For Legislators and Those Developing Sustainable Policy
A few workforce researchers are gathering into a
Distributional Analysis Policy
Center, for information, contact
rbowman@unmc.edu Recent contacts
include the province of Alberta, assistance given to the state of Iowa in new
workforce planning, collaborative works at the Rural WONCA meetings in Seattle
in 2006, and continued advice regarding the early path to admissions involving
education, college health advisors, medical students, and admissions committees.
The Physician Workforce Studies
web page is the main collection for new works. Searching on Google for Physician
Workforce will turn up this site as a top choice.
About the Site and Author
These studies involve complete data sets across the nation, not selected high
performing subgroups targeted for health policy promotion. One of the major
points throughout is the need for specific work in individual states and
individual state professional schools to help understand the distribution of
professionals, and access to education, economics, jobs, income, and health that
they provide. The works more specific to state decisions regarding health
professions include:
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Consistent Family Physician
Distributions - each class year, consistent distribution for years and years
and years to rural, to underserved to isolated and more
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Primary Care Workforce Years -
short comparing IM, PD, PA, NP, IMG 1 family physician supplies 0.85
FTE or nearly 26 primary care years out of a 30 year career. Takes 2 - 5
graduates of other primary care types to generate this level of primary care
workforce.
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Distributional Research Series
- medical school type, Visa programs, comparative studies of the best forms of
distribution, and more
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Distribution: Index Concentrations of
Physician Distribution - compare and contrast the
various types that distribute to rural underserved and urban underserved
locations. How do international medical graduate internal medicine
physicians compare to family physicians? What does birth origin have to do
with practice location?
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Five Periods of
Health Policy and Physician Career Choice - health policy has been the
primary influence upon career choice and upon physician distribution. Career
choice decisions are tracked by class year for the past 40 years. The nation
can distribute physicians but is making other choices.
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Instate Retention of Family
Physicians: Dependable Primary Care Workforce Retained Within States
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Same State Birth To Practice
Tables - which programs retain graduates instate
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Current Active Health Care Policy
Decisions
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Changes in
Specialty Choice 1987 - 1999 - lifestyle changes, not likely. Health
policy, demand, and other factors dominate career choices.
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Propositions - a variety of
amendments have been proposed to limit government. Limiting government care
prevent government from acting when it is most needed.
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Primary Care Retention
- family physicians remain in primary care while other physicians, nurse
practitioners, and physician assistants fall away over time under the
influences of current health policy and major medical centers
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Major Medical Centers
- understanding health policy, primary care, and distribution requires
understanding major medical centers, concentrations of physicians, and why
the nation cannot focus on major medical centers and still distribute health
care to rural and underserved areas.
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Distributional Medical Schools
- any medical school can graduate subspecialists and doctors for major
medical centers. Only a few serve all Americans. The ones who serve rural
and underserved America admit, train, and graduate students from rural and
underserved America and return them to the most needed locations, an effort
facilitated by health policy and choice of family medicine.
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Retention Within the Specialty of Family
Medicine - family physicians remain 98% in family medicine and 90% in
office based primary care. Sustained distribution and primary care levels
are key considerations.
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Office Based Proportions -
health policy, training choice, admissions, and education can all play a
role in improving primary care workforce and distribution. comparisons of
IM, FP, Peds, and Med Peds with data involving origins
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Bright Future Rankings - states
that invest in education and the future are more efficient, more equitable,
and also graduate, gain, and retain more family physicians
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Managed Care Comparison
Table - Managed
Care and Choice of FP - Medical school graduates of 1995 - 1997 had the
best choice of family medicine and the best physician distribution in the
nation's history. Those born in urban areas, those born instate, and younger
students were the most likely to have increased choice of FP.
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- Distributional Choices
and Health Policy - the nation can distribute physicians by health
policy, as in 1965 - 1978 and 1990 - 1997. Health care coverage for lower
and middle income and rural populations is essential.
- Family Medicine
Contributes More - the significant contributions of family medicine are
too often ignored, studies comparing physicians over longer time periods
reveal the advantages of a specialty that goes and stays and stays in family
medicine
- Medical School Expansion 2004 - 2017
School by School Table - predictions of future expansion
- Family Medicine: the Best and
Worst of Times - Why are some family physicians surviving and others
thriving? It will take improvements in the situations for the patients of FP
doctors to make them happy.
- Retention Within Family Practice - 98% of
recent family medicine graduates are still involved in FP, 1% did
fellowships and 1% have chosen other careers, not bad for those that faced
major managed care incentives to chose FP
- Changes in Admissions in US
Allopathic Schools - Higher income, fewer rural, more out of state, and
more foreign born mean more born and raised and educated and trained in
major medical centers and more physicians concentrating in the same
locations
- Patterns of Migration for FPs
- family physicians have at least 5 different patterns of distribution, all
advantages for states that wish to distribute and retain physicians
- Patterns of Rural Workforce
- states vary in their ability to recruit new family physician graduates
- Expansion Good Bad Ugly and Best
- expansion is needed, but the expansion should primarily address the needs
of lower and middle income and rural areas. There are plenty of leaks in
this pipeline to supply urban areas and specialists.
- Medical School Expansion 2004 -
2017 - attempt to keep track in a
table
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Cost, Quality, Access, and Physician Workforce
Expansion
Clearly some states have more difficult challenges regarding the delivery of
health care. When populations are sparse, the resources necessary to
delivery top notch health care become more difficult to access. The states
noted in this table face difficult challenges and any state with neglected
inner city populations is inundated with health care costs, prison costs, social
costs, and the general inefficiencies resulting when children lag behind by age
8.
The following
are some common questions with answers and references and examples:
- What are the best approaches to use?
- Why do shortages
persist despite years of effort?
- What is the
cost/benefit of a rural medical education program... ?
- What are potential
wastes of tax dollars?
- Addressing the Needs
for Rural Minorities
- Getting rural doctors to the
smallest towns
- Why doctors do go to small towns
Physician Workforce Studies
www.ruralmedicaleducation.org