 2008-12 and 2012-16 5-year estimates. Accessed via IPUMS-USA.

Production of new physicians not keeping pace with aging workforce (change)

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

ResidentsenteringACGME

Physiciansturning 65+ 101%

+ 25%

Sources: National Population by Characteristics: 2010-2017 from the U.S. Census. https://www.census.gov/data/tables/2017/demo/popest/nation-detail.html; Physicians turning 65: AMA Masterfile as of years-end 2004-2017; Residents entering GME: ACGME Data Resource Books, academic years 2003-2004 through 2016-2017.

Source: Census Bureau 1980, 1990, 2000 5% state sample, American Community Survey 2005-7 3-year estimates, 2008-12 and 2012-16 5-year estimates. Accessed via IPUMS-USA.

US physician workforce continues to grow and to include more female physicians

0

200,000

400,000

600,000

800,000

1980 1990 2000 2005-07 2008-12 2012-17

Physicians in the US, 1980 to 2012-2016

Male Female

12%10%

16%

23%

28%

31%32%

www.aamc.org/specialtydatareport

Specialties with the highest percentages of female physicians

Specialty Total physicians Percent female

Pediatrics 36,945 63.3

Obstetrics & Gynecology 23,740 57.0

Pediatric Hematology/Oncology 1,489 53.4

Internal Medicine/Pediatrics 2,704 52.8

Child and Adolescent Psychiatry 4,849 52.7

Geriatric Medicine 2,939 52.6

Source: AAMC Physician Specialty Data Report. 2018.

Active Physicians, Percent Female, by Specialty, 2017

Specialty Total physicians Percent male

Orthopedic Surgery 17,981 94.7

Sports Medicine (Orthopedic Surgery) 2,440 93.4

Thoracic Surgery 4,102 93.0

Interventional Cardiology 3,546 92.3

Neurological Surgery 5,065 91.6

Urology 9,051 91.3

Source: AAMC Physician Specialty Data Report. 2018.

Active Physicians, Percent Male, by Specialty, 2017

Specialties with the highest percentages of male physicians

Most workforce race and ethnicity diversity is from USMG and USIMG physicians

0

20,000

40,000

60,000

80,000

Black orAfrican

American

AmericanIndian or

Alaskan Native

Asian or PacificIslander

Other race Two or moreraces

Hispanic

FIMG, 2005-2007

0

20,000

40,000

60,000

80,000

Black orAfrican

American

AmericanIndian or

Alaskan Native

Asian or PacificIslander

Other race Two or moreraces

Hispanic

USMG & USIMG, 2005-2007

Source: US Census Bureau.

Most workforce race and ethnicity diversity is from USMG and USIMG physicians

0

100,000

200,000

300,000

400,000

500,000

Black orAfrican

American

AmericanIndian orAlaskanNative

Asian orPacific

Islander

Other race Two ormore races

Hispanic White

FIMG, 2005-2007

0

100,000

200,000

300,000

400,000

500,000

Black orAfrican

American

AmericanIndian orAlaskanNative

Asian orPacific

Islander

Other race Two ormore races

Hispanic White

USMG & USIMG, 2005-2007

Source: US Census Bureau.

What We Do Not Know(Because It Has Not Been Asked)

Sexual orientation Gender identity Military Service

Disability StatusExperience of Bias, Harassment, Assault or Harm

Diversity Summary

• Female matriculants > 50%

• Rural matriculants declining

• Race and ethnicity uneven - but still nowhere near representation

• Black males

• American Indians and Alaskan Natives

• Older

• More female

• Much we do not know

People Who Need Care

The State of the Physician Workforce

People Who Need Care

People

• Health Care Utilization Equity

What does health care utilization equity look like?

• Same use of care

• Says nothing about quality

• Says nothing about outcomes

• Window into magnitude of unmet need

The magnitude of unmet need

What if barriers disappeared? How much more utilization (in 2016) if…

• Everyone used care like insured people living in metropolitan areas?

• Everyone used care like white insured people living in metropolitan areas?

Scenario 1

Scenario 2

Estimated Additional Physicians Needed if U.S. Had Achieved Health Care Utilization Equity in 2016

Scenario 1:Insurance &

Metro/Non-metro

31,600 Additional Physicians

Scenario 2:Insurance,

Metro/Non-metro, &

Race/Ethnicity

95,100Additional Physicians

Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.

Estimated Additional Physicians Needed if U.S. Had Achieved Health Care Utilization Equity in 2016

Scenario 1(Insurance,

Metro) Primary CareScenario 2

(Insurance, metro, race)

Scenario 1(Insurance,

metro)

Scenario 2(Insurance,

metro, race)

Specialty Care

9,800

20,700

21,800

74,400

Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.

Health care use would change most in metropolitan areas

Scenario 1(Insurance,

Metro)

Non-metropolitan

Scenario 2(Insurance,

metro, race)

Scenario 1(Insurance,

metro)

Scenario 2(Insurance,

metro, race)

Metropolitan

15,100

19,100

16,500

76,000

Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.

People

• Population Trends

(Who Need Health Care)

The nation’s population is growing rapidly

0

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000

300,000,000

350,000,000

400,000,000

450,000,000

2016 2020 2025 2030 2035 2040 2045 2050

Total projected population

Source: Projected Age Groups and Sex Composition of the Population: Main Projections Series for the United States, 2017-2060. US Census Bureau, Population Division: Washington, DC.

+ 65,794,000

We are approaching a crossroads in our nation’s age profile

22.8%

20.1%

15.2%

22.0%

2016 2020 2025 2030 2035 2040 2045 2050

Projected percentage of the population

Under 18 years

65 years and over

Source: Projected Age Groups and Sex Composition of the Population: Main Projections Series for the United States, 2017-2060. US Census Bureau, Population Division: Washington, DC.

Demand increases as U.S population ages

Sources: NCHS NAMCS National Ambulatory Medical Care Survey, Annual Summaries 1990, 2000, 2010.

2.11.8

2.2

3.7

5.8

7.6

0

1

2

3

4

5

6

7

8

9

Under 15 15-24 25-44 45-64 65-74 75 and older

Average physician visits per person

19

90

19

95

20

00

20

05

20

10

20

15

19

90

19

95

20

00

20

05

20

10

20

15

19

90

19

95

20

00

20

05

20

10

20

15

19

90

19

95

20

00

20

05

20

10

20

15

19

90

19

95

20

00

20

05

20

10

20

15

19

90

19

95

20

00

20

05

20

10

20

15

The nation’s population is urbanizing rapidly

0

50000

100000

150000

200000

250000

300000

350000

1990 2014 2050

Urban Rural 87%

75%

81%

Source: UN report. https://esa.un.org/unpd/wup/publications/files/wup2014-highlights.pdf

Most demand will continue to come from metro areas

0

100000

200000

300000

400000

500000

600000

700000

Primary Care Non-primary Care

Projected demand, metro areas, 2016 & 2030

Metro 2016 Metro 2030

0

100000

200000

300000

400000

500000

600000

700000

Primary Care Non-primary Care

Projected demand, non-metro areas, 2016 & 2030

Nonmetro 2016 Nonmetro 2030

Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.

Most of the future demand growth will be from minority populations

White38%

Black14%

Asian, Pacific Islander, Native

American & Alaskan Native

17%

Hispanic31%

Percent of demand growth, 2016-2030

Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.

People

• Access to Care

AAMC Consumer Survey of Health Care Access

Millions of Americans cannot always get care when they need it

Did not need care,27%

Needed care last 12 months-always able to

get it, 64%

Could not afford, 4%

Could not get appointment soon enough, 1%

Could not find provider, 2%

Other, 1%

Transportation problems, <1%

9% of U.S. adults (>22

million people) could not

always get care

Source: AAMC Consumer Survey of Health Care Access Wave 16, June 2018

Access to care has been improving

19%20%

17%16%

17%

15%

12%13%

0%

5%

10%

15%

20%

25%

2011 2012 2013 2014 2015 2016 2017 2018

Percent not always able to get care

Source: AAMC Consumer Survey of Health Care Access.

Racial and ethnic access disparities persist

0

5

10

15

20

25

30

35

White Black/AfricanAmerican

Hispanic andother

Asian Hispanic/Latino Multi-race (non-Hispanic)

AmericanIndian/Alaska

Native

Percent of respondents not always able to get care

2012 2018

Source: AAMC Consumer Survey of Health Care Access Waves 3-16, Native Hawaiian/Other Pacific Islander excluded due to small sample size

Access improving in all types of places

0%

5%

10%

15%

20%

2013 2014 2015 2016 2017 2018

Percent not always able to get care, 2013-2018

Urban

Rural

Suburban

Source: AAMC Consumer Survey of Health Care Access.

Access to care varies by more than race and rurality

11%

13%

11%

21%

30%

6%

14%

11%

18%

0% 5% 10% 15% 20% 25% 30% 35%

Male

Female

Heterosexual

Gay or Lesbian

Bi-sexual

No

Yes

No

Yes

Sex

Sexu

al o

rien

tati

on

Ph

ysic

ial

limit

atio

ns

Men

tal

limit

atio

ns

Percent of respondents not always able to get care, 2017-2018

Source: AAMC Consumer Survey of Health Care Access Waves 3-16, n>10,000

People Who Need Care Summary

• Many more people

• Older

• Urban

• Moving toward majority minority

• Access • Improving

• Disparities persist

The State of the Physician Workforce

Projections

Trends

Diversity

People Who Need Care

Review

Production of new physicians not keeping pace with aging workforce and population

0

10,000

20,000

30,000

40,000

50,000

60,000

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

ResidentsenteringACGME

Physiciansturning 65

Pop 65+(in thousands)+ 101%

+ 25%

+ 40%

Sources: National Population by Characteristics: 2010-2017 from the U.S. Census. https://www.census.gov/data/tables/2017/demo/popest/nation-detail.html; Physicians turning 65: AMA Masterfile as of years-end 2004-2017; Residents entering GME: ACGME Data Resource Books, academic years 2003-2004 through 2016-2017.

Other key takeaways

• A diverse physician workforce will not get easier to create if we wait

• Physician burnout is a national crisis

• Shortages are everywhere

“bias as the biggest challenge”

In addition to admitting women into programs,

we need to address how women, including

women of color, are progressing through their

careers starting with undergraduate and

graduate schools, probably all the way up to

their retirement. It’s about all the hurdles they

have that really seem to point to bias as the

biggest challenge. The same can be said for

men of color.

-Anita Hill

Monday, November 5, 8:45-10:00 amConvention Center: Hall 4

aamc.org/workforce

What’s next for AAMC’s Workforce Studies?

• Work hours

• Retirement

• Workforce diversity• More complete data

• Specialty-specific

• Programs

• Role of PAs/APRNs

May 1-3, 2019 - The Westin Alexandria, Alexandria, VA

Developing a health workforce for 2030 and beyond

• How do we train and prepare the current and future workforce to meet current and future needs? To skillfully deploy current and future technologies? To work effectively in current and future health care systems? How do we train and educate the workforce to keep up with the pace of change? How do we reconfigure training and education to keep up with the pace of change?

• What workforce do we need, where do we need them, and doing what, in order to have fewer disparities in the future?

• What partnerships are needed to connect the health workforce with the communities they serve in order to achieve fewer disparities and better health in communities across the country?

Questions? Please contact workforce@aamc.org