Analysis of Primary Care Physicians Over 60 Years of Age in the Grand Division of Middle Tennessee

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1 Analysis of Primary Care Years of Age in the Grand Division of Middle Tennessee INTRODUCTION Primary care is the foundation of the rural health care workforce. However, a substantial percentage of primary care providers in the United States are approaching retirement age at the same time that fewer new U.S. medical graduates are opting for primary care specialties. Shortages related to retirement will coincide with accelerating demand for health care as the number of Americans aged 65 and older doubles between 2000 and 2030 and additional millions receive health insurance coverage through provisions in the Patient Protection and Affordable Care Act. 1 Driven by population growth and aging, the total number of office visits to primary care physicians is projected to increase from 462 million in 2008 to 565 million in After incorporating insurance expansion, the United States will require nearly 52,000 additional primary care physicians by Population growth will be the largest driver, accounting for 33,000 additional physicians, while 10,000 additional physicians will be needed to accommodate population aging. Insurance expansion will require more than 8,000 additional physicians, a 3% increase in the current workforce. 2 In this paper, the Tennessee Rural Partnership (TRP) will provide the number/percentage of primary care physicians over the age of in each county of the Middle Tennessee region. This will allow healthcare planners to pinpoint counties in which there will be the greatest demand for primary care physicians and assist TRP in its goal of primary care physician recruitment. 1 Fordyce, Meredith A., Mark P. Doescher, and Susan M. Skillman. The Aging of the Rural Primary Care Physician Workforce: Will Some Locations Be More Affected than Others? University of Washington, School of Medicine, Department of Family Medicine; September Petterson, Stephen M., et. al, Projecting US Primary Care Physician Workforce Needs: Annals of Family Medicine. wwwann/fammed.org. Vol. 10, No. 6. November/December Analysis of Primary Care Years of Age in Middle Tennessee Page 1

2 TRP s mission is to maximize access to primary care in rural and underserved communities in Tennessee. Additional papers will be prepared to show the same information for the West and East Tennessee grand divisions. MIDDLE TENNESSEE AREA DESCRIPTION Middle Tennessee is one of the three grand divisions of the state of Tennessee. It is comprised of 40 counties (this number differs according to the source) and is situated between the Tennessee River on the west and the Sequatchie Valley on the east. Middle Tennessee is the largest in area and the least densely populated of the three grand divisions. The total population is 2,441,799. Six counties in the region have a population of 25,000 or more. 40 Counties of Middle Tennessee (outlined in red) Counties with a population of 100,000+ / Cities with a population of 25,000+ County Population Cities Population Davidson 626,681 Nashville 1,222 Montgomery 172,331 Clarksville 132,929 Rutherford 262,4 Murfreesboro 108,755 Williamson 183,182 Franklin 62,487 Sumner 1,645 Hendersonville 51,372 Wilson 113,993 Cookeville 30,435 Analysis of Primary Care Years of Age in Middle Tennessee Page 2

3 MIDDLE TENNESSEE LICENSED PHYSICIANS Overall Physician Numbers Data is based upon the address the physician has provided in his/her Tennessee medical licensure profile; therefore, he/she may not actually practice in the county in which they list their address or may practice in multiple counties. Tennessee provides physicians a license to practice in the state, but not in a specific area or specialty. The 40 counties that comprise Middle Tennessee contain a total of 6,845 licensed physicians. Of that total, 4,749, or 69 percent, are licensed in the counties of Davidson and adjacent Williamson. in the remaining 38 Middle Tennessee counties equal 2,096, or 31 percent, of the licensed physicians in the region. Half (50 percent) or more of all the physicians in 13 Middle Tennessee counties (one-third of the 40-county region) are over years of ages. These counties are: Bedford, Fentress, Giles, Grundy, Hickman, Humphreys, Jackson, Marshall, Moore, Stewart, Trousdale, Van Buren and Wayne. MIDDLE TENNESSEE PRIMARY CARE PHYSICIANS Table 1 defines primary care as the disciplines of: family medicine, general practice, pediatrics, obstetrics/gynecology and internal medicine, showing the totals of these five disciplines and each discipline separately. COUNTY Table 1 in Middle Tennessee by County and Primary Care Discipline* Primary Care (FM-GP-IM- OB/GYN-PED) Family Medicine General Practice Internal Medicine OB/GYN Pediatric Bedford Cannon Cheatham Clay Coffee Davidson DeKalb Dickson Fentress Franklin Analysis of Primary Care Years of Age in Middle Tennessee Page 3

4 COUNTY Primary Care (FM-GP-IM- OB/GYN-PED) Family Medicine General Practice Internal Medicine OB/GYN Pediatric Giles Grundy Hickman Houston Humphreys Jackson Lawrence Lewis Lincoln Macon Marshall Maury Montgomery Moore Overton Perry Pickett Putnam Robertson Rutherford Smith Stewart Sumner Trousdale Van Buren Warren Wayne White Williamson Wilson TOTALS *See more explanation of data on page ten. Forty-four percent, or 3,011 of the total 6,845 physicians in Middle Tennessee, meet TRP s definition of primary care physicians: family medicine, general practitioner, pediatrics, obstetrics/gynecology and internal medicine. Analysis of Primary Care Years of Age in Middle Tennessee Page 4

5 Since Middle Tennessee was the home of three medical residency programs at the time the data was reported (Meharry Medical College, Vanderbilt University, University of Tennessee-Nashville) and has six counties with metropolitan areas, it is assumed these areas of the Middle Tennessee region will have a high concentration of sub-specialty physicians as opposed to traditional primary care disciplines. Even so, primary care physicians represent a significant portion of the overall physician population. Twenty-eight percent (1,916) of the total physicians that reside in the counties of Davidson and adjoining Williamson are primary care physicians. Forty-five percent (18) of the counties in Middle Tennessee contain fewer than 10 primary care physicians. Thirty counties, or 75 percent of the Middle Tennessee region, have fewer than 30 primary care physicians. 18 counties have fewer than 10 primary care physicians Cannon, Clay, Grundy, Hickman, Houston, Humphreys, Jackson, Lewis, Macon, Marshall, Moore, Perry, Pickett, Smith, Stewart, Trousdale, Van Buren, Wayne 12 counties have primary care physicians Bedford, Cheatham, DeKalb, Dickson, Fentress, Giles, Lawrence, Lincoln, Overton, Robertson, Warren, White 5 counties have primary care physicians Coffee, Franklin, Maury, Putnam, Wilson 5 counties have 100 or more primary care physicians Davidson, Montgomery, Rutherford, Sumner, Williamson MIDDLE TENNESSEE PHYSICIANS OVER YEARS OF AGE Table 2 provides an overview of physicians over years of age, with breakdowns for the total physicians in Middle Tennessee compared to only the primary care physicians (PCPs). Table 2 and Primary Care (PCPs) Years of Age COUNTY Percentage of Primary Care (PCPs) PCPs Percentag e of PCPs Of the total physiciansthe % of PCPs over Bedford % % 35% Cannon 4 0 0% Cheatham % % 8% Clay % Analysis of Primary Care Years of Age in Middle Tennessee Page 5

6 COUNTY Percentage of Primary Care (PCPs) PCPs Over Percentage of PCPs Over Of the total physiciansthe % of PCPs over Coffee % % 8% DeKalb % % 23% Dickson % % 22% Fentress % 10 6 % 50% Franklin % % 17% Giles % % 56% Grundy % % 50% Hickman % % 75% Houston % % 33% Humphreys % % 56% Jackson % % 25% Lawrence % % 27% Lewis % Lincoln % % 21% Macon % % 40% Marshall % % 50% Maury % % 14% Montgomery % % 13% Moore % Overton % % 20% Perry % % 33% Pickett % % 20% Putnam % % 16% Robertson % % 29% Rutherford % % 13% Smith % % 33% Stewart % % 100% Sumner % % 14% Trousdale % % 50% Van Buren % % 100% White % % 30% *See explanation of data definitions on page ten. Analysis of Primary Care Years of Age in Middle Tennessee Page 6

7 COUNTY Percentage of Primary Care (PCPs) PCPs Over Percentage of PCPs Over Of the total physiciansthe % of PCPs over Warren % % 21% Wayne % % 63% Williamson % % 7% Wilson % % 17% TOTALS % % 12% Twenty-five percent (1,732) of the total 6,845 Middle Tennessee physicians are over years of age. The total 795 primary care physicians over make up 12 percent of the total licensed physicians in Middle Tennessee; however, among the total 3,011 primary care physicians licensed to practice in Middle Tennessee, 26 percent (795) of all primary care physicians are over age. Eighty-two percent of the region s primary care physicians (2,462) are located in the six most populous counties of Davidson, Montgomery, Rutherford, Sumner, Williamson and Wilson. In one-third of the region (13 counties), at least half of all the physicians are over years of age. These 13 counties are: Bedford, Fentress, Giles, Grundy, Hickman, Humphreys, Jackson, Marshall, Moore, Stewart, Trousdale, Van Buren and Wayne. Looking at primary care physicians only, 50 percent or more of the primary care physicians in the 14 counties of Bedford, Coffee, Fentress, Giles, Grundy, Hickman, Humphreys, Marshall, Perry, Smith, Stewart, Trousdale, Van Buren, and Wayne are over years of age. These counties represent 35 percent of the region. The four counties of Cannon, Clay, Lewis and Moore have no primary care physicians over the age of ; however, the total number of physicians in these counties is only 19. EXECUTIVE SUMMARY The Middle Tennessee region has an almost equal percentage (approximately one-quarter) of all physicians and all primary care physicians who are years of age of older. There is some overlap in the counties in which 50 percent or more of all physicians are over years of age and those in which 50 percent or more of all primary care physicians are over years of age. Analysis of Primary Care Years of Age in Middle Tennessee Page 7

8 Counties in which 50 percent or more of all physicians are over years of age Bedford - Coffee Fentress Fentress Giles Giles Grundy Grundy Hickman Hickman Humphreys Humphreys Jackson - Marshall Marshall Moore - - Perry - Smith Stewart Trousdale Van Buren Wayne Ages of Middle Tennessee Counties in which 50 percent or more of all primary care physicians are over years of age Bedford Stewart Trousdale Van Buren Wayne Of the total 6,845 physicians licensed to practice in Middle Tennessee, 25 percent (1,732) are over years of age. Of the total 3,011 primary care physicians licensed to practice in Middle Tennessee, 26 percent (795) are over age. Urban-Rural Breakdown of Physician Numbers in Middle Tennessee Of the total licensed physicians in Middle Tennessee, 4,749, or 69 percent, have addresses in the counties of Davidson and adjacent Williamson. in the remaining 38 Middle Tennessee counties (those other than Davidson and Williamson) equal 2,096, or 31 percent of the licensed physicians in the region. Licensed Primary Care in Middle Tennessee Forty-four percent or 3,011 of the total 6,845 physicians in Middle Tennessee meet TRP s definition of primary care physicians: family medicine, general practice, pediatrics, obstetrics/gynecology and internal medicine. Analysis of Primary Care Years of Age in Middle Tennessee Page 8

9 Forty-five percent (18) of the counties in Middle Tennessee contain fewer than 10 primary care physicians. Fifty percent or more of the primary care physicians in these 14 counties are over years of age: Bedford, Coffee, Fentress, Giles, Grundy, Hickman, Humphreys, Marshall, Perry, Smith, Stewart, Trousdale, Van Buren, and Wayne. These counties represent 35 percent of the region. POTENTIAL NEXT STEPS BASED ON THIS ANALYSIS The National Center for the Analysis of Healthcare Data s (NCAHD) current data mapping tool has limited layers of information. For example, at present, TRP is unable to break down ages of licensed physicians beyond the broad category of over years of age. For future studies, it would be helpful to break down ages in a variety of age groups as identified. Supplementary tools need to be considered. For example, a more user-friendly tool to create and modify maps is needed to report findings. Partners and financial support for future healthcare workforce analysis/studies needs to be considered. INFORMATION SOURCE / DATA DETAILS TRP, in conjunction with the National Center for the Analysis of Healthcare Data (NCAHD), has developed the TRP healthcare information portal (T-HIP) to allow healthcare providers and planners access to data gathered from the 2012 enhanced state licensure data at the individual provider level nationally, by county and by zip code aggregation for the following: All physicians (MDs and DOs) by specialty Dentists Physician assistants Nurse practitioners, certified nurse specialists, certified registered nurse anesthetists, certified nurse midwives Other healthcare providers Federal shortage designations State, county, zip code, Senate and House district demographics Healthcare facilities: HPSAs, FQHCs, and hospital listings Healthcare training sites Medical school, physician assistant, nursing school and residency program information Analysis of Primary Care Years of Age in Middle Tennessee Page 9

10 Other features of T-HIP allow users to: Determine percentage of workforce at state/county/zip code level View individual provider distribution at national level View healthcare training sites relative to providers View zip code, county and congressional district aggregates of all providers Analyze number of providers by distance Print maps Download aggregate totals of a single healthcare provider by state, county, zip, or congressional district Explanation of Data Tables TRP defines primary care as the five disciplines of family medicine, internal medicine, general practice, pediatrics and obstetrics/gynecology. The category of pediatrics includes: adolescent medicine, developmental-behavioral pediatrics, hospice and palliative medicine, hospitalists, internal medicine/pediatrics, neonatal-perinatal medicine, pediatric allergy and immunology, pediatric cardiology, pediatric critical care medicine, pediatric emergency medicine, pediatric endocrinology, pediatric gastroenterology, pediatric hematology/oncology, pediatric infectious disease, pediatric nephrology, pediatric pulmonology, pediatric rheumatology, pediatric transplant hepatology, pediatric, sleep medicine and sports medicine. Of these subspecialties, those considered by NCAHD as primary care are: adolescent medicine, hospice and palliative medicine, hospitalists, pediatric critical care medicine, pediatric emergency medicine, pediatrics and sports medicine. Internal medicine contains internal medicine/pediatrics. Note: The Tennessee Rural Partnership is an operating subsidiary of the Tennessee Hospital Association. Additional information about TRP may be found on its website at Analysis of Primary Care Years of Age in Middle Tennessee Page 10