The Future Supply of Rural Family Doctors
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Transcript of The Future Supply of Rural Family Doctors
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The Future Supply of Rural Family Doctors
The WWAMI Rural Health Research CenterThe WWAMI Center for Health Workforce
StudiesSpokane Rural Health Conference - 2004
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How Many Physicians Are There?
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148 161 180 202 226 238 260 276
142144142
780684
594538
460394
334292260242220
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
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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 carenon-primary care
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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 ofrural physicians?
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Physicians per 100,000 Population by Location
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50
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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
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FP/GP GeneralInternal
Medicine
GeneralPediatrics
Ob-Gyn GeneralSurgery
28.1
11.8
5.2 5.1 7.6
26.1
35.4
17.513.7 14.6
ruralmetro
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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
0102030405060708090
100
Urban(n=402) Large rural(n=28) Small rural(n=5)
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Closures of Family Medicine TrainingPrograms: 2000 - 2004
02468
101214161820
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
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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