The State of the Physician Workforce. 5,000. 10,000. 15,000. 20,000. 25,000. 30,000. 35,000. 40,000. 2014. 2015. 2016. 2017. 2018. 2019. 2020. 2021. 2022. 2023. 2024. 2025. 75th Percentile

The State of the Physician Workforce

Michael J. DillDirector, Workforce Studies AAMC

November 13, 2016

• Michael Ferrante, BA• Kara Fisher, MPH• Sarah Hampton, BA• Karen Jones, MApStat• Scott Shipman, MD• Imam Xierali, PhD

The AAMC Workforce Studies Team

Overview: State of the Physician Workforce

UNDERLYING TRENDS

PHYSICIANPROJECTIONS

ACCESS TO CARE

UNDERLYING TRENDS

ACCESS TO CARE


High School (+4)

College (+4)Medical School (+4)

Residency (+3 to 5)

Fellowship(+1 to 3)

Practice

The long and winding road… to physician workforce data

What’s new?

• Updated data

• Primary care projections with and without hospitalists

• Extra growth in PA supply incorporated

• New entrants estimates improved (lower)

• First look at Health Care Utilization Equity

• Physician demand continues to grow faster than supply

• Projected total physician shortfall of between 61,700 and 94,700 physicians by 2025

• Shortages in both primary and specialty care – with a particularly large shortage in surgical specialties

• Consistent with 2015 projections report

Key findings from the updated projections

750,000

780,000

810,000

840,000

870,000

900,000

930,000

2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Full-

Tim

e-Eq

uiva

lent

Phy

sici

ans

Demand (+ MC)

Demand (ACA)

Demand (Demographics)

Demand (+ Retail Clinics)

Demand (+ APRN/PAModerate)Demand (+ APRN/PA High)

Column1

Supply (Retire Later)

Supply (GME Growth)

Supply (Status Quo)

Supply (Millenial Hours)

Supply (Retire Earlier)

Dem

and

Supp

ly

Demand exceeds supply across all scenarios

Source: AAMC, 2016 Update: Complexities of Physician Supply and Demand: Projections from 2014 to 2025.

0

20,000

40,000

60,000

80,000

100,000

2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Total projected physician shortfall range, 2014-202594,700

61,700

2025Range


Projected physician specialty group shortfall ranges, 2025

14,900

3,600

25,200

22,200

35,600

10,200

33,200

32,600

0 10,000 20,000 30,000 40,000

Primary Care Specialties

Medical Specialties

Surgical Specialties

Other Specialties



ACCESS TO CARE

UNDERLYING TRENDS

Supply• Pipeline• Demographics• Work patterns & workplace trends

0

200,000

400,000

600,000

800,000

1980 1990 2000 2010

Number of Physicians Who Worked in Prior Year

Male Female

454,539

612,549709,382

Source: United States Census BureauNote: Data for 2010 are a combination of 2009, 2010, 2011 American Community Surveys

Physician workforce has doubled since 1980 and is now 1/3 female.

346,660

U.S. MD enrollment expected to reach 30% increase around 2017

15,000

16,000

17,000

18,000

19,000

20,000

21,000

22,000

2002 2005 2008 2011 2014 2017 2020 2023

Original schools (n=125)

All Schools (n=145)

30% target (over 2002)

Historical Data Survey Data Projections

Source: AAMC 2015 Medical School Enrollment Survey Report

0

5000

10000

15000

20000

25000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

FYE: MD schools FYE: DO schools

UME is growing rapidly

MD: +25% (+4,161)

DO: +130% (+3,969)

Source: AAMC Data Book; AACOMM Reports on Student Enrollment


ACCESS TO CARE

UNDERLYING TRENDS


Percentage of U.S. Medical School Graduates by Sex 1980-2015

Source: AAMC Data Warehouse: Student file, as of 1/7/2016.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

1980 1985 1990 1995 2000 2005 2010 2015

Female Male

Percentage of U.S. Medical School Black or African American Graduates by Sex, 1986-2015

Source: AAMC Data Warehouse: Student data and Applicant and Matriculant file, as of 7/11/2016.

