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

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%

8 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

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

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

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

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.

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).

WCMEW Report Wisconsin Future Physician Supply 14 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 15 Projection Year Increase in Demand Increase in Supply Surplus or (Shortfall) 2020 Base Estimate 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 Demand Increase in Supply Surplus 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 18 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.