tsdc utsa physician workforce presentation 040808

Physician Workforce in Texas: Recruitment,

Retention and Distribution

• Karl Eschbach, Office of the State Demographer/Texas State Data Center, University of Texas at San Antonio (Steve H. Murdock)

• Regional Center for Health Workforce Studies, University of Texas Health Science Center at San Antonio (Antonio Furino; Brad Pollock, Director)

• Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services (Brian King, et al)

The factors contributing to health workforce’s The factors contributing to health workforce’s availability availability

and shortage are many and change rapidly over and shortage are many and change rapidly over timetime

Geographic distribution: Geographic distribution: distances between providers, patients, and resourcesdistances between providers, patients, and resources

Age distribution and distribution among specialtiesAge distribution and distribution among specialties

Payers and the economics & psychic rewards of practices Payers and the economics & psychic rewards of practices

Educational capacityEducational capacity

RetentionRetention

Ethnic and racial distributionEthnic and racial distribution

237.1

782.9824.6

36.535.6

656.8

566.8

156.7146.5

45.547.4

203.5

0

200

400

600

800

1000

Texas United States

2007 2004 2007 2004 2007 2005

Physicians Registered Nurses Dentists

+11,202+19,072

+42,464+39,819

+2,317 +2,139

+ values = the number needed to bring the Texas ratio up to parity with the US ratio and is not an indication of demand

* Direct Patient Care Physicians** General Dentists Note: 1998 US Registered Nurse Ratio extrapolated from 1996 and 2000 data

1998 1998 1998

Physicians*, Registered Nurses, and Dentists** per 100,000 Population in Texas and the U.S.,

1998 and 2007

Health Professions Resource Center, Center for Health Statistics, Texas Department of Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, April 2008State Health Services, April 2008

Medical Workforce DynamicsMedical Workforce DynamicsDirect Patient Care (DPC) in TexasDirect Patient Care (DPC) in Texas

2002 - 20072002 - 2007

left TEXAS 1,287

inactive 2,646

left DPC 1,516

entered Fed. settings 319

inactive

Fed. settings

practiced in another state

not DPC(883 of thesewere residents)

862

1,340

236 367

not licensed in Texas6,094

Status In 2002:Status In 2002:Status In 2007:Status In 2007:

2002 DPC = 33,0942002 DPC = 33,094 2007 DPC = 37,1772007 DPC = 37,177

RemainedRemained in in DPC DPC 27,31127,311

Gained9,866

Lost5,783

research, locum tenens, other 15

locum tenens, other 83


Location of Medical SchoolLocation of Medical SchoolDirect Patient Care (DPC) in TexasDirect Patient Care (DPC) in Texas

45.1 %45.1 % 44.8 %44.8 %

20022002 20072007

31.5 %31.5 % 32.0 %32.0 %

23.4 %23.4 % 23.3 23.3 %%


The Profile of Change: 2002 and 2007 The Profile of Change: 2002 and 2007 Texas Direct Patient Care Physicians (DPC)Texas Direct Patient Care Physicians (DPC)

Increases in Female and Hispanic PhysiciansIncreases in Female and Hispanic Physicians

NOTE: Includes active, direct patient care, non-Federal physicians.

2002 (Total: 33,094)

Gender Age (in 2002) Race/Ethnicity

Female 21.4% Under 35 7.9% White (Non-Hispanic) 69.2%

Male 78.6% 35-44 30.9% Black 3.7%

45-54 32.2% Hispanic 10.7%

55-64 18.9% Asian/Pacific Islander 14.0%

65+ 10.1% Amer. Indian/Alaska Native 0.2%

Unknown 2.2%

2007 (Total: 37,177)

Gender Age (in 2007) Race/Ethnicity

Female 24.8% Under 35 6.3% White (Non-Hispanic) 64.6%

Male 75.2% 35-44 29.9% Black 4.5%

45-54 30.6% Hispanic 11.2%

55-64 21.9% Asian/Pacific Islander 17.3%

65+ 11.3% Amer. Indian/Alaska Native 0.3%

Unknown 2.1%


The Profile of Change: The Profile of Change: DPCs Who Exited and Entered Texas DPCs Who Exited and Entered Texas Between 2002 and 2007Between 2002 and 2007

Proportionally, more male exiting and more younger and URM doctors Proportionally, more male exiting and more younger and URM doctors enteringentering

DPC who exited Gender Age (in 2002) Race/Ethnicity

Texas Female 23.8% Under 35 7.7% White (Non-Hispanic) 74.6%Male 76.2% 35-44 25.3% Black 3.3%

45-54 23.8% Hispanic 7.6%55-64 19.2% Asian/Pacific Islander 12.1%65+ 23.9% Amer Ind./Alaska Native 0.1%

Total 5,783 Unknown 2.1%

DPC who entered Gender Age (in 2007) Race/Ethnicity

Texas Female 35.5% Under 35 23.3% White (Non-Hispanic) 55.4%Male 64.5% 35-44 49.7% Black 6.3%

45-54 17.7% Hispanic 11.0%55-64 6.0% Asian/Pacific Islander 25.4%65+ 3.3% Amer Ind./Alaska Native 0.3%

Total 9,866 Unknown 1.6%

NOTE: Includes active, direct patient care, non-Federal physicians.