0%

10%

20%

30%

40%

50%

60%

70%

80%

1986 1990 1995 2000 2005 2010 2015

Female Male

0

2000

4000

6000

8000

10000

12000

14000

16000

Black or African American American Indian or Alaska Native Hispanic or Latino Asian White

Source: AAMC Data Warehouse: Applicant and Matriculant file, as of 3/16/2016.Note: Does not include non-U.S. matriculants, U.S. matriculants who designated “Other” race/ethnicity, U.S. matriculants whodesignated multiple race/ethnicity categories, or any matriculant for whom race data are not available.

U.S. Medical School Matriculants by Race and Ethnicity, 1980-2015

0

5000

10000

15000

20000

25000

1980 1988 1996 2004

White

American Indian orAlaska Native

Asian

Hispanic or Latino

Black or AfricanAmerican

Source: AAMC Data Warehouse: Minority Physician Database, AMA Masterfile, and other AAMC data sources, as of 1/22/2014.

U.S.-trained MD Physicians by Graduation Year, Race and Ethnicity, 1980-2004

Racial/Ethnic Diversity Varies across the Professions (1/2)

0% 20% 40% 60% 80% 100%

White (non-Hispanic)

Black/African-American (non-Hispanic)

Asian (non-Hispanic)

Hispanic or LatinoPhysician Assistants

Physicians

APRNs

US Working Age Population

Source: HRSA, Sex, Race, and Ethnic Diversity of U.S. Health Occupations (2010-2012), 2014 .

Racial/Ethnic Diversity Varies across the Professions (2/2)

0% 20% 40% 60% 80% 100%

American Indian and Alaskan Native

Native Hawaiian and Other Pacific Islander

Multiple/Other Race (non-Hispanic) Physician Assistants

Physicians

APRNs

US Working AgePopulation

Source: HRSA, Sex, Race, and Ethnic Diversity of U.S. Health Occupations (2010-2012), 2014 .

0% 1% 2% 3% 4% 5%

American Indian and Alaskan Native

Native Hawaiian and Other Pacific Islander

Multiple/Other Race (non-Hispanic)

Physician Assistants

Physicians

APRNs

US Working AgePopulation


ACCESS TO CARE

UNDERLYING TRENDS


Source: United States Census BureauNotes: Data for 2010 are a combination of 2009, 2010, 2011 American Community Surveys; Data for 2013 are a combination of 2012, 2013, 2014 American Community Surveys

0

10

20

30

40

50

60

1980 1990 2000 2010 2013

Avg

hrsw

orke

d pe

r wee

k

Male (-2.5)Combined (-3.3)Female (-0.2)

Work hours have declined, albeit modestly

780000

820000

860000

2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Projected FTE Physician Supply: All Physicians

Retire Later +2

GME Growth

Status Quo

Millennial Hours

Retire Earlier -2

Retirement scenarios create the two most extreme physician supply projections:


Focus on physician burnout, resilience, and well-being

Physician Burnout

• 54.4% of physicians reported at least 1 symptom of burnout (2014), up from 45.5% (2011)

• 81% of physicians report being overextended or at full capacity (2016)

• Burnout especially prevalent among emergency department physicians, urologists, physical medicine & rehabilitation, radiologists, and family physicians

Sources: Dyrbye, L. N., C. P. West, et al. (2014); Shanafelt, T. D., O. Hasan, et al. (2015); The Landscape Of Physician Practice. (2016); Drybye, L. N., P. Varkey, et al. (2013); Shanafelt, T. D., O. Hasan, et al. (2015).

Practicing physicians less satisfied with career in 2016 than in 2011

25%

45%

64%

50%

61%

69%

0% 10% 20% 30% 40% 50% 60% 70% 80%

I would choose the same practice setting

I would choose the same specialty

I would choose medicine as a career

2011 2016Source: Medscape Physician Compensation Report 2016 and 2011.

49%(2011)

41%(2014)

Source: Shanafelt, T. D., O. Hasan, et al. (2015).

Physician satisfaction with work-life balance is dropping

47% of physicians planned to accelerate their retirement plans in response to how health care is changing.

Source: Physician’s Foundation 2014 Survey of America’s Physicians


ACCESS TO CARE

UNDERLYING TRENDS

Demand• Population• Practice

240

250

260

270

280

290

300

310

320

330

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Mill

ions

of p

eopl

eU.S. Population Growing & Aging 1980

65+ years Below 65

2030

65+ years Below 65Source: U.S. Census Bureau, Population Division

Source: NCHS Data Brief No. 219, November 2015.Note: Aged 20 and over (age-adjusted).

