Physicians in North Carolina: Sufficiency, Shortage or “ Stress ” Thomas C. Ricketts, Ph.D. MPH, Erin Fraher, PhD MPP Katie Gaul, M.A. University of North Carolina at Chapel Hill
The Current Policy Context • Demand side : aging population, increase in chronic disease, insurance expansions, rising patient expectations • Supply Side : health workforce overall is growing, professions operate in silos, turf wars abound, and productivity is lagging With, or without health reform, cost and quality pressures will change the physician workforce
Questions • Can we trust the numbers? – YES , North Carolina has the most accurate and trustworthy inventory of physician data • What is a shortage of physicians? – Economic: When the prices of service rises because there is less of it available – Clinical: When people cannot get needed care because there aren ’ t enough doctors • How can we know a shortage exists? – Sick people get sicker? People take more time to get to a doctor?
The State of the State: Let ’ s Drown (or Swim) in a lot of Data
NC Lags US in Physicians per Population US 23 per 10,000 NC 22 per 10,000
NC Doctor Supply has grown faster than NC Population
Doctor Supply is Dynamic: 2002-2009 New Actives 2003 total 2002 Supply Left File 1,568 17,090 16,734 1,212 (returned to active 511 Net gain 356 newly licensed 1,057) New Actives 2004 total 2003 Supply Left File 1,430 17,349 17,090 1,171 (returned to active 487 Net gain 259 newly licensed 943) New Actives 2005 total 2004 Supply Left File 1,550 17,895 17,349 1,004 (returned to active 667 Net gain 546 newly licensed 883) New Actives 2006 total 2005 Supply Left File 1,951 18,396 17,895 1,450 (returned to active 630 Net gain 501 newly licensed 1,321) New Actives 2007 total 2006 Supply Left File 1,659 18,913 18,396 1,142 ( returned to active 569 Net gain 533 newly licensed 1,090) New Actives 2008 total 2007 Supply Left File 1,822 19,542 18,913 1,193 (returned to active 461 Net gain 629 newly licensed 1,361) New Actives 2009 total 2008 Supply Left File 1,808 19,901 19,542 1,449 (returned to active 499 Net gain 359 newly licensed 1,309) Source: North Carolina Health Professions Data System, with data derived from the North Carolina Medical Board, 2002-2009. Prepared 6/16/2010. Counts include active, instate, non-federal physicians. Note: Newly licensed physicians are those who are new to file with a license date in the current or previous year. New Active physicians are those who were licensed in NC in an earlier year but were either inactive or active out of state in the previous year.
Age-Gender Pyramid, Physicians Doctor Supply is Older Males and Younger Females North Carolina, 2009 Over 80 79 77 75 73 Female Male 71 69 67 65 63 61 59 57 55 53 51 49 47 45 43 41 39 37 35 33 31 Under 30 600 500 400 300 200 100 0 100 200 300 400 Number of Physicians Figures includ lude activ ive, instate, nonfederal, l, non-reside ident-in in-trainin ining physic ician ians lic icensed in North Caroli lina as of October 31, 2009. 09. Source: North Caroli lina Healt lth Professions Data System, m, Cecil il G. Sheps Center for Health Servic ices Research, Univ iversity of North h Caroli lina at Chapel l Hill ll, with data deriv ived from m the North Caroli lina Medic ical l Board, 2009.
NC Bucks National Trend: More Rapid Increase in Primary Care Physicians Percentage Growth Since 1990 of Physicians and Primary Care Physicians per 10,000 Population, North Carolina, 1991-2009 45� 39%� Primary� Care� Physicians� 40� 35� 1990� since� 30� change� 32%� 25� %� All� Physicians� 20� 15� 10� 5� Sources: North Carolina Health Professions Data System with data derived from the North Carolina Medical Board ,1979 to 2009; North Carolina Office of State Planning. Figures include all licensed, active, instate, non-federal, non-resident-in-training physicians.
And Despite Overall Growth, Persistent Maldistribution Notes: Figures include all active, instate, nonfederal, non-resident-in-training physicians licensed as of October 31st of the respective year. Primary care physicians include those indicating a primary specialty of family practice, general practice, internal medicine, Ob/Gyn or pediatrics. Persistent HPSAs are those designated as HPSAs by HRSA from 1999 through 2005, or in 6 of the last 7 releases of HPSA definitions. Sources: North Carolina Health Professions Data System, 1979 to 2010; HRSA, Bureau of Health Professions; Area Resource File; US Census Bureau; North Carolina Office of State Planning. Figures include all licensed, active, instate, non-federal, non-resident-in-training physicians.
