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The Physician workforce for the 21 st century

Explore the need for more physicians in the 21st century due to population growth, aging demographics, and increased rates of chronic illness. Discuss the challenges in meeting this demand and potential solutions.

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The Physician workforce for the 21 st century

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  1. The Physician workforce for the 21st century GW GME Core Curriculum January 7, 2015 Jim Scott

  2. What do we need?

  3. The Numbers 2010 • 680,500 physicians practicing in US (excludes residents) • 25,500 residency spots/year • 15,500 US MD • 2,900 DO • 6,600 IMG

  4. We Need More Doctors

  5. Drivers of Future Demand for Physicians • Population growth • US Pop Growing by 25 million/decade • Aging of the population • Over 65 will double 2000-2030 • Major illness/chronic illness far more prevalent among the elderly • Over 65 make twice as many physician visits as under 65 • Public expectations • Baby boom generation: high resources and expectations • Life Style factors • Rates of obesity, diabetes, etc. rising rapidly • Economic growth of the nation • Medical advances

  6. The Number of Active Physicians Approaching Retirement Age is Increasing Sharply: At the Current Level of GME, the US pop. Will Grow Faster Than the Physician Supply by 2015 26,000 Physicians Entering Training Each Year Sources: AMA Physician Masterfile (January 2007); AAMC CWS GME Analysis March 2009

  7. We Need More Doctors ?

  8. No, There Won’t Be a Doctor Shortage By SCOTT GOTTLIEB and EZEKIEL J. EMANUEL December 4, 2013

  9. “High-risk patients with certain acute heart conditions are more likely to survive than other similar patients if they are admitted to the hospital during national cardiology meetings, when many cardiologists are away from their regular practices.” • JAMA Internal Medicine December 2014

  10. We Need More Doctors!!!!

  11. The Answer • Open new Schools • Expand existing enrollment

  12. The Numbers 2016 • 680,500 physicians practicing in US (excludes residents) • 26,500 residency spots/year • 20,000 US MD • 4,000 DO • 6,600 IMG

  13. The Numbers 2016 • 26,500 residency spots/year • 20,000 US MD • 4,000 DO • 6,600 IMG • US med students caught in the middle • A hospital opportunity?

  14. More MDs does not equal more doctors

  15. The Numbers 2016 • 26,500 residency spots/year • 20,000 US MD • 4,000 DO • 6,600 IMG

  16. What we need are different doctors • Primary care • Can PAs and NPs do this? • PC without providers? • Kellerman, Health Affairs 2013 • Ku, Health Affairs 2015

  17. We need more doctors in certain locations

  18. We do need more doctors!! • But who is WE?

  19. Health Care Workforce Global Misdistribution of Health Workers

  20. GHSC Unequal Distribution of Health Workers

  21. GHSC Physician Density per 100,000 Population Source: World Health Organization (2006) Working Together for Health. The World Health Report 2006: WHO Press.

  22. Global Workforce(doctors/100k population) • US 293 • UK 231 • Canada 220

  23. Ebola • Sierra Leone Population 6 million • 136 doctors (2.2/100K) • Liberia Population 4.2 million • 51 doctors (1.2/100K, 82,000 patients per MD)

  24. Ebola • Sierra Leone Population 6 million • 136 doctors (2.2/100K) • Liberia Population 4.2 million • 51 doctors (1.2/100K, 82,000 patients per MD) • BEFORE the Ebola outbreak

  25. Global Workforce(doctors/100k population) • US 293 (15%) • UK 231 (21%) • Canada 220 (10%)

  26. Health Care Workforce Global Misdistribution of Health Workers

  27. Nigerian Medical School Graduates and the US Physician Workforce • “…one fifth of physicians in the United States come from developing countries.” • 175 Nigerian doctors entered the US physician workforce in 2012 • FAIMER Short Report 2013

  28. Washington Post 2011

  29. What can we do?

  30. Enhance Medical Education

  31. Addis Ababa University Kwame Nkrumah University University of Nairobi University of Ibadan Makerere University Kilimanjaro Christian Medical Centre University of Malawi University of Zambia University of Botswana University of Eduardo Mondlane Stellenbosch University University of KwaZulu-Natal University of Zimbabwe

  32. What can you do?

  33. The Global Health Service Partnership

  34. GHSC The History of the Global Health Service Partnership

  35. GHSC The Global Health Service PartnershipPartners • The Peace Corps • SEED Global Health • Medical and Nursing Schools in … • Malawi • Tanzania • Uganda

  36. GHSC GHSC Launch, Summer, 2013 • 38 doctors and 37 nurses deployed since July 2013 • Malawi, Tanzania and Uganda Uganda: 12 MD/100k 131 RNs/ 100k Tanzania: 1 MD/100k 24 RNs/ 100k Malawi: 2 MDs/100k 248 RNs/ 100k

  37. Can it make a difference? • Less than half (46%)of births in SSA are attended by a skilled health worker • Malaysia, Sri Lanka and Thailand decreased maternal mortality by 50% in ten years just by increasing the number of skilled birth attendants • WHO 2009

  38. Can it make a difference? • Southern Sudan • Small program to train 18 midwives • Four fold increase in attended births • 50% decline in maternal mortality

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