30.5%

37.7%

0%

10%

20%

30%

40%

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 2011-2012 2013-2014

Obesity prevalence among U.S. adults, 1999–2000 through 2013–2014

The racial and ethnic composition of the nation is changing

85%

4%

11%

1%

67%

14% 13%

5%

47%

29%

13%9%

White Hispanic Black/African American Asian

U.S. population by race and ethnicity, actual and projected

1960 2005 2050Source: Pew Research Center, 2008.White, Black and Asian are non-Hispanic; American Indian and Alaskan Native not shown.


ACCESS TO CARE

UNDERLYING TRENDS

Demand• Population• Practice

Too soon to tell for ACOs and telehealth

• ACOs tailor their solutions, target high risk patients, expand workers’ roles

• Little evidence that further adoption of telehealth will lead to a need for fewer physicians

Numbers of new PAs and NPs Growing Rapidly

Source: NCCPA; AACN.

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

NP Graduates Newly Licensed PAs


ACCESS TO CARE

UNDERLYING TRENDS

Two examples• Surgical specialists• Primary care specialists

Projected Change in FTE Physician Supply by Specialty Category, 2014 to 2025

-10,000 -5,000 0 5,000 10,000 15,000 20,000

Other Specialties

Surgical Specialties

Medical Specialties

Primary Care


Active physicians per 100,000 pop 65+ years, by surgical specialty, US, 2004-2015

0

10

20

30

40

50

60

70

80

90

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

General Surgery

OrthopedicSurgery

Ophthalmology

Urology

Source: AMA Physician Masterfile; US Census Bureau

Growing number of surgeons approaching retirement age

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

2005 2007 2009 2011 2013 2015 2017 2019 2021 2023 2025

Actual and expected number of active surgeons turning age 65

In 2015, 20% of the surgical physician workforce was 65+ compared to 17% of the non-surgical physician workforce.

Source: AMA Physician Masterfile

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

75th Percentile - PC

75th Percentile - PC +hospitalists

25th Percentile - PC

25th Percentile - PC +hospitalists

Primary Care Shortfall: With & Without PC-Trained Hospitalists


0

50

100

150

200

250

300

350

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

Internal Medicine

Family Medicine

Active physicians per 100,000 pop 65+ years, by primary care specialty, US, 2004-2015


Number of primary care physicians approaching retirement age has leveled off

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

2005 2007 2009 2011 2013 2015 2017 2019 2021 2023 2025

Actual and expected number of active primary care physicians turning age 65

In 2015, 16% of the primary care physician workforce was 65+ compared to 18% of the non-primary care physician

workforce.

Source: AMA Physician Masterfile

0

6000

12000

18000

10000

20000

30000

40000

50000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Phys

icia

ns tu

rnin

g 65

Resid

ents

/Pop

. 65+

in th

ousa

nds

Residents entering ACGME Pop 65+ Physicians turning 65

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

Source: ACGME, Census, AMA Physician Masterfile; US Census Bureau

+ 14.4%

+ 27.5%

+ 73.2%

Physician Scientists: Combined MD/PhD Program Graduates

Number of combined MD/PhD program graduates growing

4,548

3,163

1,742

922

Source: AAMC National Outcomes SurveyNote: All survey responders out of training

Women increasingly represented among combined MD/PhD program graduates


Minority representation among combined MD/PhD program graduates increasing


Current primary workplace of MD/PhD graduates


UNDERLYING TRENDS


ACCESS TO CARE

Access• Utilization Equity• Barriers• Community level

Health Care Utilization Equity

• Many face access challenges• What if barriers disappeared? How much more utilization?

