forecasting the supply and demand for physicians in california through 2015:
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Forecasting the Supply and Demand for Physicians in California Through 2015: Results of the Study by the Center for Health Workforce Studies, University at Albany Presentation to: University of California Office of the Vice President – Health Affairs July 14, 2004 Oakland, California. - PowerPoint PPT PresentationTRANSCRIPT
Forecasting the Supply and Demand for Physicians in California Through 2015:
Results of the Study by the Center for Health Workforce Studies, University at Albany
Presentation to: University of California
Office of the Vice President – Health AffairsJuly 14, 2004
Oakland, California
Edward SalsbergCenter for Workforce Studies
Association of American Medical Colleges And
Gaetano ForteCenter for Health Workforce Studies
University at Albany
Overview of Presentation
1. The Demographic Forecast
2. The Physician Workforce 3. The Forecasting Methodology and Assumptions
4. The Findings
Project Goals
1. To create a demographic profile of California’s population in 2002 and 2015
2. To compile a current profile of physicians practicing in California
3. To identify and discuss factors affecting the California’s physician supply in the coming decade
Project Goals (cont.)
4. To identify and discuss the factors affecting demand for physicians services in California through 2015
5. To forecast and compare future physician workforce supply and needs (under 2 scenarios) in California through 2015
6. To advise UC on the steps necessary to better ensure an adequate supply of physicians in California through 2015
Demographic Profile of California
California Population
• 34.7 million (as of 2000)• About 12% of Americans • California population increased by 15.7%
between 1990 and 2000 (compared to 13% for U.S.)
• The population of California is projected to increase by 7.5 million (22%) between 2000 and 2015
Projected Population Growth in California, 2000-2015
30,000,000
32,500,000
35,000,000
37,500,000
40,000,000
42,500,000
45,000,000
Source: California Department of Finance
Projected Growth in Population 65 Years of Age and Greater in CA, 2002-2015
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
65+: 37% increase from 2002 to 2015
85+: 38% increase from 2002 to 2015
Source: CA Department of Finance, 1998
Projected Population Growth by Region, 2000-2015
Region 2000 Population 2015 Population % Change
Bay Area 7,199,291 8,308,080 15.4%
Central Coast 1,874,448 2,370,148 26.4%
Central Valley/Sierra 1,149,033 1,591,237 38.5%
Inland Empire 3,298,337 4,859,820 47.3%
Los Angeles 8,838,861 10,978,502 11.6%
North Valley/Sierra 2,085,706 2,736,248 31.2%
Northern California 904,963 1,149,853 27.1%
Orange County 2,833,190 3,277,959 15.7%
San Diego 3,097,190 3,900,304 25.9%
South Valley/Sierra 2,372,133 3,198,748 34.9%
Total 34,653,395 42,370,899 22.3%
Source: California Department of Finance
Projected Population Change by Age Group, 2000-2015
Age Group Population Change % Change
Under 5 Years 653,131 23.5%
5 to 17 Years 1,040,259 14.9%
18 to 24 Years 1,394,232 43.7%
25 to 44 Years - 117,247 - 1.0%
45 to 64 Years 3,188,320 44.1%
65 to 74 Years 1,144,704 58.5%
75 to 84 Years 195,247 15.0%
85 Years and Over 218,858 48.7%
Total 7,717,504 22.3%
Source: California Department of Finance
Racial/Ethnic Composition of California: 1990, 2000, and 2015
1990 2000 2015
White (non-Hispanic) 57.2% 50.3% 42.4%
African American/Black (non Hispanic) 7.0% 6.7% 6.4%
Asian/Pacific Islander (non Hispanic) 9.2% 11.5% 13.7%
Native American/Alaskan Native (non-Hispanic) 0.6% 0.6% 0.6%
Hispanic/Latino 26.0% 30.8% 36.9%
Source: California Department of Finance
The Current Physician Workforce
Number of Physicians in California by Activity, 2002
69,252
9,452
1,659 998 1,8197,290
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
Office/HospitalBased Patient
Care
Residents/Fellows
Research Teaching Administration Other
Source: AMA Physician Masterfile, 12/2002
Gender of Active Patient Care Physicians in California by Age, 2002
0
5,000
10,000
15,000
20,000
25,000
Under 35 35-44 45-54 55-64 65 or Older
Male Female
Source: AMA Physician Masterfile, 12/2002
4,317
54%46%
16,919
64%
36%
21,668
74%
26%15,738
85%
15%
10,610
92%
8%
Race/Ethnicity of Active Patient Care Physicians in California Compared to California Population, 2002
66%
3%
22%
4%
50%
12%
31%
< 1%
7%
1%0%
10%
20%
30%
40%
50%
60%
70%
White, non-Hispanic Black, non-Hispanic Asian/PacificIslander
NativeAmerican/Alaskan
Hispanic/Latino
CA Physicians CA Population
Sources: AMA Physician Masterfile, 12/2002; California Department of Finance
Location of Medical Education of Active Patient Care Physicians in California, 2002
UCAllopathic
62.3%
Non-UCAllopathic
34.3%
Non-UC Ostepathic
3.4%
California25.5%
Other Foreign County22.4%
Other US/Canada52.1%
Source: AMA Physician Masterfile, 12/2002
California Physician Supply and Demand Forecasting: Methodology
California Physician Supply and Demand Forecasting: General Approach
• Develop simple forecasting model for physician supply
• Use existing forecasting model for physician demand
• Use historical data to inform forecasting models
• Develop alternative scenarios to supplement baseline forecasts
• Assumes supply equals demand in base year
California Physician Supply Forecasting Model Details
Physician Supply Model Components
• Current active physicians
• New entrants• Graduate year 1 residents
• In-flow from other states
• Separations• Retirements
• Deaths
California Physician Supply Forecasting Model Details (cont.)
Physician Supply Model Equation:
Current year’s active physician supply
=Prior year’s active physician supply
+New Entrants and In Migration
-Retirements and Deaths
California Physician Supply Forecasting Model Details (cont.)
Assumptions• Entrants: 1900 graduate year 1 physicians
annually (based on actual average annual graduate year 1 physicians in CA between 1996 and 2002)
• In-Flow: 900 other physicians initiating practice in CA annually (based upon historical estimates of non graduate year 1 physicians initiating practice in CA between 1996 and 2002)
California Physician Supply Forecasting Model Details (cont.)
Assumptions (cont.)• Retirements: CA physicians will retire at the same
rate as physicians retired nationally in the past (estimated retirement rate grows from 0.87% to 1.22% between 2002 and 2015 due to aging of physician workforce)
• Deaths: Physician death rates in CA will mirror national physician death rates (estimated death rate grows from 0.37% to 0.45% between 2002 and 2015)
California Physician Supply Forecasting Scenarios
Supply Scenario Assumptions
1. Baseline Historical trends remain constant over period
2. Lifestyle Changes 10% reduction in work hours phased in over period
3. Productivity Increases
5% increase in physician productivity phased in over period
4. Lifestyle/Productivity Hybrid
10% reduction in work hours and 5% increase in physician productivity phased in over period
California Physician Demand Forecasting Details• Application of the HRSA Physician Demand Model (PDM)
• Demand forecasts consider:
• Population distribution (CA Dept of Finance)
• Trends in population demographics (CA Dept of Finance)
• Insurance coverage (US Census; Baumgarten 2002; California Health Interview Survey 2001)
• Utilization rates (by Race/Gender/Age/Specialty) (PDM)
• Contribution of non-physician clinicians (PDM)
California Physician Demand Forecasting Details
Assumptions• Use rates remain constant over time (baseline data
derived from national data - 2003 update of the PDM) by age, gender, insurance status, & setting.
• Physician productivity (time spent with a patient) remains constant over time (baseline data from national 2003 update of physician requirements – PARM)
• Physician demand equals supply in 2002
California Physician Demand Forecasting Insurance Environments
Physician demand was forecast in two distinct insurance environments:
1. Constant Insurance Environment: current levels of health insurance remain over forecast period
2. Expanded Insurance Environment: universal health insurance/other barriers to care removed; historically uninsured use physician services similarly as historically insured
California Physician Demand Forecasting Scenarios
Demand Scenario Assumptions
1. Baseline Historical trends remain constant over period
2. Economic Expansion
1% annual increase in the per capita GSP in CA; demand increases 0.75% for every 1% increase in GSP
3. Changing Physician Utilization Rates
Age-specific physician utilization rates in CA will change between 2002 and 2015 similarly to those observed nationally between 1990 and 2000
4. Elimination of Unnecessary/Marginally Beneficial Services
5% of physician services in CA eliminated over forecast period
California Physician Demand Forecasting Scenarios (cont.)
