Southwestern Medical Center ... Nearly 25% of population is not w/in 60 minutes of a Level I trauma center. ⢠Neither
Everything You Thought You Knew About the Physician Shortage: The Specialty (Neurosurgical) Perspective Presented by: H. Hunt Batjer, MD Darwin E. Smith Distinguished Chair in Neurological Surgery, The University of Texas Southwestern Medical Center President‐Elect, American Association of Neurological Surgeons President‐Elect, Society of Neurological Surgeons
Key Points • Increasing Demand for Surgical care • Distribution/ Maldistribution of Surgeons • Poor availability of Trauma and Pediatric specialty services in many areas • The Aging Surgeon Problem • The Neurosurgical Pipeline Problem • Implications of GME Funding Decisions
Increased Demand for Specialty Care
Source: Health Affairs
Increased Demand for Specialty Care
Source: Medicine Use and Shifting Costs of Healthcare. Report by the IMS Institute for Healthcare Informatics.
Significant Appointment Wait Times Specialty (Adults) Neurology OB‐GYN Neurosurgery Dermatology Family Medicine Orthopaedic Surgery Cardiology
Source: Health Affairs
Wait Time (Days) 34.8 27.5 24.1 22.1 20.3 16.8 15.5 Specialty (Pediatrics) Developmental Pediatrics Genetics Neurology Rheumatology Dermatology Child Psychology Endocrinology
Wait Time (Days) 101 76 62 55 54 52 51
Number of People per Active Physician Neurosurgery: 1/61,235
Maldistribution of Surgeons • 25% of the U.S. population lives in county w/out a neurosurgeon • 50% percent of the U.S. population lives in counties w/ 15.5% of neurosurgeons Source: American College of Surgeons Health Policy Research Institute
Higher Maldistribution Rate Among Specialists • More even distribution of primary care • Neurosurgery and ophthalmology highest maldistribution – Reason: Need high population areas to sustain quality practice Source: American College of Surgeons Health Policy Research Institute
Neurosurgeons Per 100,000 Population, 2011 Most counties have NONE
Source: American College of Surgeons Health Policy Research Institute
Level I Trauma Centers, 2010
• •
Nearly 25% of population is not w/in 60 minutes of a Level I trauma center Neither Alaska or Hawaii have Level I trauma centers
Source: http://www.traumamaps.org/home.html
Surgeons are Getting Older
Source: American College of Surgeons Health Policy Research Institute
Aging Workforce = National Problem
Source: American College of Surgeons Health Policy Research Institute
Even a Bigger Problem in Rural Areas
Source: American College of Surgeons Health Policy Research Institute
Number of Neurosurgeons by Age 800
718 666
700 600
667
531
487
500 359
400 300
182 161
200 100 0
34‐39
40‐44
45‐49
50‐54
55‐59
60‐64
65‐69
70‐74
Age Range
44% of practicing neurosurgeons over the age of 55 Source: American Board of Neurological Surgery
Neurosurgery Workforce: Basics • In 2013, 3,771 practicing board certified neurosurgeons • Over 5,700 hospitals – 1,600 provide some trauma care – 1,000 are certified primary stroke centers – 200 are children’s hospitals
• More than 317 million people – Aging population in need of care for neurologic problems such as stroke, degenerative spine disease, Parkinson’s Sources: Neurosurgery Statement to IOM ‐‐ Ensuring an Adequate Neurosurgical Workforce American Board of Neurological Surgery
Neurosurgical Training: Basics Neurosurgical training is unique • • • •
105 accredited residency programs in the U.S. 1,200 total residents 160 graduates complete residency per/year Length of post graduate residency training for neurosurgeons is among the longest = 7 years – Subspecialty fellowship adds additional 1‐2 years – TOTAL from medical school thru board certification = 18 yrs.
