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) Wait Time (Days) Neurology 34.8 OB GYN 27.5 Neurosurgery 24.1 Dermatology 22.1 Family Medicine 20.3 Orthopaedic Surgery 16.8 Cardiology 15.5 Source: Health Affairs Specialty (Pediatrics) Wait Time (Days) Developmental Pediatrics 101 Genetics 76 Neurology 62 Rheumatology 55 Dermatology 54 Child Psychology 52 Endocrinology 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 800 700 718 666 667 600 500 531 487 400 359 300 200 100 182 161 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 $65,621,392 Divided by 442 residents Departmental Costs: $148,465 (per res/per year) 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 Total Costs: $172,563 per resident/per year x 7 years Source: Neurosurgery Statement to IOM Ensuring an Adequate Neurosurgical Workforce $24,098 (per resident/per year) $1,207,941 (per resident)
Neurosurgery Residency Match Data Year PGY 1 Applicants Positions Offered Positions Filled Percent Filled 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
Neurosurgery Residency Match Data 350 300 250 200 150 100 50 0 Applicants Offered Filled Applicants Offered Filled Applicants Offered Filled Applicants Offered Filled Applicants Offered Filled Applicants Offered Filled 2009 2010 2011 2012 2013 2014 Source: National Residency Matching Program
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 574 22.6% Neurology 184 93.8% Neurosurgery 15 7.8% Orthopaedic Surgery 54 8.4% Otolaryngology 20 7.2% Physical Med & Rehab 14 17.0% Primary Medicine 88 35.6% Surgery 135 11.7% TOTAL 4,251 18.9% 2009 2010 2011 2012 2013 2014 500 0 Neurosurgery is Falling Behind! Source: National Residency Matching Program
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 Source: Journal of Graduate Medical Education Positions Lost = 33,000
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. Ratio of Physicians per 100,000 Tex. Ratio as % of U.S. Ratio Specialty Texas U.S. All Physicians 167.3 210.2 79.6% Emergency Medicine 6.64 9.12 72.9% Family Medicine 21.7 24.9 87.1% Neurology 3.13 4.01 78.1% Neurosurgery 1.28 1.46 87.3% Orthopaedic Surgery 5.46 6.73 81.1% Otolaryngology 2.41 2.78 86.7% Pediatrics 62.8 84.8 74.1% Physical Med & Rehab 1.96 2.5 78.6% Surgery 7.23 8.99 80.4% Source: Texas Medical Association, Medical Education Department
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 korrico@neurosurgery.org