Demand Scenario Assumptions
5. Economic Expansion/Unnecessary Services Reduction Hybrid
Combines assumptions in Scenarios 2 and 4
6. Changing Physician Use Rates & Unnecessary Services Reduction Hybrid
Combines assumptions in Scenarios 3 and 4
California Physician Supply and Demand Forecasting: Findings
California Physician Supply: 2002-2015Total Physicians per 100,000 Population
2002 2015 % Change1. Baseline 252.7 253.6 0.4%
2. Lifestyle Changes
252.7 238.4 - 5.7%
3. Productivity Increases
252.7 266.7 5.6%
4. Lifestyle-Productivity Hybrid
252.7 249.9 - 1.1%
California Physician Demand: 2002-2015 (Constant Insurance Environment) Total Physicians per 100,000 Population
2002 2015 % Change1. Baseline 252.7 258.3 2.2%2. Economic Expansion 252.7 282.8 11.9%3. Changing Physician Use Rates
252.7 278.6 10.3%
4. Eliminate Unnecessary –Marginally Beneficial Services
251.8 245.4 - 2.5%
5. Econ Expans & Unnecessary Services Reduction Hybrid
251.8 268.7 6.7%
6. Changing MD Use Rates & Unnecessary Services Reduction Hybrid
251.8 264.7 5.1%
California Physician Demand: 2002-2015 (Expanded Insurance Environment) Total Physicians per 100,000 Population
2002 2015 % Change1. Baseline 252.7 282.9 11.9%2. Economic Expansion 252.7 309.6 22.5%3. Changing Physician Use Rates
252.7 298.9 18.3%
4. Eliminate Unnecessary –Marginally Beneficial Services
251.8 268.7 6.7%
5. Econ Expans & Unnecessary Services Reduction Hybrid
251.8 294.2 16.8%
6. Changing MD Use Rates & Unnecessary Services Reduction Hybrid
251.8 283.9 12.8%
Percent Difference between Physician Demand and Supply Growth, 2002-2015
Supply ScenariosConstant Insurance Environment
Demand Scenarios 1 2 3 4
1. Baseline 1.8% 7.9% (3.4%) 3.3%
2. Economic Expansion 11.5% 17.6% 6.3% 13.0%
3. Changing Physician Use Rates
9.9% 16.0% 4.7% 11.4%
4. Eliminate Unnecessary –Marginally Beneficial Services
(2.9%) 3.2% (8.1%) (1.4%)
5. Econ Expans & Unnecessary Services Reduction Hybrid
6.3% 12.4% 1.1% 7.8%
6. Changing MD Use Rates & Unnecessary Services Reduction Hybrid
4.7% 10.8% (0.4%) 6.2%
Red values in parentheses indicate physician surpluses.
Percent Difference between Physician Demand and Supply Growth 2002-2015, cont.
Supply ScenariosExpanded Insurance Environment
Demand Scenarios 1 2 3 4
1. Baseline 11.5% 17.6% 6.3% 13.0%
2. Economic Expansion 22.1% 28.2% 16.9% 22.7%
3. Changing Physician Use Rates 17.9% 24.0% 12.7% 21.0%
4. Eliminate Unnecessary –Marginally Beneficial Services
6.3% 12.4% 1.2% 6.6%
5. Econ Expans & Unnecessary Services Reduction Hybrid
16.4% 22.5% 11.3% 16.8%
6. Changing MD Use Rates & Unnecessary Services Reduction Hybrid
12.4% 18.5% 7.2% 12.8%
Absolute Difference between Physician Demand and Supply Growth, 2002-2015
Supply ScenariosConstant Insurance Environment
Demand Scenarios 1 2 3 4
1. Baseline 1,997 8,448 (3,556) 3,557
2. Economic Expansion 12,366 18,817 6,813 13,926
3. Changing Physician Use Rates 10,588 17,039 5,035 12,148
4. Eliminate Unnecessary –Marginally Beneficial Services
(3,153) 3,298 (8,076) (1,593)
5. Econ Expans & Unnecessary Services Reduction Hybrid
6,698 13,149 1,145 8,258
6. Changing MD Use Rates & Unnecessary Services Reduction Hybrid
5,008 11,459 (545) 6,568
Red values in parentheses indicate physician surpluses.
