UPDATE ON EASTERN & CENTRAL WASHINGTON GME EXPANSION COMMITTEE€¦ · · 2013-10-15UPDATE ON EASTERN & CENTRAL WASHINGTON GME EXPANSION COMMITTEE GME Summit March 23, ... Note:

UPDATE ON EASTERN & CENTRAL

WASHINGTON GME EXPANSION

COMMITTEE

GME Summit

March 23, 2012

John McCarthy, MD

Assistant Dean for Regional Affairs

University of Washington School of Medicine

GME EXPANSION COMMITTEE – EASTERN &

CENTRAL WASHINGTON

GME EXPANSION COMMITTEE - EASTERN &

CENTRAL WASHINGTON --- THE CHARGE

1. Refine & update physician supply & workforce needs

2. Initiate planning for GME programs to meet physician

workforce needs

3. Develop recommendations for business plans and

financing for GME programs

GME EXPANSION COMMITTEE – EASTERN &

CENTRAL WA ---- MEMBERS & COMMUNITIES

Greater Spokane Incorporated

Residencies

UWSOM/WSU

VA

Hospitals

Spokane County Medical Society

GME EXPANSION COMMITTEE – PRE WORK

PHYSICIAN SUPPLY & WORKFORCE NEEDS

a) Spokane County Medical Society/EWU – 2009

“The Challenges of Providing Primary Care in Spokane County”

72% respondents - not enough primary care or physician assistants

20% of Spokane Primary Care physicians graduates of UWSOM

b) WWAMI Rural Health Research Center/Mark Doescher, MD, MSPH – 06/10

“Current & Projected Supply of Physicians in Eastern WA: 2009 & 2030”

WA relies heavily on importing physicians

EWA physician/population below US

Will need 150 additional FM physicians by 2030 to retain ratio

c) Tripp Umbach UME Study – 04/10

“America’s Next Great Academic Health Science Center”

Expand to 80-120 First Year Medical Students

GME EXPANSION – PRE WORK FINDINGS

PHYSICIAN SUPPLY & WORKFORCE NEEDS

We have too few physicians

18.5/10K population vs. US 21.3/10K population

We have proportionately fewer residents

6.8/100k population vs. US 35.7/100k population

We have modest number of entering medical

students

40 MS1 vs. 80-120 MS1 recommended by UME study

GME EXPANSION COMMITTEE

CURRENT RESIDENT SUPPLY GME expansion is vital for meeting physician needs in Central/Eastern Washington,

given the strong correlation between where residents train and where they practice.

Region currently has only seven residency programs

Region currently imports 86% of its physicians to meet the region’s needs

Recent planning by Tripp Umbach for the Academic Health Sciences Center at Riverpoint

suggest that by 2030, 38%, or 46 out of 120 of WWAMI Medicine Spokane graduates are

expected to choose work in communities throughout eastern Washington

Specialty Washington State Eastern Washington Spokane County

Family Medicine 79% 79% 77%

General Internal 84% 83% 81%

General Pediatrics 85% 91% 89%

Obstetrics 86% 87% 87%

General Surgery 90% 91% 91%

Psychiatry 84% 92% 94%

Total Physicians 85% 86% 85%

Source: “Current and Projected Supply of Physicians in Eastern Washington: 2009 and 2030”, Mark Doescher, MD June 2010 ; “American’s Next Great Academic Health Science Center”, Tiripp Umbach;

ACGME website and phone verification May 2010


RESIDENT NEEDS COMPARATIVE Based on current number of residents in the U.S. and Western Washington (W WA), Central/

Eastern Washington (C/E WA) lags behind by 253 and 172 residency positions, respectively.

Family

Medicine

Internal

Medicine OB/GYN Pediatrics Surgery

Emergency

Medicine Psychiatry Total

US Ratio (1) 46 109 23 40 35 24 23 300

W WA Ratio (2) 62 63 11 29 37 11 18 231

C/E WA Slots (3) 46 21 0 0 0 0 6 73

E/C WA Residency Targets based on US and W WA Ratios:

Target

Slots

Current C/E

WA Slots (3)

Target

Incremental

Slots

US Ratio (1) 326 73 253

W WA Ratio (2) 245 73 172

E/C WA Targeted Totals:

Notes: (1) Based on a population of 304,059,000 and the number of residents in each specialty per 100,000 population

(2) Based on a population of 5,084,000 and the number of residents in each specialty per 100,000 population

(3) Central / Eastern Washington slots exclude transitional and radiology residents Source:

ACGME Data Resource Book 2009-2010:

Western Washington based on October, 2009 data


RESIDENTS NEEDS ASSESSMENT

Central/Eastern Washington ratio of 6.8 residents per 100K population

falls significantly below the United States average of 35.7 residents

Region Residents Population Residents per 100K

population

United States 108,488 304.059 million 35.7

Western Washington 1,517 5.084 million 29.8

Central/Eastern

Washington 100 1.465 million 6.8

Alaska 34 .689 million 4.87

Idaho 56 1.545 million 3.62

Montana 20 .974 million 2.05

Wyoming 40 .544 million 7.35

Source: “2009 State Physician Workforce Data Book: Center For Workforce Studies,” AAMC November 2009; WWAMI Clinical Medical Education – E&C WA


RESIDENTS NEEDS ASSESSMENT

Central & Eastern

Washington Programs 100 Slots Region City

Central Washington Family Medicine 18 Central Yakima

Family Medicine Spokane 22 Eastern Spokane

Family Medicine Spokane RTT 3 Eastern Colville

Internal Medicine Residency

Spokane

21 Eastern Spokane

Sacred Heart Transitional Program 18 Eastern Spokane

Radiology Residency 9 Eastern Spokane

UW Psychiatry 6 Eastern Spokane

Source: “2009 State Physician Workforce Data Book: Center For Workforce Studies,” AAMC November 2009; WWAMI Clinical Medical Education – E&C WA


MEMBER SURVEY GOAL

Goal of next 10 years = 144

COGME recommendations - primary care training

will exceed 40% overall

Family Medicine goal should be considered a

minimum target

Expansion Committee survey - most agreed the GME expansion target

should be based on current Western Washington ratios


MEMBER SURVEY GOAL

Program

Current Incremental Total GME

# % # # %

Family Medicine 46 46% 15 61 25%

Internal Medicine 21 21% 27 48 20%

OB/GYN - - 18 18 7%

Pediatrics - - 23 23 9%

Surgery - - 23 23 9%

Emergency Med - - 14 14 6%

Psychiatry 6 6% 13 19 8%

Radiology 9 9% - 9 4%

Transitional Year 18 18% - 18 7%

Fellowships - - 11 11 5%

Total 100 100% 144 * 244 100%

Note:

(*) With an incremental goal of 144 residency positions, the total slots for C/E Washington of 244 almost equals the total for W Washington of 245.


WHERE GROWTH CAN OCCUR

Wenatchee FQHC

Tri-Cities Hospitals

Ellensburg FQHC

Rural Training Tracks – Moses Lake, Colville, Colfax?

Coeur d’Alene – Kootenai Medical Center

Spokane – Providence Holy Family Hospital

Spokane’s IM & FM Residencies


SURVEY GOAL

GME expansion alone won’t meet the region’s

needs

How to meet the requirements of evolving

delivery models

Changes in GME funding will influence the

scope and timing of expansion

Most agreed GME expansion target should be based

on current Western Washington ratios


10 YEAR TIMELINE The proposed schedule below would exceed the minimum 2020 goal of 144 new residency

positions through a combination of new, expanded, and WWAMI opportunities.

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Total Goal

C/WA

2

KEY

New Program

Incremental Growth of Existing Program

Potential WWAMI Regional Rotation/Track

FAMILY MED 24 15

INTERNAL MED 32 27

PEDIATRICS* 24 23

OB/GYN* 18 18

SURGERY* 22 23

EMER MED 20 14

PSYCHIATRY* 19 13

FELLOWSHIPS 11 11

CUMULATIVE SLOTS 2 6 22 49 81 109 129 146 158 170

4 4 4 4

4 4 4 4 4

8 8 8

4 4 4 4

5 5 5

6 6 6

C/WA

2

C/WA

2

WWAMI

2

WWAMI

2

WWAMI

2

1 1 1

1 1 1

Cardio

GI

SM 2

6 6 6

5 5 5

1 1 1 Pulm

WWAMI

2

3

Note: (*) Size of new residency program reflected on the 10 year timeline is different from the minimum RRC program requirements used for financial modeling purposes.


BUSINESS PLAN & FINANCING

Business Plan Template

Review of Funding Mechanisms

Review of Legislative Initiatives


COMPLEXITIES

Staging Implementation

Funding

Health Systems

ACGME/RRC

Faculty Development


OUTCOME THEMES

Be Prepared - Shovel Ready

Cooperative Infrastructure

Think Creatively – Out of the Box

Think Bigger – Accept Incremental Growth

UWSOM Commitment to GME


Updates?

Next steps?

Questions

Documents

UPDATE ON EASTERN & CENTRAL WASHINGTON GME EXPANSION COMMITTEE€¦ · · 2013-10-15UPDATE ON EASTERN & CENTRAL WASHINGTON GME EXPANSION COMMITTEE GME Summit March 23, ... Note: