The State of the Physician Workforce
Michael J. Dill
Director, Workforce Studies, AAMC
November 3, 2018
• Da’Shia Davis, BS
• Kara Fisher, MPH
• Sarah Hampton, BA
• Xiaochu Hu, PhD
• Karen Jones, MApStat
• Scott Shipman, MD, MPH
• Preeti Iyer, BSE
• Camille Moeckel
• Michelle Ogunwole, MD
• Laura Ostapenko, MD, MPP
The AAMC Workforce Studies Team
The State of the Physician Workforce
Projections
Trends
Diversity
People Who Need Care
Overview
How it all fits together
Projections
Trends
Diversity
People Who Need Care
Will we meet our need?
Pipeline growth & limits
Workforce changes
Pipeline growth & limits
Workforce changes
Access growth & limits
Population changes
Projections
Projections
The State of the Physician Workforce
Projections inform policy, and updates inform projections
For the fourth time,
projections show
shortages of
physicians in both
primary and
specialty care, with
a large shortage
among critical
surgical specialties.
Projections based on key trends, current utilization, most likely scenarios
• Begin with 2016 “level of care” as status quo
• Key trends modeled as supply and demand scenarios
• Focus on most likely 25th-75th percentiles of paired projections
We model multiple scenarios
Supply scenarios Demand scenarios
Status quo Status quo
Work hours Managed care
GME Retail clinics
Retirement – earlier APRNs/PAs – moderate
Retirement - later APRNs/PAs - high
Population health
We look at all possible pairings of scenarios
700,000
750,000
800,000
850,000
900,000
950,000
1,000,000
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Demand (Status Quo)
Demand (Managed Care)
Demand (Retail Clinics)
Demand (APRN/PA High)
Demand (APRN/PA Moderate)
Demand (Population Health)
Supply (Declining Hours)
Supply (GME Expansion)
Supply (Retire 2 Years Earlier)
Supply (Retire 2 Years Later)
Supply (Status Quo)
Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.
Growing shortage of physicians projected from 2015 to 2030
42,600
121,300
-50,000
0
50,000
100,000
150,000
200,000
2016 2030
Projected Physician Shortfall Range, 2015-2030
2030Range
Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.
The size and range of projected physician shortages varies by specialty group
14,800
33,800
-700
20,700
20,300
49,300
72,700
9,600
30,500
31,800
Primary Care Specialties
Non-Primary Care
Medical Specialties
Surgical Specialties
Other Specialties
Projected physician specialty group shortfall ranges, 2030
Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.
Projections - Summary
• Most recent report consistent with past• Shortages
• Surgical specialties
Trends
Trends
The State of the Physician Workforce
Trends
• UME
We have 26 27 new medical schools since 2006
Central Michigan
UC Riverside
Western Michigan
Cooper Rowan
South Carolina
Greenville
Quinnipiac-Netter
Florida Atlantic-
Schmidt
Arizona Phoenix
California Northstate
University
Oakland Beaumont
Hofstra
Northwell
Geisinger
Commonwealth
Virginia Tech
Carilion
Texas Tech-Foster
Central Florida
FIU-Wertheim
San Juan Bautista
(Puerto Rico)
Dell Medical School
at UT-Austin
College of
Henricopolis
Roseman University
of Health Sciences
Seton Hall-
Hackensack
UT-Rio Grande
Valley
Applicant or
Candidate
School
Preliminarily
Accredited
Provisionally
Accredited
Fully
Accredited
University of
Nevada, Las Vegas
CUNY
CA University of
Science and
Medicine
TCU and UNTHSC
WA State University
Kaiser Permanente
Nova
Southeastern
Carle Illinois
New York– Long Island
US MD enrollment expected to exceed 30% increase
Source: Results of the 2017 AAMC Medical School Enrollment Survey
0
5,000
10,000
15,000
20,000
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Original schools
(n=125)
All Schools (n=149)
Actual Enrollment Survey data Projections
30% over 2002
Medical schools’ concern about clinical training opportunities for their students continues to grow
73%77%
54%
85%89%
67%
0%
20%
40%
60%
80%
100%
Number of clinical training sites Supply of qualified primary care preceptors Supply of qualified specialty preceptors
Pe
rce
nta
ge o
f sc
ho
ols
co
nce
rne
d a
bo
ut
clin
ical
tra
inin
g o
pp
ort
un
itie
s
2010 2017
Source: AAMC 2017 Medical School Enrollment Survey Report