• Policy/ Funding Changes take 15‐20 YEARS to have an impact‐ The Pipeline Problem Source: Neurosurgery Statement to IOM ‐‐ Ensuring an Adequate Neurosurgical Workforce
Cost to Train a Neurosurgery Resident Institutional Costs Total Institutional Costs Divided by 442 residents
$65,621,392 $148,465 (per res/per year)
Departmental Costs: 20% Salary & Benefits for Program Director
$260,396
Salary & Benefits for Program Coordinator
$39,741
Travel and Conferences
$14,039
Food
$7,998
Books and Equipment
$5,366
Licensing
$4,761
Interview Costs
$3,641
Miscellaneous
$1,431
Total Department Costs
$337,373
Divided by 14 residents
$24,098 (per resident/per year)
Total Costs:
$172,563 per resident/per year x 7 years Source: Neurosurgery Statement to IOM ‐‐ Ensuring an Adequate Neurosurgical Workforce
$1,207,941 (per resident)
Neurosurgery Residency Match Data Year
PGY 1 Applicants
2009
317
191
191
100.0
2010
309
191
188
98.4
2011
283
195
192
98.5
2012
318
196
194
99.0
2013
314
204
203
99.5
2014
335
206
206
100.0
Source: National Residency Matching Program
Positions Positions Offered Filled
Percent Filled
2009 2010
Source: National Residency Matching Program 2011 2012 2013 2014
Filled
Offered
Applicants
Filled
Offered
Applicants
Filled
Offered
Applicants
Filled
Offered
Applicants
Filled
Offered
Applicants
Filled
Offered
Applicants
Neurosurgery Residency Match Data
350
300
250
200
150
100
50
0
Residency Growth by Specialty, 2009‐14 3,500
3,000
2,500
2,000
1,500
1,000
Specialty
5‐Year Change
% 5‐Year Change
Family Medicine Neurology Neurosurgery Orthopaedic Surgery Otolaryngology Physical Med & Rehab Primary Medicine Surgery TOTAL
574 184 15 54 20 14 88 135 4,251
22.6% 93.8% 7.8% 8.4% 7.2% 17.0% 35.6% 11.7% 18.9%
500
0
Neurosurgery is Falling Behind! Source: National Residency Matching Program
2009 2010 2011 2012 2013 2014
Primary Care
Number of First Year Residents by Specialty Neurosurgery: 195
Neurosurgical Workforce Shortages • Only 83% of neurosurgeons take emergency call 24/7/365 • 178 board certified pediatric neurosurgeons – w/in next decade, 42% will retire – Only 6 enter workforce each year, falling short of demand
• Job data demonstrate shortages: in 2011, 305 vacant neurosurgery positions in the U.S. – 192 generalists, spine‐focused neurosurgeons, or unidentified – 113 subspecialists, including neurovascular, endovascular, pediatric Sources: Neurosurgery Statement to IOM ‐‐ Ensuring an Adequate Neurosurgical Workforce American Board of Neurological Surgery
Medical School Grads Entering Residencies vs. Available Positions
24.5% Reduction in Positions Estimated w/cuts in GME funding
Implications of GME Cuts
Positions Lost = 33,000 Source: Journal of Graduate Medical Education
Snapshot of Texas • Texas population growing faster than most other parts of the country: 500,000 per year • Overall, and in virtually every medical specialty, Texas has fewer physicians per person than the rest of the U.S.
Specialty All Physicians Emergency Medicine Family Medicine Neurology Neurosurgery Orthopaedic Surgery Otolaryngology Pediatrics Physical Med & Rehab Surgery
Ratio of Physicians per 100,000 Texas U.S. 167.3 210.2 6.64 9.12 21.7 24.9 3.13 4.01 1.28 1.46 5.46 6.73 2.41 2.78 62.8 84.8 1.96 2.5 7.23 8.99
Source: Texas Medical Association, Medical Education Department
Tex. Ratio as % of U.S. Ratio 79.6% 72.9% 87.1% 78.1% 87.3% 81.1% 86.7% 74.1% 78.6% 80.4%
Concluding Thoughts • In Texas alone, to keep up with our population growth – we need to produce 2 ½ to 3 ½ doctors PER DAY! • Cuts to GME funding will exacerbate current physician shortage. • To alleviate current and future physician shortage, Congress should pass legislation increasing Medicare support for GME. • We will be short 65K Specialists as well as 65K PCPs in the US by 2025!
For More Information Katie O. Orrico, Director Washington Office American Association of Neurological Surgeons 202‐446‐2024
[email protected] 