1 / 46

Will The Last Physician in America Please Turn Off The Lights?

Will The Last Physician in America Please Turn Off The Lights?. PHYSICIANS:. Are they REALLY an endangered species?. OR:. …are we just pushing the panic button?. THE HISTORY OF:. Physician Supply in America. (Readers Digest Version). IN THE LATE 19 TH CENTURY:.

milla
Download Presentation

Will The Last Physician in America Please Turn Off The Lights?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Will The Last Physician in America Please Turn Off The Lights?

  2. PHYSICIANS: • Are they REALLY an endangered species?

  3. OR: • …are we just pushing the panic button?

  4. THE HISTORY OF: Physician Supply in America (Readers Digest Version)

  5. IN THE LATE 19TH CENTURY: • The United States was producing nearly half of the world’s medical graduates • Many of them were… Source: Annals of Surgery, Oct. 2007

  6. ALONG COMES • THE FLEXNER REPORT (1910) • 1890….approximately 450 medical schools • 1910….131 medical schools • 1924…..79 medical schools Source: Association of American Medical Colleges

  7. GOVERNMENT PROVIDES A PUSH • WWII….first federal subsidy of medical education • (the V-12 program) • The GI Bill…first stipend allowing medical graduates to afford a residency and a family • Medicare (1965)….direct and indirect payment for graduate medical education (GME) • MEDICARE FUNDS 30% MORE RESIDENT POSITIONS THAN THERE ARE GRADUATES OF U.S. MEDICAL SCHOOLS Source: Annals of Surgery, Oct. 2007

  8. THE POST WAR BABY BOOM • 1946 – 1964…. • 75 million kids seeking “life, liberty and • the pursuit of happiness.”

  9. MORE PEOPLE, MORE GOVERNMENT SPENDING, MORE TECHNOLOGY • = MORE DOCTORS • 1950…79 medical schools, • 5,553 graduates • 1988…127 medical schools, • 16,000 graduates Source: Association of American Medical Colleges

  10. BUT DID WE GO TOO FAR? • 1980: Council on Graduate Medical Education National Advisory Committee (GMENAC)…. • 145,000 too many doctors by 2000 • 1993: Council on Graduate Medical Education… • 100,000 to 165,000 too many doctors by 2000

  11. PUTTING ON THE BRAKES • 1997: CONGRESS CAPS MEDICARE RESIDENCY FUNDING • Total number of residents coming out each year is fixed at around 24,000 • 17,000 U.S. grads • 6,000 – 7,000 foreign grads and U.S. IMGs • 129 medical schools (two added in 20 years)

  12. PHYSICIAN SUPPLY HAS BEEN STATIC • FOR ABOUT 25 YEARS

  13. MEANWHILE, • THE EARTH STOOD STILL Well, not quite.

  14. 50 MILLION PATIENTS ADDED (we will be adding the population of Britain) Source: U.S. Census

  15. 75 MILLION BABY BOOMERS BEGIN TURNING 65 IN 2011

  16. PATIENT VISITS BY AGE Source: National Ambulatory Medical Care Survey; www.cdc.gov

  17. FLORIDA IS OUR FUTURE • By 2030, the entire country will be as old, on average, • as Florida is now. Source: U.S. Census Bureau

  18. WHAT ELSE HAS CHANGED? • 33% of physicians 55 or older • Cap on resident hours • 50% of medical students female • Obesity increases 60% from 1991 to 2000 • ED visits rise 14% in 3 years (1997-2000) • Botox, bariatrics, non-invasive, gene therapy, etc. • 10,000 prescription drugs (up from 3,000 in 1970)

  19. OUR APPETITE FOR HEALTHCARE KEEPS GROWING…. • …WHILE THE SUPPLY OF PHYSICIANS (NET FTEs) IS SHRINKING

  20. SHRINKING FTEs • Young physicians seek set hours, regular vacations • 48% of physicians 50-65 plan to retire, find a non-clinical job, work PT or close their practices in the next one to three years. • 2016: Doctor exits to exceed entrants Source: MHA 2007 Survey of Physicians 50 – 65: MGT of America

  21. A MATTER OF ACCESS Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians

  22. PRIMARY CARE… • ONE OF THOSE JOBS AMERICANS “JUST WON’T DO?” • 52% of Year 1 FP residency positions filled by IMGs • 42% of Year I IM residency positions filled by IMGs

  23. WAVE OF THE FUTURE? • Concierge medicine decreases access Two physicians in Arlington, Virginia, drop 4,000 of their 5,000 patients 1000 patients pay $1,500 a year for unlimited access

  24. CONFIRMED: • A GROWING GAP BETWEEN PHYSICIAN SUPPLY AND DEMAND Demand 1.1 Million Supply 0.9 Million

  25. CONFIRMED BY WHOM? • American Medical Association • The looming physician shortage is “no less ominous” than the threat of a pandemic • ~ Dr. J. Edward Hill, • Past President, American Medical Assn. • American Medical News, Feb. 20, 2006

  26. ALSO: • Association of American Medical Colleges • (seeks to increase medical school enrollment by 30%) • Council on Graduate Medical Education • (now projects a shortage of 90,000 physicians by 2020) • 15 State Medical Associations and Societies • 15 Medical Specialty Societies.