Pressure from sites regarding payment for student rotations on the rise
32%
46%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Pressure from existing clinical training sites regarding payment(s) for student rotations
Perc
enta
ge o
f sc
ho
ols
exp
erie
nci
ng
dif
ficu
ltie
s w
ith
exi
stin
g cl
inic
al t
rain
ing
site
s
Source: AAMC 2017 Medical School Enrollment Survey Report
2009 2017
Turnover and difficulties with replacement of physician volunteers are growing problems
11%
17%
19%
24%
0%
5%
10%
15%
20%
25%
30%
High turnover among volunteer physicians Difficulty in replacing retired physician volunteers
Perc
enta
ge o
f sc
ho
ols
exp
erie
nci
ng
dif
ficu
ltie
s w
ith
ex
isti
ng
clin
ical
tra
inin
g si
tes
Source: AAMC 2017 Medical School Enrollment Survey Report
2009 2017 2009 2017
Overall MD & DO first year enrollment is projected to grow 59% between 2002 and 2021
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Firs
t ye
ar e
nro
llmen
t
Projected MD and DO first year enrollment through 2021
DO - 196%
MD - 35%
Source: AAMC 2016 Medical School Enrollment Survey Report
30 new DO programs, including remote sites and branch campuses
PAs & NPs are growing their pipelines rapidly
2007 2008 2016
PA programs 134 209
PA enrollment 10,920 21,585
DNP programs 53 313
DNP enrollment 3,415 25,289
Source: PAEA Program Reports; AACN Correspondence.
Competition, especially from DO, NP & PA programs, rising rapidly
26%24% 24%
54%
31%
58%
0%
10%
20%
30%
40%
50%
60%
70%
Competition from osteopathic medicalschools for clinical training sites
Competition from offshore medicalschools for clinical training sites
Competition from other health careprofessionals (e.g., NPs, PAs)
Perc
enta
ge o
f sc
ho
ols
exp
erie
nci
ng
dif
ficu
ltie
s w
ith
ex
isti
ng
clin
ical
tra
inin
g si
tes
Source: AAMC 2017 Medical School Enrollment Survey Report
2009 2017 2009 2017 2009 2017
The Economics of Supply and Demand for Year 3 and 4 Clinical Clerkships
• Create an understanding of current situation
• Highlight contributing factors
• Focus on challenges and options moving forward with innovative solutions
• Hilton: Austin Grand Salon FG
• Today: 3:15-4:30 pm
• Anne Barnes
• Raymond Curry
• Tim Johnson
Trends
• GME
Medical schools concerned about students’ ability to find a residency training position
2012 2012 20122013 2013 20132014 2014 20142015 2015 20152016 2016 20162017 2017 20170%
25%
50%
75%
100%
For my incoming students In my state Nationally
Percent of schools reporting major or moderate concern
Source: AAMC 2017 Medical School Enrollment Survey Report
Residents entering pipeline rising, but slowly
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Residents entering ACGME
+ 1.2% per year
Sources: ACGME Data Resource Books.
+ 3.4% per year
Recent growth in DO residents and fellows may reflect shift to a single GME accreditation system
Source: ACGME Data Resource Books.
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Residents entering ACGME pipeline by school type
USMD
IMG
DO
Average annual growth rate
2005-2015 2015-2017
USMD 1% 2%
IMG 0% 3%
DO 5% 14%
Trends
• GME Retention
11 years after
residency37,818
Clinically Active Physicians
30% Practicing
in same HRR as Residency
• Higher retention for• Female physicians
• Physicians with 3+ gap years before med school
• Primary care physicians
• Physicians with ties to state of residency
How far does the apple fall from the tree?
Source: Ostapenko & Fisher. Forthcoming. “How far does the apple fall from the tree? Factors Associated with Physician Retention in the Geographic Location of their Residency”.
HRR RetentionNumber of
Physicians
Birth State
Same as residency 9,212
Different than residency 28,606
Undergraduate State
Same as residency 10,912
Different than residency 23,130
Medical School State
Same as residency 14,568
Different than residency 22,472
Previous times in Residency State
None 19,373
One 6,857
Two 6,929
Three 4,659
43%
26%
43%
25%
42%
23%
21%
34%
43%
47%
Ties to location have the strongest effect
Source: Ostapenko & Fisher. Forthcoming. “How far does the apple fall from the tree? Factors Associated with Physician Retention in the Geographic Location of their Residency”.
Trends
• Practicing physicians
Physicians are working fewer hours, especially male physicians
2005-07 2005-072008-12 2008-122012-16 2012-160
10
20
30
40
50
60
Male Female
Average hours worked per week
- 17,700 FTE physicians in 8 years
Source: Census Bureau, American Community Survey 2005-7 3-year estimates, 2008-12 and 2012-16 5-year estimates. Accessed via IPUMS-USA.
0
2,000
4,000
6,000
8,000
10,000
12,000
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Physicians retiring
Post-recession, physician retirements are rising
Source: AMA Masterfile year end 2004-year end 2016. Notes: Figures are three-year rolling averages. Only counts those who move to fully retired TOP='071’.
Some large specialties are older than others
Specialty Total active physicians Percent 55+ years
Psychiatry 38,193 61.3
Anesthesiology 41,753 51.7
Radiology and Diagnostic Radiology 27,711 51.6
General Surgery 25,026 46.4
Family Medicine/General Practice 113,283 45.7
Internal Medicine 115,476 44.2
Obstetrics and Gynecology 41,623 43.5
Pediatrics 58,406 42.2
Emergency Medicine 42,280 34.8
Psychiatry
Source: AMA Physician Masterfile; CDC Wonder Database.
General surgery
Source: AMA Physician Masterfile; CDC Wonder Database.
Trends
• Wellness
Physician wellness
matters to everyone
“Physician burnout is associated with
suboptimal patient care and professional
inefficiencies; health care organizations have
a duty to jointly improve these core and
complementary facets of their function.”
• Pangioti, Geraghty, Johnson, et al. JAMA Intern Med. 20148.
Physician Burnout
• 42% burned out
➢Male – 38%
➢Female – 48%
Source: Medscape National Physician Burnout & Depression Report, 2018.
The roots of burnout are many
Main physician-reported causes of burnout:
• Too many bureaucratic tasks (e.g., charting, paperwork)
• Spending too many hours at work
• Lack of respect from administrators/employers, colleagues, or staff
• Increasing computerization of practice
https://www.aamc.org/wellbeingSource: Medscape National Physician Burnout & Depression Report, 2018.
Sexual harassment is common in academic medicine
“Women students, trainees, and
faculty in academic medical
centers experience sexual
harassment by patients and
patients’ families in addition to the
harassment they experience from
colleagues and those in
leadership positions.”
-National Academies of Sciences,
Engineering, Medicine
Trends Summary
• Exceed enrollment goal
• Clerkships & GME
• Single accreditation
• Work hours declining
• Retirement on the rise
• Burnt out
Diversity
Diversity
The State of the Physician Workforce
Diversity
• UME
Number of schools with programs to recruit under-represented groups rising
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Minority groups currentlyunderrepresented in
medicine
Students withdisadvantaged
backgrounds (low income,low SES, recent
immigrants, etc.)
Students from ruralcommunities
Students from urbanunderserved communities
Students from localunderserved communities
Percentage of respondents who have an established program for recruiting the following populations, 2015-2017
2015 2016 2017
Source: AAMC Medical School Enrollment Survey Reports, 2015-2017.
Most medical school matriculants are now female
30
35
40
45
50
55
2008-2009 2011-2012 2014-2015 2017-2018
Applicants and Matriculants to U.S. Medical Schools, Percent Female, 2008-2009 through 2017-2018
Matriculants
Applicants
Source: AAMC Applicants and Matriculants Data.
Recent diversification of matriculants has been uneven
-21%
17%23%
12%
-48%
0%
-26%
35%
-60%
-50%
-40%
-30%
-20%
-10%
0%
10%
20%
30%
40%
American Indianor Alaska Native
Asian Black or AfricanAmerican
Hispanic, Latino,or of Spanish
Origin
Native Hawaiianor Other Pacific
Islander
White Other MultipleRace/Ethnicity
Change in Matriculants to U.S. Medical Schools by Race/Ethnicity, 2014-2015 through 2017-2018
Source: AAMC Applicants and Matriculants Data.
Many minorities still under-represented among medical school graduates and residents
Actual 2017 Composition
American Indian or
Alaska Native Asian
Black or African
American
Hispanic, Latino or of
Spanish Origin
Native Hawaiian or
Other Pacific
Islander White
Multiple Race/
Ethnicity
Graduates 0% 21% 6% 5% 0% 56% 8%
Residents 0% 27% 5% 8% 0% 53% 4%
Population 25-29 yrs. 1% 7% 15% 21% 0% 55% 2%
Source: AAMC FACTS Table B4 with the persons of Hispanic origin and one or more race moved out of the Multiple Race/Ethnicity into Hispanic; ACS Data from the US Census.
