health workforce now and tomorrow urgent matters

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Health WorkforceNow and Tomorrow

Urgent Matters

Delaware Health Care Commission

December 1, 2011

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International Comparison of Spending on Health, 1980–2008

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United StatesNorwaySwitzerlandCanadaNetherlandsGermanyFranceDenmarkAustraliaSwedenUnited KingdomNew Zealand

Average spending on healthper capita ($US PPP)

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United StatesFranceSwitzerlandGermanyCanadaNetherlandsNew ZealandDenmarkSwedenUnited KingdomNorwayAustralia

Total expenditures on healthas percent of GDP

Source: OECD Health Data 2010 (June 2010).

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Number of Practicing Physiciansper 1,000 Population, 2006

3.8 3.8

3.53.4

3.3

2.8

2.52.4

2.32.1

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Netherlands Switzerland Germany France OECD

Median

Australia* United

Kingdom

United

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New

Zealand

Canada

*2005

Source: OECD Health Data 2008, “June 2008.”

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Federal Snapshot

• AAMC projects 91,500 physician shortage by 2020

• COGME projects 85,000 shortage by 2020

• HRSA: demand will outstrip supply

• Nearly 40% doctors over 55 – economists say 1/3 could retire in next 10 years

• More women physicians – work fewer hours

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Federal Snapshot

• RN’s over 50: 2000 2008– % total RN’s 33% 44.7%

• 157,000 pharmacy shortage -2020*

• Faculty shortages: nursing & pharmacy

• Demographics do not reflect population

• *Health Resources and Services Administration

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Delaware Snapshot

• 2,255 Est. physicians active practice

• 863 Est. pcp: 1 pcp to 1187 people

• Federally designated shortage areas: all Kent & Sussex & portions NCC– Meet or exceed 3500 to 1 ratio– COGME low end of acceptable – 1250 to 1

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Delaware Snapshot

• DE Healthcare Assn– 7900 nurses and allied professional between 2009 -

2014

• 1 to 9582 - Psychiatrist to population ratio

• 80% bachelor’s program report faculty shortage• Average faculty age (2006)

– 46 – diploma, certificate, associates– 53 – bachelor and graduate

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PCP – DE Age Distribution

PCP ‘08 DE ‘08 DE 2020 DE 2030

Under 40 19% 19% 19% 17%

40-49 29.2% 14.9% 11% 12%

50 – 64 35.4% 19% 20% 17%

Over 65 16.3% 14% 19% 24%

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PCP – DE Race Distribution

• Caucasian– PCP ’08 73% DE 2030 72%

• Asian– PCP ’08 20.%% DE 2030 .04%*

• African American– PCP ’08 4.5% DE 2030 23.5%

• Other– PCP ’08 1.2% DE 2030 .04%

– * Population Consortium does not separate Asian from “other”

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Hispanic & Non-Hispanic

Hispanic Non-Hispanic

• PCP ’08 4.2% 95.8%

• DE ’08 6% 94%

• DE 2020 10% 90%

• DE 2030 12.5% 87.5%

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Primary Care: WHY IT MATTERS

• Aging “Boomers” will create more demand for services

• Increased insured from ACA

• Increased rates of chronic illness

• Proven efficiency; cost effective; better outcomes

• Adequate supply critical to insuring access and maintain healthy populations

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Primary Care Challenges

• Medical School Debt $145,000 - $180,000• Annual Compensation:

– Orthopedics $473,770– Radiology $468,594– Dermatology $385,088– Pediatrics $192,000– Family Medicine $183,999– Geriatrics $179,950

• “ROAD” to success

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DHCC Strategies• DIMER DE Institute Medical Education & Research

– 20 slots Jefferson Medical College– 6 slots Phil. College Osteopathic Medicine

• DIDER – Delaware Institute Dental Education & Research– Dental residency support – CCHS– 5 slots Temple Univ. Kornberg School of Dentistry

• Loan Repayment– Repay undergraduate and graduate education debt – Must locate in federally designated under-served area

• Workforce Development

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SLRP Gets Results!

• 78 total

• 46 physicians

• 12 nurses

• 20 dentists

• 5 left after service

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Looking Ahead -

• Patient Centered Medical Home– Payment Reform– Scope of Practice

• Accountable Care Organizations– Team approach – best care, less spending– Evidence based medicine

• Technology – health information exchanges and electronic medical records

• Incentives – Loan Repayment

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CONTACT INFORMATIONPaula K. Roy

Executive Director

Delaware Health Care Commission

Margaret O’Neil Building

410 Federal St. Suite 7

Dover, DE 19901

302-739-2730

302-739-6927 fax

Paula.roy@state.de.us

www.dhcc.delaware.gov