Systems Analysis of Primary Care Physician Supply

Major problems discovered

Increasing marketplace and policy emphasis is focused on the supply and distribution of primary care physicians. Accurate data sources at the state and national levels are lacking. Also, we lack analytical tools to incorporate data and to project future supply and distribution of the workforce effectively and to predict the consequences of proposed policy changes.

For more than 20 years the Department of Family Practice of the Medical College of Virginia has been surveying primary care physicians in non-metropolitan Virginia. The department has been repeatedly requested by the state policy makers to supply them with different ad hoc reports because the official information base (licensing board) is inexact. The starting point of these surveys is the Virginia State Board of Medicine Masterfile on physicians licensed to practice in Virginia. The main observation of the annual primary physicians surveys is that the official data from this Masterfile do not reflect the real situation with actively practicing primary care physicians. The annual surveys show that only about 60% of the primary care physicians listed in non-metropolitan areas are subsequently verified as actively practicing primary care. Some other assessments suggest that a similar effect takes place in the metropolitan areas.

[ Click here to see the elusive primary care physicians ]

The systems analysis of the situation in the supply of primary care physicians in Virginia discovered three fundamental problems:

  1. There are much fewer active primary care physicians than the official data sources report which may create a false understanding that their number is sufficient or even redundant.
  2. After the year 2005 we may be faced with the "retirement crisis" when the attrition of workforce would increase because of the special form of the existing age distribution curve. (This may happen not only in Virginia but, as a preliminary analysis showed, in some other states - like North Carolina - as well)
  3. The immigration of primary care physicians has been playing the dominant role in their supply in Virginia. In the annual increase of these physicians the out-of-state medical graduates were 85%, a half of these being international medical graduates.
    However, this channel of supply is seemingly turning shallow. This may make the situation by 2005 even more serious making the production of the primary care physicians by the in-state medical education system much more important that it was expected.

    [ Fig. 1 ] [ Fig. 2 ] [ Fig. 3 ]

In addition to these problems there is a problem of unequal distribution of primary care physicians among metropolitan and non-metropolitan areas, to enumerate just a few.

Based upon the age distributions of physicians for a number of past years, we were able to make projections of primary care physicians supply for the future years. Such projections are done by a dynamic mathematical model that takes account both of the in-state physicians production and the out-of-state migration.

This model may become a tool for health policy makers to study the results of the decisions taken to change the primary care physicians' workforce to cover the population's needs better.

It may also study the results of changing needs in primary care physicians in the framework of managed care and their replacement with mid-level practioners. The model of displaced specialists readjustment may be a further extension of this model.

The model will be a very consistent tool because it will be based on detailed study of the significant data variables and internal relations among them. Many of these are unknown now.

See a detailed slide presentation of the Physician Supply Model

 

These results have been reported in conferences:

And published in journals:

first posted 10-28-1995
last modified 10-18-2002
For further details please contact
V. Olchanski by email volchans@vcu.edu or
voice (804)828-5384.