Black Males in Medicine
American Indians and Alaskan Natives under-represented in the physician workforce
Only 0.56% of active physicians in the US identify as American Indian or Alaskan Native (alone or in combination with another race)
Active U.S. MD physicians in 2016 who identify as American Indian or Alaska Native.
Source: American Medical Association Physician Masterfile, Dec. 31, 2016; US Census, 2012-2016 5-year ACS.
The demographics on graduating AI-AN
physicians and those represented within
the Native health care workforce are
appalling and embarrassing.
-Ronald Shaw, MD (Osage-Creek)
The AAMC is honored to co-create this
report with the AAIP, and it is our hope that
we can all assist in addressing the
challenges facing our Native communities
across America. There has never been a
better time to… remind ourselves of the
social accountability we have, as
academic medical institutions, to society.
-David A. Acosta, MD, FAAFP
Diversity
• Practicing physicians
The US physician workforce is aging
0
50,000
100,000
150,000
200,000
250,000
Age 26 to 35 Age 36 to 45 Age 46 to 55 Age 56 to 65 Age 66 or older
Physicians in the US, 1980 to 2012-16
1980 1990 2000 2008-12 2012-16
Source: Census Bureau 1980, 1990, 2000 5% state sample, American Community Survey 2005-7 3-year estimates, 2008-12 and 2012-16 5-year estimates. Accessed via IPUMS-USA.
Production of new physicians not keeping pace with aging workforce (change)
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
ResidentsenteringACGME
Physiciansturning 65+ 101%
+ 25%
Sources: National Population by Characteristics: 2010-2017 from the U.S. Census. https://www.census.gov/data/tables/2017/demo/popest/nation-detail.html; Physicians turning 65: AMA Masterfile as of years-end 2004-2017; Residents entering GME: ACGME Data Resource Books, academic years 2003-2004 through 2016-2017.
Source: Census Bureau 1980, 1990, 2000 5% state sample, American Community Survey 2005-7 3-year estimates, 2008-12 and 2012-16 5-year estimates. Accessed via IPUMS-USA.
US physician workforce continues to grow and to include more female physicians
0
200,000
400,000
600,000
800,000
1980 1990 2000 2005-07 2008-12 2012-17
Physicians in the US, 1980 to 2012-2016
Male Female
12%10%
16%
23%
28%
31%32%
www.aamc.org/specialtydatareport
Specialties with the highest percentages of female physicians
Specialty Total physicians Percent female
Pediatrics 36,945 63.3
Obstetrics & Gynecology 23,740 57.0
Pediatric Hematology/Oncology 1,489 53.4
Internal Medicine/Pediatrics 2,704 52.8
Child and Adolescent Psychiatry 4,849 52.7
Geriatric Medicine 2,939 52.6
Source: AAMC Physician Specialty Data Report. 2018.
Active Physicians, Percent Female, by Specialty, 2017
Specialty Total physicians Percent male
Orthopedic Surgery 17,981 94.7
Sports Medicine (Orthopedic Surgery) 2,440 93.4
Thoracic Surgery 4,102 93.0
Interventional Cardiology 3,546 92.3
Neurological Surgery 5,065 91.6
Urology 9,051 91.3
Source: AAMC Physician Specialty Data Report. 2018.
Active Physicians, Percent Male, by Specialty, 2017
Specialties with the highest percentages of male physicians
Most workforce race and ethnicity diversity is from USMG and USIMG physicians
0
20,000
40,000
60,000
80,000
Black orAfrican
American
AmericanIndian or
Alaskan Native
Asian or PacificIslander
Other race Two or moreraces
Hispanic
FIMG, 2005-2007
0
20,000
40,000
60,000
80,000
Black orAfrican
American
AmericanIndian or
Alaskan Native
Asian or PacificIslander
Other race Two or moreraces
Hispanic
USMG & USIMG, 2005-2007
Source: US Census Bureau.