Physician Supply and Demand in California, 2015: Supply Scenario 1Baseline
107,464109,461
119,830118,052
103,988
113,839112,149
90,000
95,000
100,000
105,000
110,000
115,000
120,000
125,000
130,000
135,000
140,000
SupplyScenario 1
Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Scenario 6
Constant Insurance Environment
Physician Supply and Demand in California, 2015: Supply Scenario 2Lifestyle Changes
101,013
109,461
119,830118,052
103,988
113,839112,149
90,000
95,000
100,000
105,000
110,000
115,000
120,000
125,000
130,000
135,000
140,000
SupplyScenario 1
Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Scenario 6
Constant Insurance Environment
Physician Supply and Demand in California, 2015: Supply Scenario 3Productivity Increases
113,017109,461
119,830118,052
103,988
113,839112,149
90,000
95,000
100,000
105,000
110,000
115,000
120,000
125,000
130,000
135,000
140,000
SupplyScenario 1
Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Scenario 6
Constant Insurance Environment
Physician Supply and Demand in California, 2015: Supply Scenario 4Lifestyle Changes/Productivity Increases Hybrid
105,904109,461
119,830118,052
103,988
113,839112,149
90,000
95,000
100,000
105,000
110,000
115,000
120,000
125,000
130,000
135,000
140,000
SupplyScenario 1
Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Scenario 6
Constant Insurance Environment
Absolute Difference between Physician Demand and Supply Growth, 2002-2015 cont.
Supply ScenariosExpanded Insurance Environment
Demand Scenarios 1 2 3 4
1. Baseline 12,383 18,834 6,830 13,943
2. Economic Expansion 23,736 30,187 18,183 25,296
3. Changing Physician Use Rates 19,172 25,623 13,619 20,732
4. Eliminate Unnecessary –Marginally Beneficial Services
6,714 13,165 1,161 8,274
5. Econ Expans & Unnecessary Services Reduction Hybrid
17,499 23,950 11,946 19,059
6. Changing MD Use Rates & Unnecessary Services Reduction Hybrid
13,163 19,614 7,610 14,723
Physician Supply and Demand in California, 2015: Supply Scenario 1Baseline
107,464
119,847
131,200
126,636
113,855
124,640
120,304
90,000
95,000
100,000
105,000
110,000
115,000
120,000
125,000
130,000
135,000
SupplyScenario 1
Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Scenario 6
Expanded Insurance Environment
Physician Supply and Demand in California, 2015: Supply Scenario 2Lifestyle Changes
101,013
119,847
131,200
126,636
113,855
124,640
120,304
90,000
95,000
100,000
105,000
110,000
115,000
120,000
125,000
130,000
135,000
140,000
SupplyScenario 1
Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Scenario 6
Expanded Insurance Environment
Physician Supply and Demand in California, 2015: Supply Scenario 3Productivity Increases
113,017
119,847
131,200
126,636
113,855
124,640
120,304
90,000
95,000
100,000
105,000
110,000
115,000
120,000
125,000
130,000
135,000
140,000
SupplyScenario 1
Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Scenario 6
Expanded Insurance Environment
Physician Supply and Demand in California, 2015: Supply Scenario 4Lifestyle Changes/Productivity Increases Hybrid
105,904
119,847
131,200
126,636
113,855
124,640
120,304
90,000
95,000
100,000
105,000
110,000
115,000
120,000
125,000
130,000
135,000
140,000
SupplyScenario 1
Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Scenario 6
Expanded Insurance Environment
Mean Difference between Physician Demand and Supply Growth, 2002-2015
Supply Scenarios
Mean Difference 1 2 3 4
Percent Difference 9.8% 15.9% 4.7% 11.1%
Absolute Difference 10,514 16,965 4,961 12,074
Options for Addressing Physician Shortages
• Increase the Supply of Physicians in State• Increase medical school capacity• Increase GME capacity• Incentives for in-migration• Incentives to keep physicians in practice
• Other Approaches• Expand Use and supply of NPs, PAs and others• Invest in IT and other technologies • Increase utilization review and monitoring
Other Policy Options for California to
Address Physician Workforce Needs • Programs and policies to increase diversity
• Programs and policies to address major geographic mal-distribution of physicians
• Develop systems to assess and monitor physician workforce supply, demand and need
Conclusions
• California is likely to face moderate to significant shortages of physicians in the next decade
• Even if these shortages are moderate statewide, they are likely to be severe in some communities and in some specialties
• There are a number of steps the state can take to increase the supply of physicians and to address the geographic mal-distribution of physicians
• Tracking the supply, demand and need for physicians combined with tools to address likely gaps are critical if California is to assure access to care for its citizens in the coming decades