Texas Direct Patient Care PhysiciansTexas Direct Patient Care PhysiciansAged 30-39, 40-49, 50-59Aged 30-39, 40-49, 50-59

1997 and 20071997 and 2007

30-39

40-49

50-59

Ages

20,000 15,000 10,000 5,000 0 5,000 10,000 15,000 20,000

1997 2007

* Includes active, direct patient care, Non-Federal physicians

6,622

10,137

6,291

10,313

10,491

7,668


There are marked differences in the way physiciansThere are marked differences in the way physiciansare distributed among the Texas Public Health Regionsare distributed among the Texas Public Health Regions

Direct Patient Care Physicians per 100,000 Population by Health Region in Texas,

1995 and 2005

147.5

125.8

166.0

152.7

115.1

155.7

140.7

119.1 119.3

99.2104.4

142.4

104.8

132.1123.1

104.6

125.1

141.3

114.7103.0

96.288.9

128.0

151.6

0

25

50

75

100

125

150

175

200

1 2 3 4 5 6 7 8 9 10 11 Texas

Pe

r 1

00

,00

0 P

op

ula

tio

n

1995 2005

Health Region

Rural Counties

Metropolitan Counties

Border Patient-Care Physicians -- 2002-2007

2002 DPC: 2,207 2002 DPC: 2,207 2007 DPC: 2,4682007 DPC: 2,468

1,761Remained in Remained in border (DPC)border (DPC)

Texas Non-Border Counties

Texas Border Counties

126

124

left Texas – 77left DPC – 51became inactive - 154entered Fed. Setting – 36other - 2

new licensees - 394from another state – 56entered DPC – 57became active - 14left Fed. Setting – 30residents/fellows - 32


Active DPC Physician Retention (1997 Cohort)Active DPC Physician Retention (1997 Cohort)Non-Border and 32 Border Texas CountiesNon-Border and 32 Border Texas Counties

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

1997 1999 2001 2003 2005 2007

Su

rviv

al

Non-Border

Border


Physician Retention (1993 Cohort)Physician Retention (1993 Cohort)Non-Border and 43 Border Texas CountiesNon-Border and 43 Border Texas Counties

Non-BorderNon-BorderBorderBorder

Population Change in Texas Counties, 2000-2005

Source: Prepared from U.S. Bureau of the Census, 2005 County Estimates by Texas State Data Center, The University of Texas at San Antonio

Percent Change 2000-2005

< 0.0% (n=101)

0.0 - 1.9% (n=33)

2.0 - 5.4% (n=48)

5.5 - 46.1% (n=72)

Number of Obese Adults by Race/Ethnicity, 1.0 Migration Scenario--Texas, 2000-2040

0

2

4

6

8

10

12

14

2000 2004 2008 2012 2016 2020 2024 2028 2032 2036 2040

Mill

ion

s o

f O

be

se A

du

lts

Hispanic

Black

Anglo

Other

Labor market processes as a function of physician Labor market processes as a function of physician

characteristics.characteristics.

Characteristics of practice environments Characteristics of practice environments

affecting recruitment and retention.affecting recruitment and retention.

Processes of recruitment, survival, migration of Processes of recruitment, survival, migration of

physicians within the state and in sub-areas of physicians within the state and in sub-areas of

the state.the state.

Evolving population-based demand based on Evolving population-based demand based on

projections of population growth by projections of population growth by

characteristics related to demand for health-care characteristics related to demand for health-care

services.services.

Identification of interventions that can increase Identification of interventions that can increase

supply of services areas where they are most supply of services areas where they are most

needed.needed.

What are the factors affecting What are the factors affecting

“optimal” physician workforce “optimal” physician workforce

distributiondistribution

It is necessary to complement shortage It is necessary to complement shortage data with reliable data with reliable and current information on practice and current information on practice location, location, service area, race/ethnicity/age of service area, race/ethnicity/age of providers and of the providers and of the population in need of health carepopulation in need of health care

These data are strategically important These data are strategically important for planning realistic, for planning realistic, location-targeted training options and a location-targeted training options and a sustainable sustainable educational capacity that would educational capacity that would effectively address effectively address the Texas health challengesthe Texas health challenges

ConclusionsConclusions

tsdc utsa physician workforce presentation 040808

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