Most workforce race and ethnicity diversity is from USMG and USIMG physicians
0
100,000
200,000
300,000
400,000
500,000
Black orAfrican
American
AmericanIndian orAlaskanNative
Asian orPacific
Islander
Other race Two ormore races
Hispanic White
FIMG, 2005-2007
0
100,000
200,000
300,000
400,000
500,000
Black orAfrican
American
AmericanIndian orAlaskanNative
Asian orPacific
Islander
Other race Two ormore races
Hispanic White
USMG & USIMG, 2005-2007
Source: US Census Bureau.
What We Do Not Know(Because It Has Not Been Asked)
Sexual orientation Gender identity Military Service
Disability StatusExperience of Bias, Harassment, Assault or Harm
Diversity Summary
• Female matriculants > 50%
• Rural matriculants declining
• Race and ethnicity uneven - but still nowhere near representation
• Black males
• American Indians and Alaskan Natives
• Older
• More female
• Much we do not know
People Who Need Care
The State of the Physician Workforce
People Who Need Care
People
• Health Care Utilization Equity
What does health care utilization equity look like?
• Same use of care
• Says nothing about quality
• Says nothing about outcomes
• Window into magnitude of unmet need
The magnitude of unmet need
What if barriers disappeared? How much more utilization (in 2016) if…
• Everyone used care like insured people living in metropolitan areas?
• Everyone used care like white insured people living in metropolitan areas?
Scenario 1
Scenario 2
Estimated Additional Physicians Needed if U.S. Had Achieved Health Care Utilization Equity in 2016
Scenario 1:Insurance &
Metro/Non-metro
31,600 Additional Physicians
Scenario 2:Insurance,
Metro/Non-metro, &
Race/Ethnicity
95,100Additional Physicians
Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.
Estimated Additional Physicians Needed if U.S. Had Achieved Health Care Utilization Equity in 2016
Scenario 1(Insurance,
Metro) Primary CareScenario 2
(Insurance, metro, race)
Scenario 1(Insurance,
metro)
Scenario 2(Insurance,
metro, race)
Specialty Care
9,800
20,700
21,800
74,400
Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.
Health care use would change most in metropolitan areas
Scenario 1(Insurance,
Metro)
Non-metropolitan
Scenario 2(Insurance,
metro, race)
Scenario 1(Insurance,
metro)
Scenario 2(Insurance,
metro, race)
Metropolitan
15,100
19,100
16,500
76,000
Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.
People
• Population Trends
(Who Need Health Care)
The nation’s population is growing rapidly
0
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
300,000,000
350,000,000
400,000,000
450,000,000
2016 2020 2025 2030 2035 2040 2045 2050
Total projected population
Source: Projected Age Groups and Sex Composition of the Population: Main Projections Series for the United States, 2017-2060. US Census Bureau, Population Division: Washington, DC.
+ 65,794,000
We are approaching a crossroads in our nation’s age profile
22.8%
20.1%
15.2%
22.0%
2016 2020 2025 2030 2035 2040 2045 2050
Projected percentage of the population
Under 18 years
65 years and over
Source: Projected Age Groups and Sex Composition of the Population: Main Projections Series for the United States, 2017-2060. US Census Bureau, Population Division: Washington, DC.
Demand increases as U.S population ages
Sources: NCHS NAMCS National Ambulatory Medical Care Survey, Annual Summaries 1990, 2000, 2010.
2.11.8
2.2
3.7
5.8
7.6
0
1
2
3
4
5
6
7
8
9
Under 15 15-24 25-44 45-64 65-74 75 and older
Average physician visits per person
19
90
19
95
20
00
20
05
20
10
20
15
19
90
19
95
20
00
20
05
20
10
20
15
19
90
19
95
20
00
20
05
20
10
20
15
19
90
19
95
20
00
20
05
20
10
20
15
19
90
19
95
20
00
20
05
20
10
20
15
19
90
19
95
20
00
20
05
20
10
20
15
The nation’s population is urbanizing rapidly
0
50000
100000
150000
200000
250000
300000
350000
1990 2014 2050
Urban Rural 87%
75%
81%
Source: UN report. https://esa.un.org/unpd/wup/publications/files/wup2014-highlights.pdf
Most demand will continue to come from metro areas
0
100000
200000
300000
400000
500000
600000
700000
Primary Care Non-primary Care
Projected demand, metro areas, 2016 & 2030
Metro 2016 Metro 2030
0
100000
200000
300000
400000
500000
600000
700000
Primary Care Non-primary Care
Projected demand, non-metro areas, 2016 & 2030
Nonmetro 2016 Nonmetro 2030
Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.
