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