The Future Supply of Rural Family Doctors The WWAMI Rural Health Research Center The WWAMI Center...
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The Future Supply of Rural Family Doctors
The WWAMI Rural Health Research Center
The WWAMI Center for Health Workforce Studies
Spokane Rural Health Conference - 2004
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How Many Physicians
Are There?
How Many Physicians
Are There?
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148 161 180 202 226 238 260 276
142144142
780
684
594538
460394
334292
260242220
0
100
200
300
400
500
600
700
800
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000
Year
physicians per100,000 populationtotal physicians(1,000s)
Total Active Physicians
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What do Physicians do?
Primary care versus
specialization
What do Physicians do?
Primary care versus
specialization
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Definition of Primary CareInstitute of Medicine
Accessibility
Comprehensiveness
Coordination
Continuity
Accountability
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Incentives for Specialization inthe United States Health Care System
Higher income
Greater prestige
Technological mastery
Personal autonomy
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Growth of Number of Recognized Medical Specialties
0
20
40
60
80
100
120
140
1927 1933 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000
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Percentage of Primary Care and Non-Primary Care Physicians
87%
59%53%
45%38%
34% 33% 32% 31%
13%
41%47%
55%62%
66% 67% 68% 69%
1931 1949 1960 1965 1970 1981 1988 1995 2000
primary care
non-primary care
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What is happening to
Family Medicine?
What is happening to
Family Medicine?
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Family Medicine Residency Positions:1992 - 2004
1000
1500
2000
2500
3000
3500
Positions OfferedPositions FilledUS Grads
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What is happening to the supply of
rural physicians?
What is happening to the supply of
rural physicians?
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Physicians per 100,000 Population by Location
0
50
100
150
200
250
300
350
1940 1950 1960 1970 1980 1990 1995 2000
Year
large metro
small metro(<1,000,000)large rural
small rural
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Patient Care Physicians per 100,000Population by Location and Specialty
0
10
20
30
40
FP/GP GeneralInternal
Medicine
GeneralPediatrics
Ob-Gyn GeneralSurgery
28.1
11.8
5.2 5.17.6
26.1
35.4
17.513.7 14.6
rural
metro
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UW students choosing family medicine(% of graduating class)
35%
14%
0%
5%
10%
15%
20%
25%
30%
35%
1997 2004
%
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Results of 2004 Family Medicine Matchin the WWAMI states – All Programs
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Results of the 2004 Family Medicine Matchin the WWAMI States – Urban Sites
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Results of the 2004 Family Medicine Matchin the WWAMI States – Rural Programs
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Per cent of family medicine trainingthat takes place in rural areas
0
10
20
30
40
50
60
70
80
90
100
Urban(n=402) Large rural(n=28) Small rural(n=5)
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Closures of Family Medicine TrainingPrograms: 2000 - 2004
0
24
6
8
1012
14
1618
20
2000-2001 2001-2002 2002-2003 2003-2004
UrbanRural
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Career choices of graduating med studentsand the impact of total student debt
0
5
10
15
20
25
30
35
40
Primary Care Under-served area
none0-49K50-99K100-149K150-199K200-250K>250K
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Which students choose to become family physicians?
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First Tentative Conclusions:Declining interest in family medicine
• Increasing student debt - important at the margin
• Persistent salary disparities
• Increased emphasis on “life-style” control
• Cultural factors - very sensitive to broader societal trends
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Second Tentative Conclusions:Greater challenges for rural recruitment
• Family medicine - and all of primary care - is becoming increasingly a female occupation
• Increasing diversity of medical school class makes rural practice less likely
• Falling family medicine match rates has led to closure of residency programs - disproportionately in rural areas
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So what are we doing about it?
• UW Pipeline committee
• Targeted research on student debt, student career choice and the well-being of rural-based residency programs
• Engaging our rural constituency - that means all of us
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Where will we find the doctors?
• They are already there - living and going to school in rural areas.
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The future is waiting for us
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We still have mountains to climb