Most of the future demand growth will be from minority populations
White38%
Black14%
Asian, Pacific Islander, Native
American & Alaskan Native
17%
Hispanic31%
Percent of demand growth, 2016-2030
Source: AAMC, 2018 Update: Complexities of Physician Supply and Demand: Projections from 2016 to 2030.
People
• Access to Care
AAMC Consumer Survey of Health Care Access
Millions of Americans cannot always get care when they need it
Did not need care,27%
Needed care last 12 months-always able to
get it, 64%
Could not afford, 4%
Could not get appointment soon enough, 1%
Could not find provider, 2%
Other, 1%
Transportation problems, <1%
9% of U.S. adults (>22
million people) could not
always get care
Source: AAMC Consumer Survey of Health Care Access Wave 16, June 2018
Access to care has been improving
19%20%
17%16%
17%
15%
12%13%
0%
5%
10%
15%
20%
25%
2011 2012 2013 2014 2015 2016 2017 2018
Percent not always able to get care
Source: AAMC Consumer Survey of Health Care Access.
Racial and ethnic access disparities persist
0
5
10
15
20
25
30
35
White Black/AfricanAmerican
Hispanic andother
Asian Hispanic/Latino Multi-race (non-Hispanic)
AmericanIndian/Alaska
Native
Percent of respondents not always able to get care
2012 2018
Source: AAMC Consumer Survey of Health Care Access Waves 3-16, Native Hawaiian/Other Pacific Islander excluded due to small sample size
Access improving in all types of places
0%
5%
10%
15%
20%
2013 2014 2015 2016 2017 2018
Percent not always able to get care, 2013-2018
Urban
Rural
Suburban
Source: AAMC Consumer Survey of Health Care Access.
Access to care varies by more than race and rurality
11%
13%
11%
21%
30%
6%
14%
11%
18%
0% 5% 10% 15% 20% 25% 30% 35%
Male
Female
Heterosexual
Gay or Lesbian
Bi-sexual
No
Yes
No
Yes
Sex
Sexu
al o
rien
tati
on
Ph
ysic
ial
limit
atio
ns
Men
tal
limit
atio
ns
Percent of respondents not always able to get care, 2017-2018
Source: AAMC Consumer Survey of Health Care Access Waves 3-16, n>10,000
People Who Need Care Summary
• Many more people
• Older
• Urban
• Moving toward majority minority
• Access • Improving
• Disparities persist
The State of the Physician Workforce
Projections
Trends
Diversity
People Who Need Care
Review
Production of new physicians not keeping pace with aging workforce and population
0
10,000
20,000
30,000
40,000
50,000
60,000
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
ResidentsenteringACGME
Physiciansturning 65
Pop 65+(in thousands)+ 101%
+ 25%
+ 40%
Sources: National Population by Characteristics: 2010-2017 from the U.S. Census. https://www.census.gov/data/tables/2017/demo/popest/nation-detail.html; Physicians turning 65: AMA Masterfile as of years-end 2004-2017; Residents entering GME: ACGME Data Resource Books, academic years 2003-2004 through 2016-2017.
Other key takeaways
• A diverse physician workforce will not get easier to create if we wait
• Physician burnout is a national crisis
• Shortages are everywhere
“bias as the biggest challenge”
In addition to admitting women into programs,
we need to address how women, including
women of color, are progressing through their
careers starting with undergraduate and
graduate schools, probably all the way up to
their retirement. It’s about all the hurdles they
have that really seem to point to bias as the
biggest challenge. The same can be said for
men of color.
-Anita Hill
Monday, November 5, 8:45-10:00 amConvention Center: Hall 4
aamc.org/workforce
What’s next for AAMC’s Workforce Studies?
• Work hours
• Retirement
• Workforce diversity• More complete data
• Specialty-specific
• Programs
• Role of PAs/APRNs
May 1-3, 2019 - The Westin Alexandria, Alexandria, VA
Developing a health workforce for 2030 and beyond
• How do we train and prepare the current and future workforce to meet current and future needs? To skillfully deploy current and future technologies? To work effectively in current and future health care systems? How do we train and educate the workforce to keep up with the pace of change? How do we reconfigure training and education to keep up with the pace of change?
• What workforce do we need, where do we need them, and doing what, in order to have fewer disparities in the future?
• What partnerships are needed to connect the health workforce with the communities they serve in order to achieve fewer disparities and better health in communities across the country?
Questions? Please contact [email protected]