WHERE DO DOCTORS IN NORTH CAROLINA COME FROM?
Total Enrollment and Residency Status of First Year Students North Carolina and Neighboring States’ Medical Schools, 2010-2011 Duke 419 ECU ETSU Wake Forest 309 UNC-CH 483 650 Campbell 600* Total Enrolled, by First Year State Residency Status 810 405 81 First Year In-State Residents First Year Out-of-State Residents School of Osteopathy No State Residency Status Available Source: Campbell University, 2012; Barzansky B, Etzel SI. 2011. Medical Schools in the United States, 2010-2011. JAMA . 306(9): 1007-1014. Accessed 10/8/12. Produced by the North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University o f North Carolina at Chapel Hill.
Post Graduate Residency Programs: AKA “ Teaching Hospitals ” • 10 programs in North Carolina. 2,681 residents in training – UNC Hospitals 714 – Duke Hospitals 709 – Wake Forest Baptist 506 – ECU Pitt County 294 – Charlotte AHEC 254 – Other AHECs 204 • Nationally 8,750 programs with 109,000 Trainees
North Carolina ’ s Physicians Come from Outside the State Medical School Location of Primary Care Physicians Practicing in North Carolina, 1990-2010 70% Other US and Canada 60% n =2,509 n =5,001 57.2% 55.7% 50% Percent 40% North Carolina n =1,587 36.2% 30% n =2,484 27.7% 20% n =1,496 International Medical Graduates 16.7% 10% n =289 6.6% 0% 1990 1995 2000 2005 2010 Year Sources: North Carolina Health Professions Data System with data derived from the North Carolina Medical Board, 1990 to 2010; Figures include all licensed, active, instate, non-federal, non-resident-in-training physicians.
Total North Carolina Graduates: 5,221 Total Physicians: 20,752
Total North Carolina Graduates: 2,484 Total PC Physicians: 9,017
Percent of Active Pharmacists in 2008 Graduating from a School of Pharmacy in North Carolina Elizabeth City State University / UNC-CH UNC Chapel Hill Northwest AHEC Greensboro AHEC Wake AHEC Area L AHEC Eastern AHEC Mountain AHEC Charlotte AHEC Percent of Pharmacists by School Wingate Southern 1,100 Regional AHEC 550 Campbell Southeast AHEC 110 UNC Campbell Wingate Outside of NC Size of circle represents total number of active pharmacists in the county. Size of slices indicates percent of those pharmacists by school. Pharmacists included are active or have unknown activity status. Source: North Carolina Health Professions Data System, with data derived from the North Carolina Board of Pharmacy, 2008. Produced by: North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University of N orth Carolina at Chapel Hill.
Contribution of NC Medical Schools to NC Supply North Carolina Medical School for Primary Care Physicians Practicing in North Carolina, 1990-2010 50% UNC-CH 44% 44% 45% n =699 n =1,101 40% How will this look when 35% Campbell starts graduating Percent 29% 30% Wake Forest n =461 150 students per year? 23% 25% n =578 21% n =337 n =507 20% Duke 20% 15% n =298 10% ECU 12% n =90 5% 6% 0% 1990 1995 2000 2005 2010 Year Sources: North Carolina Health Professions Data System with data derived from the North Carolina Medical Board, 1990 to 2010; Figures include all licensed, active, instate, non-federal, non-resident-in-training physicians.
Graduate Training by Med School Affiliated Hospitals Class of 2011: Distribution of NC Medical Student Residencies 160 5% Psychiatry 140 5% General Surgery Number of 2011 graduates 120 1% Other 6% Primary Care 35 % 100 3% 4% 44% 80 6% 57% 60 9% 28% 54% 40 49% 20 35% 57% 0 UNC-CH Wake Forest Duke ECU School n=147 n=118 n=94 n=68 Prepared by the North Carolina Health Professions Data System and the North Carolina AHEC Program. Source: Duke Office of Medical Education, UNC-CH Office of Student Affairs, ECU Office of Medical Education, Wake Forest University SOM Office of Student Affairs, Association of American Medical Colleges, and the NC Medical Board.
Why Do We Care Where Physicians Trained? Because it affects specialty choice, practice location and workforce diversity
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