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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. How Many Physicians Are There?. Total Active Physicians. What do Physicians do? Primary care versus specialization. - PowerPoint PPT Presentation
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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
How Many Physicians Are There?
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
What do Physicians do?
Primary care versus specialization
Definition of Primary CareInstitute of Medicine
Accessibility Comprehensiveness Coordination Continuity Accountability
Incentives for Specialization inthe United States Health Care System
Higher income Greater prestige Technological mastery Personal autonomy
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
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
What is happening to Family Medicine?
Family Medicine Residency Positions:1992 - 2004
1000
1500
2000
2500
3000
3500
Positions OfferedPositions FilledUS Grads
What is happening to the supply ofrural physicians?
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
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 5.1 7.6
26.1
35.4
17.513.7 14.6
ruralmetro
UW students choosing family medicine(% of graduating class)
35%
14%
0%
5%
10%
15%
20%
25%
30%
35%
1997 2004
%
Results of 2004 Family Medicine Matchin the WWAMI states – All Programs
Results of the 2004 Family Medicine Matchin the WWAMI States – Urban Sites
Results of the 2004 Family Medicine Matchin the WWAMI States – Rural Programs
Per cent of family medicine trainingthat takes place in rural areas
0102030405060708090
100
Urban(n=402) Large rural(n=28) Small rural(n=5)
Closures of Family Medicine TrainingPrograms: 2000 - 2004
02468
101214161820
2000-2001 2001-2002 2002-2003 2003-2004
UrbanRural
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
Which students choose to become family physicians?
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
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
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
Where will we find the doctors?
• They are already there - living and going to school in rural areas.
The future is waiting for us
We still have mountains to climb
