Physician Workforce in Nevada

Transcription

1 UNSOM Health Policy Report Physician Workforce in Nevada 2014 Edition John Packham, PhD, Tabor Griswold, PhD, Laima Etchegoyhen, MPH, and Christopher Marchand, MPH July 2014 Office of Statewide Initiatives University of Nevada School of Medicine 411 West Second Street Reno, Nevada

2 Acknowledgements Physician Workforce in Nevada 2014 Edition contains current, historical, and comparative data on the Allopathic (MD) and Osteopathic (DO) physician workforce in Nevada. The focus of this report is to improve health workforce planning and policy development in Nevada through the preparation and dissemination of the most current information on the physician workforce. The data presented in this report are drawn from two principal sources: America Association of Medical Colleges (AAMC). State Physician Workforce Data Book. Washington DC: AAMC Center for Workforce Studies (2013). American Medical Association (AMA). Physician Characteristics and Distribution in the US. Washington DC: AMA (2014, 2004, 1994, 1982). The major professional activity categories, self-designated specialty areas and geographic regions are those used by the American Medical Association (AMA). In this report, states in the AMA Mountain Region include Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming. Other tables reference Nevada and Neighboring States, which include the five states bordering Nevada: Arizona, California, Idaho, Oregon, and Utah. Suggested Citation Packham, J., Griswold, T., Etchegoyhen, L., and Marchand, C. (2014). Physician Workforce in Nevada 2014 Edition. Reno, NV: Office of Statewide Initiatives, University of Nevada School of Medicine.

3 Table of Contents Highlights and Key Findings... 1 Section One: Demographic Characteristics of the Allopathic Physician Workforce (MDs) in Nevada Table 1: Allopathic Physicians (MDs) by Age in Nevada 1992 to Table 2: Allopathic Physicians (MDs) by Gender in Nevada 1992 to Table 3: Male Allopathic Physicians (MDs) by Age in Nevada 1992 to Table 4: Female Allopathic Physicians (MDs) by Age in Nevada 1992 to Table 5: U.S. Medical Graduates (USMGs) by Age and Gender in Nevada Table 6: International Medical Graduates (IMGs) by Age and Gender in Nevada Section Two: Distribution of the Allopathic Physician Workforce (MDs) in Nevada by Major Professional Activity and Self-Designated Specialty Table 7: Allopathic Physicians (MDs) by Major Professional Activity in Nevada 1992 to Table 8: Female Allopathic Physicians (MDs) by Major Professional Activity in Nevada 1992 to Table 9: Male Allopathic Physicians (MDs) by Major Professional Activity in Nevada 1992 to Table 10: International Medical Graduates Physicians (IMGs) by Major Professional Activity in Nevada 2002 to Table 11: Allopathic Physicians (MDs) by Country of Undergraduate Medical Education and Self-Designated Primary Care Specialty in Nevada Table 12: Allopathic Physicians (MDs) by Gender and Self-Designated Primary Care Specialty in Nevada Table 13: Allopathic Physicians (MDs) by Self-Designated Primary Care Specialty in Nevada 2002 to Table 14: Allopathic Physicians (MDs) by Self-Designated Primary Care Specialty in Nevada and the U.S Table 15: Allopathic Physicians (MDs) by Self-Designated Specialty in Nevada 1992 to Table 16: Allopathic Physicians (MDs) by Gender and Self-Designated Specialty in Nevada Office of Statewide Initiatives i

4 Table 17: Allopathic Physicians (MDs) in Patient Care by Self-Designated Specialty in Nevada 1992 to Table 18: Allopathic Physicians (MDs) in Patient Care by Gender and Self-Designated Specialty in Nevada Section Three: Comparative Data on the Physician Workforce in Nevada and the United States Table 19: Active Physicians (MDs) by Selected Age Groups in Nevada and Neighboring States Table 20: Active Female Physicians (MDs) in Nevada and Neighboring States Table 21: Active Male Physicians (MDs) in Nevada and Neighboring States Table 22: Allopathic Physicians (MDs), Population, and Physician/Population Ratios in Nevada and the U.S to Table 23: Number of Allopathic Physicians (MDs) per 100,000 Population in Nevada and Neighboring States 1992 to Table 24: Population per One Allopathic Physician (MD) in Nevada and Neighboring States 1992 to Table 25: Number of Allopathic Physicians (MDs) in Patient Care per 100,000 Population in Nevada and Neighboring States 1992 to Table 26: Population per One Allopathic Physician (MD) in Patient Care in Nevada and Neighboring States 1992 to Table 27: Allopathic Physicians (MDs) per 100,000 Population by Self-Designated Specialty in Nevada 1992 to Table 28: Allopathic Physicians (MDs) per 100,000 Population by Self-Designated Specialty in Nevada, Mountain Region, and the U.S Table 29: Allopathic Physicians (MDs) in Patient Care per 100,000 Population by Self- Designated Specialty in Nevada 1992 to Table 30: Allopathic Physicians (MDs) in Patient Care per 100,000 Population by Self- Designated Specialty in Nevada, Mountain Region, and the U.S Table 31: Number of Allopathic Physicians (MDs) Needed in Nevada to Meet Mountain Region Average per Capita Rates Table 32: Number of Allopathic Physicians (MDs) Needed in Nevada to Meet the U.S. Average per Capita Rates Table 33: Number of Patient Care Allopathic Physicians (MDs) Needed in Nevada to Meet Mountain Region Average per Capita Rates Table 34: Number of Patient Care Allopathic Physicians (MDs) Needed in Nevada to Meet the U.S. Average per Capita Rates Table 35: Total Allopathic Physicians (MDs) by County in Nevada 1992 to Table 36: Total Allopathic Physicians (MDs) per 100,000 Population by County in Nevada 1992 to Table 37: Allopathic Physicians (MDs) in Patient Care by County in Nevada 1992 to Table 38: Allopathic Physicians (MDs) in Patient Care per 100,000 Population by County in Nevada 1992 to ii Office of Statewide Initiatives

5 Table 39: Allopathic Physicians (MDs) by Self-Designated Primary Care Specialty in Metropolitan/Micropolitan Areas in Nevada Table 40: Allopathic Physicians (MDs) by Major Professional Activity in Metropolitan/Micropolitan Areas in Nevada Table 41: Active Physicians by Medical School Type in Nevada and Neighboring States Table 42: Active Physicians per 100,000 Population by Degree Type in Nevada and Neighboring States Table 43: Active Patient Care Physicians per 100,000 Population by Degree Type in Nevada and Neighboring States Table 44: Active Primary Care Physicians per 100,000 Population by Degree Type in Nevada and Neighboring States Table 45: Active Patient Care Primary Care Physicians per 100,000 Population by Degree Type in Nevada and Neighboring States Section Four: Undergraduate Medical Education and Graduate Medical Education in Nevada, Neighboring States and the United States Table 46: Graduates of the University of Nevada School of Medicine (UNSOM) Practicing in the U.S. by Year of Graduation and Gender Table 47: Graduates of the University of Nevada School of Medicine (UNSOM) Practicing in the United States by Self-Designated Primary Care Specialty 2002 to Table 48: University of Nevada School of Medicine (UNSOM) Retention of Graduate Medical Education (GME) Graduates Table 49: University of Nevada School of Medicine (UNSOM) Graduation and Retention 2004 to Table 50: Physicians Retained from Undergraduate Medical Education (UME) in Nevada and Neighboring States Table 51: Physicians Retained from Public Undergraduate Medical Education (UME) in Nevada and Neighboring States Table 52: Physicians (MDs and DOs) Retained from Graduate Medical Education (GME) in Nevada and Neighboring States Table 53: Physicians (MDs and DOs) Retained from Undergraduate Medical Education (UME) and Graduate Medical Education (GME) Combined in Nevada and Neighboring States Table 54: Students Enrolled in All Medical or Osteopathic Schools in Nevada and Neighboring States Academic Year Table 55: Students Enrolled in Public Medical or Osteopathic Schools in Nevada and Neighboring States Academic Year Table 56: Change in the Number of Students Enrolled in Medical or Osteopathic Schools in Nevada and Neighboring States 2002 to Table 57: In-State Matriculation to Medical School Academic Year Table 58: Ratio of Residents and Fellows (GME) to Medical and Osteopathic Students (UME) in Nevada and Neighboring States Academic Year Office of Statewide Initiatives iii

6 Table 59: Change in the Number of Residents and Fellows in ACGME-Accredited Programs in Nevada and Neighboring States 2002 to Table 60: Residents and Fellows on Duty as of December 31, 2012 in ACGME-Accredited Programs in Nevada and Neighboring States Table 61: Residents and Fellows on Duty as of December 31, 2012 in ACGME-Accredited Programs per 100,000 Population by Degree Type in Nevada and Neighboring States Table 62: Residents and Fellows on Duty as of December 31, 2012 in ACGME-Accredited Primary Care Programs per 100,000 Population by Degree Type in Nevada and Neighboring States Section Five: Characteristics of the Osteopathic Physician (DOs) Workforce in Nevada Table 63: Osteopathic Physicians (DOs) by Gender and Age in Nevada Table 64: Osteopathic Physicians (DOs) by Gender and Major Professional Activity in Nevada Table 65: Osteopathic Physicians (DOs) by Self-Designated Primary Care Specialty in Nevada and the U.S Table 66: Osteopathic Physicians (DOs) by Major Professional Activity in Metropolitan/Micropolitan Areas in Nevada Table 67: Osteopathic Physicians (DOs) by Self-Designated Specialty and Major Professional Activity in Nevada Table 68: Total MD and DO Physicians by Self-Designated Specialty and Major Professional Activity in Nevada Table 69: Total MD and DO Physicians by Gender and Age in Nevada Table 70: Total MD and DO Physicians by Gender and Major Professional Activity in Nevada Table 71: Total MD and DO Physicians by Self-Designated Primary Care Specialty in Nevada and the U.S Section Six: Physician Workforce Rankings Table 72: Nevada s Rank Among the U.S. States in Physicians per 100,000 Population Table 73: Nevada s Rank Among the U.S. States in Physicians in Patient Care per 100,000 Population Table 74: Nevada s Rank Among the U.S. States in the Number of Allopathic Physicians (MDs) per 100,000 Population 1980 to Table 75: Nevada s Rank Among the U.S. States in the Number of Allopathic Physicians (MDs) in Patient Care per 100,000 Population 1980 to Appendix iv Office of Statewide Initiatives

7 Highlights and Key Findings Section One: Demographic Characteristics of the Allopathic Physician Workforce (MDs) in Nevada According to the American Medical Association (AMA), the number of allopathic physicians (MDs) in Nevada has grown from 2,342 in 1992 to 6,153 in 2012 an increase of 162.7% over the past twenty years (Table 1). While the number of MDs in Nevada has increased in every age category over the past two decades, the rate of growth has been faster in the older age categories. The percent of Nevada MDs over the age of 65 has increased from 16.3% in 1992 to 25.2% in 2012 (Table 1). In 1992, 11.5% of Nevada MDs were female, as compared to 25.0% in 2012 (Table 2). The relatively recent entry of women into the Nevada physician workforce is reflected in the different age distribution of the male versus female physician workforce. For example, 50.0% of male MDs in Nevada are over the age of 55, as compared to only 28.6% of female MDs who are over the age of 55 in Conversely, 44.8% of female MDs in Nevada are under the age of 45, as compared to 26.2% of male MDs who are under the age of 45 (Tables 3 and 4). In 2012, 2,023 MDs or 33.3% of all MDs in Nevada are international medical graduates (IMGs) that is, they received their undergraduate medical education (UME) in another country excluding Canada (Tables 5 and 6). Section Two: Distribution of the Allopathic Physician Workforce (MDs) in Nevada by Major Professional Activity and Self-Designated Specialty According to the American Medical Association (AMA), since 1992, the number of MDs in Nevada in each type of patient care activity office-based and hospital-based patient Office of Statewide Initiatives 1

8 care has grown. However, the proportion of the total physician workforce in Nevada whose major professional activity is patient care has declined from 84.7% in 1992 to 75.9% in 2012 (Table 7). Currently, 79.8% of female MDs in Nevada report that their major professional activity is patient care, as compared to 74.9% of male MDs who report that their major professional activity is patient care (Tables 8 and 9). Over the past decade, the number of international medical graduates (IMGs) in Nevada in each type of patient care activity has grown. Reflecting general trends in the Nevada physician workforce, the proportion of the total IMG physician workforce in Nevada whose major professional activity is patient care declined from 83.6% in 2002 to 74.3% in 2012 (Table 10). In 2012, 51.2% of MDs who are IMGs (1,037 of 2,023 IMGs) in Nevada report a primary care specialty or sub-specialty, as compared to 31.9% of MDs in Nevada who are US Medical Graduates (USMGs) (1,298 of 4,059 USMGs) (Tables 11). Currently, 38.3% of MDs in Nevada report that their self-designated practice specialty was in primary care family medicine, general practice, internal medicine, obstetrics/gynecology, or pediatrics or a primary-care sub-specialty (Table 12). In 2012, 33.0% of male MDs in Nevada are in a primary care specialty or subspecialty, as compared to 54.1% of female MDs reporting a primary care specialty or subspecialty (Table 12). Over the past decade, the number of MDs in a primary care specialty has grown by 378 (24.7%) and the number of MDs in a primary care sub-specialty has grown by 201 (83.4%). However, the proportion of the total physician workforce in a primary care specialty or sub-specialty declined from 40.2% in 2002 to 38.9% in 2012 (Table 13). The proportion of the allopathic physician workforce in Nevada (MDs) practicing in primary care (31.1%) is comparable to the national rate of 30.6% (Table 14). Since 1992, the number of MDs in Nevada has increased in almost every self-designated specialty area. Major specialties with the greatest numerical growth over the past two decades include internal medicine (763 or 228.4%), family medicine (381 or 202.7%), pediatrics (272 or 251.9%), anesthesiology (228 or 170.1%), emergency medicine (179 or 2 Office of Statewide Initiatives

9 229.5%), obstetrics/gynecology (123 or 82.6%), and psychiatry (107 or 148.6%) (Table 15). In 2012, when comparing the total female MD workforce with the total male MD workforce, greater percentages of women report a primary care specialty than do men. For example, 13.3% of female MDs are in pediatrics, as compared to 3.8% of male MDs in Nevada; likewise, 21.2% of female MDs in Nevada are in internal medicine, as compared to 16.7% of male MDs (Table 16). Over the past two decades, the number of patient care MDs in Nevada that is, physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital has increased across most self-designated specialty areas. Major specialties with the greatest numerical growth of patient care MDs over the past two decades include internal medicine (733 or 227.6%), family medicine (370 or 201.1%), pediatrics (267 or 259.2%), anesthesiology (226 or 171.2%), emergency medicine (179 or 232.5%), obstetrics/gynecology (122 or 84.1%), and psychiatry (106 or 171.0%) (Table 17). Currently, when comparing the total female MD workforce in patient care with the total male MD workforce in patient, greater percentages of women report a primary care specialty than do men. For example, 16.4% of female patient care MDs are in pediatrics, as compared to 3.9% of male patient-care MDs in Nevada; 25.6% of female patient care MDs in Nevada are in internal medicine, as compared to 17.1% of male patient care MDs; 15.0 % of female patient care MDs in Nevada are in family medicine, as compared to 8.5% of male patient care MDs; and 8.4% of female patient care MDs in Nevada are in obstetrics/gynecology, as compared to 3.8% of male patient care MDs (Table 18). Section Three: Comparative Data on the Physician Workforce in Nevada and the US According to the American Medical Association (AMA), only 14.1% of allopathic physicians (MDs) in Nevada are under the age of 40. Among states bordering Nevada, Utah had the largest percentage of physicians under the age of 40 (17.8%). Currently, 17.2% of the national physician workforce is under the age of 40 (Table 19). Currently, 25.0% of the MD workforce in Nevada is aged 60 and over. Nationally, 27.6% of the MD workforce is aged 60 and over (Table 19). Office of Statewide Initiatives 3

10 Women currently represent 25.5% of the MD workforce in Nevada. Nationally, 31.9% of the MD workforce is women (Tables 20 and 21). Over the past three decades, the number of MDs in Nevada has grown from 1,171 in 1980 to 6,153 in 2012 (425.4%). Likewise, the number of MDs per 100,000 population in Nevada has grown from 147 to 223 (51.7%). However, Nevada s physician-to-population rank among US states dropped from 36 th to 47 th during the same time period (Table 22). While the number of MDs per 100,000 population in Nevada has improved from 173 to 223 over the last two decades, Nevada is bordered by three states Arizona, Idaho and Utah with physician-to-population ratios below the national rate of 323 MDs per 100,000 population (Tables 23 and 24). The number of MDs in patient care per 100,000 population in Nevada has improved from 145 in 1992 to 169 in Nonetheless, the Nevada population-to-physician ratio is well below the national rate of 247 MDs in patient care per 100,000 population (Tables 25 and 26). Since 1992, the number of MDs in Nevada has increased in almost every self-designated specialty area (Table 14). However, over the past two decades, change in the number of MDs per capita has been comparatively modest. For example, the number of family medicine MDs increased by 202.7% since 1992; however, the number of family medicine MDs per capita increased by only 44.6% during the same time period (Table 27). In 17 of 39 medical specialties, the number of MDs per capita has not kept pace with population growth in Nevada over the last two decades. For example, while the number of MDs in obstetrics/gynecology increased by 123 or 82.6% since 1992, the number of MDs in obstetrics/gynecology per capita declined by 12.8% during the same time period (Table 27). Currently, of the 39 self-designated specialties, only five specialty areas possess a higher number of MDs per capita in Nevada versus states in the Mountain Region: cardiovascular diseases, internal medicine, plastic surgery, forensic medicine, and transplant surgery. Across all 39 specialty areas, the number of MDs per capita in Nevada is 82.6% of the average rate for the Mountain Region (Table 28). 4 Office of Statewide Initiatives

11 In 2012, only 1 of 39 medical specialties has a higher number of MDs per capita in Nevada versus the US: forensic medicine. Across all 39 specialty areas, the number of MDs per capita in Nevada is 68.2% of the average rate for the US (Table 28). Over the past two decades, the number of patient care MDs in Nevada has increased in almost every self-designated specialty area (Table 16). However, change in the number of MDs per capita has been comparatively modest. For example, the number of patient care MDs in internal medicine increased by 227.6% since 1992; however, the number of patient care MDs in internal medicine per capita increased by only 57.0% during the same time period (Table 29). In 17 of 39 medical specialties, the number of patient care MDs per capita has not kept pace with population growth in Nevada over the last two decades. For example, while the number of MDs specializing in orthopedic surgery increased by 72 or 97.3% since 1992, the number of MDs in orthopedic surgery per capita declined by 5.4% during the same time period (Table 29). Currently, only 4 of 39 self-designated specialty areas possess a higher number of patient care MDs per capita in Nevada versus states in the Mountain Region: cardiovascular diseases, internal medicine, plastic surgery, and transplant surgery. Across all 39 specialty areas, the number of patient care MDs per capita in Nevada is 82.5% of the average rate for the Mountain Region (Table 30). In 2012, only 1 of 39 medical specialties has a higher number of patient care MDs per capita in Nevada versus the US: forensic medicine. Across all 39 specialty areas, the number of MDs per capita in Nevada is 67.7% of the average rate for the US (Table 30). Currently, there are 6,153 MDs in Nevada or MDs per 100,000 population. By comparison, the per capita number of MDs in the Mountain Region is per 100,000 population. To meet or exceed the regional per capita rate, Nevada would need a minimum of 1,264 additional MDs. In other words, the supply of MDs in Nevada would need to increase by 20.5% to reach the regional rate (Table 31). Of 39 self-designated specialties, 34 specialty areas possess a lower number of MDs per capita in Nevada compared to the Mountain Region. For example, there are 569 family medicine MDs in Nevada or 20.6 family medicine MDs per 100,000 population. The per capita number of family medicine MDs in the Mountain Region is 31.0 per 100,000 Office of Statewide Initiatives 5

12 population. To meet or exceed the regional number of family medicine MDs per capita, Nevada would need a minimum of 285 additional family medicine MDs (Table 31). Currently, there are 6,153 MDs in Nevada or MDs per 100,000 population. By comparison, the per capita number of MDs in the United States is per 100,000 population. To meet or exceed the national per capita rate, Nevada would need a minimum of 2,829 additional MDs. In other words, the supply of MDs in Nevada would need to increase by 46.0% to reach the national rate (Table 32). Of 39 self-designated specialties, 38 specialty areas possess a lower number of MDs per capita in Nevada compared to the United States. For example, there are 179 MDs in psychiatry in Nevada or 6.5 psychiatric MDs per 100,000 population. The per capita number of psychiatric MDs in the United States is 12.7 per 100,000 population. To meet or exceed the national number of psychiatric MDs per capita, Nevada would need a minimum of 172 additional psychiatric MDs (Table 32). In 2012, there are 4,661 patient care MDs in Nevada or patient care MDs per 100,000 population. By comparison, the per capita number of patient care MDs in the Mountain Region is per 100,000 population. To meet or exceed the regional per capita rate, Nevada would need a minimum of 996 additional patient care MDs. In other words, the supply of patient care MDs in Nevada would need to increase by 21.4% to reach the regional rate (Table 33). Currently, the per capita number of patient care MDs in the United States is per 100,000 population. To meet or exceed the national per capita rate, Nevada would need a minimum of 2,235 additional patient care MDs. In other words, the supply of patient care MDs in Nevada would need to increase by 48.0% to reach the national rate (Table 34). Since 1992, the number of MDs in Nevada has increased by 3,878 or 170.5%. This growth has occurred across all regions of the state. In rural and frontier counties, the number of MDs has increased by 150 or 138.9%. In urban counties, the number has increased by 3,728 or 172.0% (Table 35). Currently, 70.2% of MDs in Nevada are located in Clark County, 23.1% are located in Washoe County, 2.5% are located in Carson City, and 4.2% are located in the state s fourteen rural and frontier counties (Table 35). By comparison, 72.3% of the state s 6 Office of Statewide Initiatives

13 population resides in Clark County, 15.4% resides in Washoe County, 2.0% resides in Carson City, and 10.3% resides in rural and frontier Nevada. Over the past two decades, the number of MDs per 100,000 population in Nevada has increased by 34.9%. In rural and frontier counties, the number of MDs per capita has increased by 52.7%, as compared to 31.3% in urban counties (Table 36). Since 1992, the number of patient care MDs in Nevada has increased by 2,751 or 143.5%. In rural and frontier counties, the number of patient care MDs has increased by 104 or 128.4%. In urban counties, the number has increased by 2,647 or 144.2% (Table 37). Over the past two decades, the number of patient care MDs per 100,000 population in Nevada has increased by 21.5%. In rural and frontier counties, the number of MDs per capita has increased by 46.1%, as compared to 17.9% in urban counties (Table 38). Currently, 37.9% of MDs in metropolitan counties in Nevada list a primary care specialty or sub-specialty as their self-designated specialty, as compared to 41.3% of MDs in micropolitan counties and 72.7% of MDs in non-metropolitan counties (Table 39). In 2012, 64.7% of MDs in metropolitan counties in Nevada are providing patient care in an office-based practice, as compared to 57.3% of MDs in micropolitan counties and 54.5% of MDs in non-metropolitan counties. Currently, 11.3% of MDs in metropolitan counties in Nevada and 12.5% of MDs in micropolitan counties are providing patient care in a hospital-based practice, as compared to 30.3% of MDs in non-metropolitan counties (Table 40). Currently, 28.3% of physicians with an active license in Nevada are international medical graduates (IMGs) that is, they received their undergraduate medical education in another country. In 2012, Nevada ranked 7 th among US states in the percentage of physicians who are IMGs (Table 41). There are currently 5,361 total active physicians in Nevada, including 4,813 allopathic physicians (MDs) and 548 osteopathic physicians (DOs). In 2012, Nevada ranked 46 th among US states in the number of active physicians (MD and DO) per capita. Nevada has active physicians per 100,000 population, as compared to the US rate of active physicians per 100,000 population (Table 42). Office of Statewide Initiatives 7

14 There are currently 4,838 total active patient care physicians in Nevada, including 4,377 allopathic physicians (MDs) and 461 osteopathic physicians (DOs). In 2012, Nevada ranked 47 th among US states in the number of active patient care physicians (MD and DO) per capita. Nevada has active patient care physicians per 100,000 population, as compared to the US rate of active patient care physicians per 100,000 population (Table 43). There are currently 1,916 total active primary care physicians in Nevada, including 1,694 allopathic physicians (MDs) and 222 osteopathic physicians (DOs). In 2012, Nevada ranked 48 th among US states in the number of active primary care physicians (MD and DO) per capita. Nevada has 69.4 active primary care physicians per 100,000 population, as compared to the US rate of 90.1 active primary care physicians per 100,000 population (Table 44). There are currently 1,726 total active patient care primary care physicians in Nevada, including 1,524 allopathic physicians (MDs) and 202 osteopathic physicians (DOs). In 2012, Nevada ranked 48 th among US states in the number of active patient care primary care physicians (MD and DO) per capita. Nevada has 62.6 active patient care primary care physicians per 100,000 population, as compared to the US rate of 80.7 active patient care primary care physicians per 100,000 population (Table 45). Section Four: Undergraduate Medical Education (UME) and Graduate Medical Education in Nevada and the US According to the American Medical Association (AMA), 1,595 graduates of the University of Nevada School of Medicine (UNSOM) practicing in the United States. Nearly, three in five UNSOM graduates currently practicing in the US (57.9%) received their undergraduate medical education degree (MD) prior to 2000 (Table 46). Over the past decade, the number of UNSOM graduates practicing in the US has increased by 517 or 48.0%. During the same period, the number of UNSOM graduates with a self-designated primary care specialty or sub-specialty has increased from 520 in 2002 to 702 in 2012 (Table 47). In 2013, 29.8% of physicians completing UNSOM residencies and fellowships report that they will remain in Nevada to begin patient care practice or continue their graduate medical education (GME) (Table 48). 8 Office of Statewide Initiatives

15 Over the past decade, 49.3% of physicians completing UNSOM residencies and fellowships reported that they will remain in Nevada to begin patient care practice or continue their GME (Table 49). In 2012, there were 1,393 active physicians in the US who graduated from an MD or DO school in Nevada of this total, 513 or 36.8% are currently practicing in Nevada (Table 50). Among US states, Nevada ranks 27 th in the percentage of physicians who are practicing in the same state within which they received their undergraduate medical education (UME) degree (MD or DO) (Table 50). In 2012, there were 1,318 active physicians in the US who graduated from a public MD or DO school in Nevada of this total, 495 or 37.6% are currently practicing in Nevada (Table 51). Among US states, Nevada ranks 31 th in the percentage of physicians who are practicing in the same state within which they received their public undergraduate medical education (UME) degree (MD or DO) (Table 51). In 2012, there were a total of 1,026 active physicians (MD and DO) in the US who completed their GME in Nevada of this total, 573 or 55.8% are currently practicing in Nevada (Table 52). Among US states, Nevada ranks 9 th in the percentage of physicians who are practicing in the same state within which they completed their GME (Table 52). In 2012, there were a total of 211 active physicians (MD and DO) in the US who completed both their UME and GME in Nevada of this total, 167 or 79.1% are currently practicing in Nevada (Table 53). Among US states, Nevada ranks 5 th in the percentage of physicians who are practicing in the same state within which they completed both their UME and GME (Table 53). In Academic Year (AY 12-13), there were 803 students enrolled in an allopathic or osteopathic medical school in Nevada. This figure translated to a rate of Office of Statewide Initiatives 9

16 29.1 medical students per 100,000 population and a rank of 23 rd among US states in per capita medical school enrollment (Table 54). In AY 12-13, there were 262 students enrolled in a public medical school in Nevada. This figure translated to a rate of 9.5 students enrolled in a public medical school per 100,000 population and a rank of 38 th among US states in per capita public medical school enrollment (Table 55). Over the past decade, the number of students enrolled in an allopathic or osteopathic medical school in Nevada increased from 212 in 2002 to 803 in 2012 an increase of 278.8% in Nevada and a ranking of 1 st among US states in total enrollment growth in medical schools during that time period (Table 56). In AY 12-13, 54 of 78 first-year medical school matriculants (allopathic schools only) in Nevada were legal residents of Nevada Nevada s in-state matriculation rate of 69.2% was above the national average of 61.3% and resulted in a ranking of 21 st among US states (Table 57). In 2012, there were 791 medical students (MD and DO) enrolled in undergraduate medical education (UME) programs and 354 physicians (MD and DO) enrolled in graduate medical education (GME) programs in Nevada. The ratio of physicians enrolled in GME to students enrolled in UME in Nevada was 0.45 which resulted in a rank of 45 th among US states (Table 58). Over the past decade, the number of residents and fellows in ACGME-Accredited Programs (Accreditation Council for Graduate Medical Education) in Nevada increased from 189 in 2002 to 274 in 2012 an increase of 45.0% in Nevada and a ranking of 2 nd among US states in the growth of medical residents and fellows during that time period (Table 59). In 2012, there were 274 residents and fellows in ACGME-Accredited Programs in Nevada, including 102 MDs who graduated from US allopathic medical schools, 54 DOs, and 118 MDs who are international medical graduates (IMGs). In Nevada, 43.1% of residents and fellows in ACGME-Accredited Programs were IMGs among US states, Nevada has the 5 th highest percentage of IMGs in ACGME-Accredited residency and fellowship programs (Table 60). 10 Office of Statewide Initiatives

17 Among US states, Nevada has a rate of 10.1 residents and fellows per 100,000 population in ACGME-Accredited residency and fellowship programs resulting a rank of 46 th among US states (Table 61). In 2012, there were 166 residents and fellows in ACGME-Accredited primary care residency and fellowship programs in Nevada, including 136 MDs and 30 DOs (Table 62). Among US states, Nevada has a rate of 6.1 residents and fellows per 100,000 population in primary care residency and fellowship programs resulting a rank of 47 th among US states (Table 62). Section Five: Osteopathic Physicians (DOs) According to the American Medical Association (AMA), there are 690 osteopathic physicians currently licensed to practice in Nevada, including 522 male DOs (75.7%) and 168 female DOs (24.3%) (Table 63). Currently, 39.5% of male DOs in Nevada are over the age of 55, as compared to only 27.4% of female DOs who are over the age of 55 in Conversely, 72.6% of female DOs in Nevada are under the age of 45, as compared to 60.6% of male DOs who are under the age of 45 (Table 63). Currently, 570 DOs or 82.6% of DOs in Nevada are in patient care, including 418 DOs in office-based practice and 152 DOs in hospital-based practice (Table 64). In 2012, there were a total of 246 osteopathic physicians (DOs) in Nevada with a selfdesignated primary care specialty or sub-specialty. This number represents 35.7% of the total number of DOs in Nevada. By comparison, 41.4% of the DO workforce in the US had a self-designated primary care specialty or sub-specialty in 2012 (Table 65). Currently, 657 or 95.2% of all licensed DOs in Nevada are based in a metropolitan county of Nevada. The vast majority (94.7%) of patient care DOs in Nevada work in a metropolitan county (Table 66). Office of Statewide Initiatives 11

18 In 2012, 570 or 82.6% of all licensed DOs report patient care as their major professional activity (Table 67). The top three self-designated specialties of osteopathic physicians (DOs) in Nevada are: family medicine (21.9%), internal medicine (11.6%), and emergency medicine (8.4%) (Table 67). Currently, there are 7,015 physicians (MDs and DOs) in the physician workforce in Nevada, including 6,671 physicians in patient care and 1,611 physicians in non-patient care activities (Table 68). In 2012, the total number of active physicians in Nevada (MDs & DOs) was 6,883. Of this number, 5,136 were male (75.1%). Inversely, 1,707 active physicians were female or 24.9% (Table 69). Currently, 80.1% of active female physicians (MDs & DOs) in Nevada report that their major professional activity is patient care (either office-based or hospital-based) as compared to 75.4% of active male physicians (MDs & DOs) who report that their major professional activity is patient care (Table 70). Currently, 38.2% of active physicians (MDs & DOs) in Nevada report that their selfdesignated practice specialty is in primary care family medicine, general practice, internal medicine, obstetrics/gynecology, or pediatrics or a primary-care sub-specialty (Table 71). Section Six: Physician Workforce Rankings In 2012, there were 233 allopathic physicians (MDs) per 100,000 population. Among US states, Nevada ranks 47 th in number of physicians per capita (Table 72). In 2012, there were 169 MDs in patient care per 100,000 population. Among US states, Nevada ranks 48 th in number of physicians in patient care per capita (Table 73). 12 Office of Statewide Initiatives

19 Over the past decade, among US states, Nevada rank decreased from 36 th in 1980 to 47 th in 2012 resulting in drop of 11 positions in number of MDs per 100,000 population (Table 74). Over the past decade, among US states, Nevada rank decreased from 36 th in 1980 to 48 th in 2012 resulting in drop of 12 positions in number of MDs in patient care per 100,000 population (Table 75). Office of Statewide Initiatives 13

20

21 Section One: Demographic Characteristics of the Allopathic Physician Workforce (MDs) in Nevada

22

23 Age Category Table 1: Allopathic Physicians (MDs) by Age in Nevada 1992 to Change 1992 to 2012 Number Percent Number Percent Number Percent Number Percent < , , , , , , , Total MDs 2, , , , Source: AMA. Physician Characteristics and Distribution in the U.S., 2014; AMA. Physician Characteristics and Distribution in the U.S., 2004; AMA. Physician Characteristics and Distribution in the U.S., Notes: Figures for 1992, 2002, and 2012 include both federal and nonfederal physicians. Table 2: Allopathic Physicians (MDs) by Gender in Nevada 1992 to 2012 Gender Change 1992 to 2012 Number Percent Number Percent Number Percent Number Percent Male Physicians 2, , , , Female Physicians , , Total MDs 2, , , , Source: AMA. Physician Characteristics and Distribution in the U.S., 2014; AMA. Physician Characteristics and Distribution in the U.S., 2004; AMA. Physician Characteristics and Distribution in the U.S., Notes: Figures for 1992, 2002, and 2012 include both federal and nonfederal physicians. Office of Statewide Initiatives 17

24 Table 3: Male Allopathic Physicians (MDs) by Age in Nevada 1992 to 2012 Age Category Change 1992 to 2012 Number Percent Number Percent Number Percent Number Percent < , , Total Male MDs 2, , , , Source: AMA. Physician Characteristics and Distribution in the U.S., 2014; AMA. Physician Characteristics and Distribution in the U.S., 2004; AMA. Physician Characteristics and Distribution in the U.S., Notes: Figures for 1992, 2002, and 2012 include both federal and nonfederal physicians. Table 4: Female Allopathic Physicians (MDs) by Age in Nevada 1992 to 2012 Age Category Change 1992 to 2012 Number Percent Number Percent Number Percent Number Percent < , ,123.5 Total Female MDs , , Source: AMA. Physician Characteristics and Distribution in the U.S., 2014; AMA. Physician Characteristics and Distribution in the U.S., 2004; AMA. Physician Characteristics and Distribution in the U.S., Notes: Figures for 1992, 2002, and 2012 include both federal and nonfederal physicians. 18 Office of Statewide Initiatives

25 Table 5: U.S. Medical Graduates (USMGs) by Age and Gender in Nevada 2012 United States Medical Graduates (USMG) in Nevada Age Category Male Female Total Number Percent Number Percent Number Percent < , Total USMG MDs 3, , Source: AMA. Physician Characteristics and Distribution in the U.S., Notes: Figures for USMGs include American and Canadian Medical School Graduates. Office of Statewide Initiatives 19

26 Table 6: International Medical Graduates (IMGs) by Age and Gender in Nevada 2012 International Medical Graduates (IMGs) Age Category Male Female Total Number Percent Number Percent Number Percent < Total IMG MDs 1, , Source: AMA. Physician Characteristics and Distribution in the U.S., Notes: Figures do not include Canadian Medical School Graduates. 20 Office of Statewide Initiatives

27 Section Two: Distribution of the Allopathic Physician Workforce (MDs) in Nevada by Major Professional Activity and Self-Designated Specialty

28 Major Professional Activity Table 7: Allopathic Physicians (MDs) by Major Professional Activity in Nevada 1992 to Change 1992 to 2012 Number Percent Number Percent Number Percent Number Percent Patient Care Office-based 1, , , , Hospital-based Residents & Hospital-based Fellows Physicians Staff Subtotal Patient Care 1, , , , Other Professional Activity Administration Medical Teaching Medical Research Other MDs Subtotal Other Prof Activity Not Classified MDs Inactive MDs , Total MDs 2, , , , Source: AMA. Physician Characteristics and Distribution in the U.S., 2014; AMA. Physician Characteristics and Distribution in the U.S., 2004; AMA. Physician Characteristics and Distribution in the U.S., Notes: Physicians in Patient Care refers to physicians whose principal professional activity is the provision of patient care in an office based setting or hospital. Figures for 1992, 2002, and 2012 include both federal and nonfederal physicians, but not physicians whose address is unknown. Inactive MDs include physicians who are retired, semi-retired, working parttime, temporarily not in practice, or not active for other reasons and who indicated they worked 20 hours or less per week. Not Classified MDs includes physicians who did not provide information on their type of practice or their present employment. 22 Office of Statewide Initiatives

29 Table 8: Female Allopathic Physicians (MDs) by Major Professional Activity in Nevada 1992 to 2012 Major Professional Activity Change 1992 to 2012 Number Percent Number Percent Number Percent Number Percent Patient Care Office-based Hospital-based Residents & Hospital-based Fellows Physicians Subtotal Patient Staff Care , Other Professional Activity Administration Medical Teaching Medical Research Other MDs Subtotal Other Prof Activity Not Classified MDs ,011.1 Inactive MDs Total Female MDs , , Source: AMA. Physician Characteristics and Distribution in the U.S., 2014; AMA. Physician Characteristics and Distribution in the U.S., 2004; AMA. Physician Characteristics and Distribution in the U.S., Notes: Physicians in Patient Care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. Figures for 1992, 2002, and 2012 include both federal and nonfederal physicians, but not physicians whose address is unknown. Inactive MDs include physicians who are retired, semi-retired, working part-time, temporarily not in practice, or not active for other reasons and who indicated they worked 20 hours or less per week. Not Classified MDs includes physicians who did not provide information on their type of practice or their present employment. Office of Statewide Initiatives 23

30 Table 9: Male Allopathic Physicians (MDs) by Major Professional Activity in Nevada 1992 to 2012 Major Professional Activity Change 1992 to 2012 Number Percent Number Percent Number Percent Number Percent Patient Care Office-based 1, , , , Hospital-based Residents Hospital-based & Fellows Physicians Subtotal Patient Staff Care 1, , , , Other Professional Activity Administration Medical Teaching Medical Research Other MDs Subtotal Other Prof Activity Not Classified MDs Inactive MDs Total Male MDs 2, , , , Source: AMA. Physician Characteristics and Distribution in the U.S., 2014; AMA. Physician Characteristics and Distribution in the U.S., 2004; AMA. Physician Characteristics and Distribution in the U.S., Notes: Physicians in Patient Care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. Figures for 1992, 2002, and 2012 include both federal and nonfederal physicians, but not physicians whose address is unknown. Inactive MDs include physicians who are retired, semiretired, working part-time, temporarily not in practice, or not active for other reasons and who indicated they worked 20 hours or less per week. Not Classified MDs includes physicians who did not provide information on their type of practice or their present employment. 24 Office of Statewide Initiatives

31 Major Professional Activity Table 10: International Medical Graduates Physicians (IMGs) by Major Professional Activity in Nevada 2002 to Change 2002 to 2012 Number Percent Number Percent Number Percent Number Percent Patient Care Office-based , , Hospital-based Subtotal Patient Care , , Other Professional Activity Not Classified MDs Inactive MDs Total IMG MDs 1, , , Source: AMA. Physician Characteristics and Distribution in the U.S., 2014; AMA. Physician Characteristics and Distribution in the U.S., 2009; AMA. Physician Characteristics and Distribution in the U.S., Notes: Physicians in Patient Care refers to physicians whose principal professional activity is the provision of patient care in an office-based setting or hospital. Figures for 2002, 2007, and 2012 include both federal and nonfederal physicians, but not physicians whose address is unknown. Inactive MDs include physicians who are retired, semi-retired, working parttime, temporarily not in practice, or not active for other reasons and who indicated they worked 20 hours or less per week. Not Classified MDs includes physicians who did not provide information on their type of practice or their present employment. Office of Statewide Initiatives 25

32 Table 11: Allopathic Physicians (MDs) by Country of Undergraduate Medical Education and Self-Designated Primary Care Specialty in Nevada 2012 Specialty U.S. Medical Graduates (USMGs) Total MDs International Medical Graduates (IMGs) Total Number Percent Number Percent Number Percent Primary Care Specialties Family Medicine General Practice Internal Medicine Obstetrics/Gynecology Pediatrics Total Primary Care MDs 1, , Primary Care Sub-specialties All Other Specialties 1, , Not Classified MDs Inactive or Address Unknown , Total MDs 4, , , Source: AMA. Physician Characteristics and Distribution in the U.S., Notes: See Appendix for sub-specialty classifications. Figures exclude Canadian Medical School Graduates. Inactive MDs include physicians who are retired, semi-retired, working part-time, temporarily not in practice, or not active for other reasons and who indicated they worked 20 hours or less per week. Not Classified MDs includes physicians who did not provide information on their type of practice or their present employment. 26 Office of Statewide Initiatives

33 Table 12: Allopathic Physicians (MDs) by Gender and Self- Designated Primary Care Specialty in Nevada 2012 Total MDs Specialty Male Female Total Number Percent Number Percent Number Percent Primary Care Specialties Family Medicine General Practice Internal Medicine Obstetrics/Gynecology Pediatrics Total Primary Care MDs 1, , Primary Care Sub-specialties All Other Specialties 2, , Not Classified MDs Inactive or Address Unknown , Total MDs 4, , , Source: AMA. Physician Characteristics and Distribution in the U.S., Notes: See Appendix for sub-specialty classifications. Office of Statewide Initiatives 27