1. 1 Health Workforce Now and Tomorrow Urgent Matters Delaware Health Care Commission December 1, 2011

2. 2 International Comparison of Spending on Health, 1980–2008 Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP Source: OECD Health Data 2010 (June 2010).

3. 3 Number of Practicing Physicians per 1,000 Population, 2006 *2005 Source: OECD Health Data 2008, “June 2008.”

4. 4 Federal Snapshot AAMC projects 91,500 physician shortage by 2020 COGME projects 85,000 shortage by 2020 HRSA: demand will outstrip supply Nearly 40% doctors over 55 – economists say 1/3 could retire in next 10 years More women physicians – work fewer hours

5. 5 Federal Snapshot RN’s over 50: 20002008 –% total RN’s 33% 44.7% 157,000 pharmacy shortage -2020* Faculty shortages: nursing & pharmacy Demographics do not reflect population * Health Resources and Services Administration

6. 6 Delaware Snapshot 2,255 Est. physicians active practice 863 Est. pcp: 1 pcp to 1187 people Federally designated shortage areas: all Kent & Sussex & portions NCC –Meet or exceed 3500 to 1 ratio –COGME low end of acceptable – 1250 to 1

7. 7 Delaware Snapshot DE Healthcare Assn –7900 nurses and allied professional between 2009 - 2014 1 to 9582 - Psychiatrist to population ratio 80% bachelor’s program report faculty shortage Average faculty age (2006) –46 – diploma, certificate, associates –53 – bachelor and graduate

8. 8 PCP – DE Age Distribution PCP ‘08 DE ‘08 DE 2020 DE 2030 Under 40 19% 19% 19% 17% 40-49 29.2% 14.9% 11% 12% 50 – 6435.4% 19% 20% 17% Over 6516.3% 14% 19% 24%

9. 9 PCP – DE Race Distribution Caucasian –PCP ’08 73%DE 2030 72% Asian –PCP ’08 20.%DE 2030.04%* African American –PCP ’08 4.5%DE 2030 23.5% Other –PCP ’08 1.2%DE 2030.04% –* Population Consortium does not separate Asian from “other”

10. 10 Hispanic & Non-Hispanic HispanicNon-Hispanic PCP ’084.2%95.8% DE ’086%94% DE 202010%90% DE 203012.5%87.5%

11. 11 Primary Care: WHY IT MATTERS Aging “Boomers” will create more demand for services Increased insured from ACA Increased rates of chronic illness Proven efficiency; cost effective; better outcomes Adequate supply critical to insuring access and maintain healthy populations

12. 12 Primary Care Challenges Medical School Debt $145,000 - $180,000 Annual Compensation: –Orthopedics$473,770 –Radiology$468,594 –Dermatology$385,088 –Pediatrics$192,000 –Family Medicine$183,999 –Geriatrics$179,950 “ROAD” to success

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17. 17 DHCC Strategies DIMER DE Institute Medical Education & Research –20 slotsJefferson Medical College –6 slotsPhil. College Osteopathic Medicine DIDER – Delaware Institute Dental Education & Research –Dental residency support – CCHS –5 slots Temple Univ. Kornberg School of Dentistry Loan Repayment –Repay undergraduate and graduate education debt –Must locate in federally designated under-served area Workforce Development

18. 18 SLRP Gets Results! 78total 46physicians 12nurses 20dentists 5left after service

19. 19 Looking Ahead - Patient Centered Medical Home –Payment Reform –Scope of Practice Accountable Care Organizations –Team approach – best care, less spending –Evidence based medicine Technology –health information exchanges and electronic medical records Incentives – Loan Repayment

20. 20 CONTACT INFORMATION Paula K. Roy Executive Director Delaware Health Care Commission Margaret O’Neil Building 410 Federal St. Suite 7 Dover, DE 19901 302-739-2730 302-739-6927 fax Paula.roy@state.de.us www.dhcc.delaware.gov