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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 --- 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
GME EXPANSION COMMITTEE
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
GME EXPANSION COMMITTEE
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
GME EXPANSION COMMITTEE
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
GME EXPANSION COMMITTEE
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
GME EXPANSION COMMITTEE
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.
GME EXPANSION COMMITTEE
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
GME EXPANSION COMMITTEE
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
GME EXPANSION COMMITTEE
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.
GME EXPANSION COMMITTEE
BUSINESS PLAN & FINANCING
Business Plan Template
Review of Funding Mechanisms
Review of Legislative Initiatives
GME EXPANSION COMMITTEE
COMPLEXITIES
Staging Implementation
Funding
Health Systems
ACGME/RRC
Faculty Development
GME EXPANSION COMMITTEE
OUTCOME THEMES
Be Prepared - Shovel Ready
Cooperative Infrastructure
Think Creatively – Out of the Box
Think Bigger – Accept Incremental Growth
UWSOM Commitment to GME