• People without medical insurance and people living in non-metropolitan areas => utilization patterns equivalent to their insured peers living in metropolitan areas

• Everyone => utilization patterns equivalent to white insured populations residing in metropolitan areas

Estimated Additional Physicians Needed if U.S. Had Achieved Health Care Utilization Equity in 2014

Scenario 1:Insurance & Metro/

Non-metro40,100 Additional Physicians

Scenario 2:Insurance,

Metro/Non-metro, &

Race/Ethnicity

96,200Additional Physicians


UNDERLYING TRENDS


ACCESS TO CARE


AAMC collects data on health care access from consumers

Did not need care

57%

Needed care last 12 months-always able to

get it…Could not afford

4%

Could not get an appt. soon enough

1%

Could not find a provider

1%Other 1%

Transportation problems

<1%

Source: AAMC Consumer Survey of Health Care Access

7% of U.S. adults (>17 million

people) could not always get care

December 2015

Difficulty Getting Care(Respondent Race and Ethnicity)

0 5 10 15 20 25 30 35 40 45

White/Caucasian

Hispanic and Other

Asian

Hispanic/Latino

Black/African American

Multi-race (non-Hispanic)

Other

Native Hawaiian/Other Pacific Islander

American Indian/Alaska Native

Percent not always able to get care

Source: AAMC Consumer Survey of Healthcare Access, Jan-16 and Jun-16

Difficulty Getting Care(Respondent Sexual Orientation)

Source: AAMC Consumer Survey of Healthcare Access, Jan-16 and Jun-16

0 5 10 15 20 25

Heterosexual or straight

Gay or lesbian

Bisexual

Percent not always able to get care

Cost is a declining factor among access barriers

16%

62%

18%

58%

18%

57%

26%

50%

33%

39%

0%

10%

20%

30%

40%

50%

60%

70%

Could not find a provider Could not afford

Reasons consumers could not get care when needed

2011, 2012, 2013 2014, 2015-2016

Pre-ACA Post-ACA

Source: AAMC Analysis in Brief, 14(3), March 2016.

1 out of 7 who seek same day care report waiting longer

86%

8% 7%

44%40%

16%

84%

7% 9%

20%

57%

23%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Seen same day Seen 2-3 days Waited >3 days Seen same day Seen 2-3 days Waited >3 days

Think need to be seen same day Think need to be seen 2-3 days

On your most recent medical care visit how long did you wait between the time you made the appointment and actually saw the provider, based on when you thought you needed to be seen

2011-2013 2014-2016Source: AAMC Consumer Survey of Health Care Access

76.9%

17.7%

5.4%

85.9%

13.0%

1.1%0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Always able to get it Only able to get it some of the time Never able to get it

Perc

ent o

f res

pond

ents

who

nee

ded

care

Mental or behavioral health care Medical care

Access to mental and behavioral health is more limited than access to medical care

Source: AAMC Consumer Survey of Health Care Access, June 2016.

Among those who needed medication-assisted therapy for substance abuse problems, 3 out of 4 are having trouble finding a provider (2016)

Source: AAMC Consumer Survey of Health Care Access, June 2016.Note: Survey only samples those who report needing medical or mental or behavioral health care in the last 12 months.

UNDERLYING TRENDS


ACCESS TO CARE


Access to general surgeons depends on where you are

Total active general surgeons per 100,000 population, 2014


This is where health care really happens

The problem is shortage and distribution

• Pervasive barriers, including limited capacity• Minority groups face greater access and health challenges• Workforce shortages exist across professions and specialties• Maldistribution is a growing problem

Projections of local area physician supply reveal a need to look outside the box

2,000

2,100

2,200

2,300

2,400

2,500

2015 2020 2025 2030 2035

Projected local area physician supply, Albuquerque, NM

Low growth More residencies Better retention

Source: AAMC Local Area Modeling Project.

Review: State of the Physician Workforce

UNDERLYING TRENDS


ACCESS TO CARE

Summary

• Shortages projected across specialty groups

• Aging population & aging physician workforce key drivers

• Access to care remains a problem for certain groups

• Local variations reinforce national conclusions

• Need to tackle the social determinants of health care

AAMC Workforce Studies: What We Do

PROJECTIONS

RESEARCH

DATA

SUPPORT

RESOURCES

LEADERSHIP

Physician data reports

State and specialty rankings and data on:

• Physician Supply• UME/GME• In-State Retention

[email protected] www.aamc.org/workforce

2017 Health Workforce Research Conference, May 3-5, 2017Arlington, VA

Documents

The State of the Physician Workforce. 5,000. 10,000. 15,000. 20,000. 25,000. 30,000. 35,000. 40,000. 2014. 2015. 2016. 2017. 2018. 2019. 2020. 2021. 2022. 2023. 2024. 2025. 75th Percentile