  27. MEANWHILE, HEALTH REFORM IS BACK ON THE TABLE

  28. IMPLICATIONS OF HEALTHCARE REFORM • Increasing coverage = increased demand • The Lewin Group projects that demand created by universal access would require: • 35,000 more physicians costing $9 billion • 40,000 more nurses costing $3 billion • 15,000 pharmacists costing $2 billion • 4,000 dentists costing $700 million SOURCE: Forbes.com 03/26/07

  29. IMPLICATIONS OF OBAMA’S PLAN The Lewin Group predicts plan would cover an additional 26.6 million people • Uninsured obtaining coverage through Medicaid expansion to 150% FPL….13.4 million • Uninsured signing up for national plan…3.78 million • Uninsured purchasing insurance through private plans…2.1 million • Uninsured obtaining insurance in national plan through employer…3.59 million • Uninsured obtaining private insurance through employer…5.42 million

  30. IMPLICATIONS OF OBAMA’S PLAN Total of additional primary care docs needed by 2010 to serve newly insured…

  31. THE STIMULUS PACKAGE • $95 billion for state Medicaid programs • $20 billion to expand health information technology • $30 billion for COBRA coverage for laid off workers • $4 billion for preventive medicine • $500 million to increase the number of primary care providers • Additional funds for NIH, Indian Health, VA facilities, CDC, Department of Defense facilities

  32. THE STIMULUS PACKAGE • $500 million to increase primary care providers • $300 million doubles annual budget for National Health Services Corps for 2009 & 2010. • $200 million for Health Professionals Training Programs

  33. FUNDING FOR SCHIP $34.3 billion for SCHIP over 5 yrs. for children of families at up to 300% of FPL, as well as documented immigrants who have been in the country less than 5 years.

  34. HYPOTHETICAL • WHAT IF 47 MILLION PEOPLE, NEWLY INSURED, GENERATE TWO VISITS PER YEAR MORE EACH TO PRIMARY CARE PHYSICIANS THAN THEY DID BEFORE THEY OBTAINED ACCESS? • 94 million divided by 2,200 = 42,727 more physicians needed                                                                                                                                                               Source: MGMA Physician Compensation & Production Survey

  35. HAVE WE SEEN THIS MOVIE BEFORE? Universal Access! Repeat Performance Repeat Performance

  36. A TEST CASE: MASSACHUSETTS: • 340,000 of the state’s 600,000 uninsured gained coverage • RESULT: SOURCE: *UPI, July 27, 2007 ** New York Times, April 4, 2008

  37. WE HATE TO SAY“I TOLD YOU SO,” BUT… • “WITHOUT MORE DOCTORS, UNIVERSAL ACCESS IS A MOOT POINT,” • By Joseph Hawkins • HealthWeek, • May 20, 1991

  38. WHAT CAN BE DONE? • Based at: • The University of Pennsylvania

  39. 30% increase in nurse training • (emphasis on 4-tier BSN training) • 30% increase in physician GME • (Medicare cap to be remanded) • An immediate White House conference on medical and nurse education “COUNCIL CALLS ON WHITE HOUSE TO CONVENE NATIONAL CONFERENCE ON PHYSICIAN AND NURSE SUPPLY”

  40. THE KEY: • REMOVE THE CAP ON RESIDENCY FUNDING See: The Resident Physician Shortage Reduction Act 1,222 new residency slots

  41. FEBRUARY 10, 2009 • Congressman Michael Burgess, M.D. (R –Texas) introduces: • The Physician Workforce & Graduate Medical Education Enhancement Act • $1 million to hospitals in small an emerging areas to attract and retain the physicians they need

  42. ALSO: • RETHINK PAYMENT FOR PRIMARY CARE

  43. WILL THE MEDICAL HOME SAVE PRIMARY CARE?

  44. WHAT TO DO: • RETHINK GME • Is there a way to plan for the number and type of physicians we need most? • Primary care • Geriatrics • General surgeons

  45. HEALTH CARE IS ALL ABOUT PEOPLE …AND WE DON’T HAVE ENOUGH OF THEM.

  46. Will The Last Physician in America Please Turn Off The Lights?

More Related