Amid doc shortage fears, new forecasting tool helps predict supply

Physician shortages have been a key part of the discussion surrounding the rollout of the Affordable Care Act. As more Americans obtain insurance, there’s growing concern that a lack of doctors – especially in areas like primary care—will keep those patients from accessing that care.

A new online interactive tool from The Physicians Foundation and the Cecil G. Sheps Center for Health Services Research at The University of North Carolina-Chapel Hill is designed to help analyze and predict the country’s physician supply.

The FutureDocs Forecasting Tool can predict the supply of physicians in a variety of disciplines as well as specific geographic areas within the United States through 2030. It’s inherently hard to predict physician shortages since so many factors can come into play, yet this tool attempts to address some of the possibilities.

Users can experiment with different scenarios, such as whether a state adopts Medicaid expansion, changes to physician retirement rates, or the growth of nurse practitioners/physician assistants. It’s also constructed with the understanding that physicians in different specialties and other health workers often have overlapping scopes of practice.

“We need a tool that doesn’t give us one answer but provides a way to view the future under different scenarios,” said Erin Fraher, the leader of the tool’s development team.

A primary objective of the tool is to help regions throughout the nation have a more accurate sense of their recruitment and training needs, especially with the ACA’s insurance expansion.

“Now, more than ever, as the implementation phase of the Affordable Care Act continues and shifting U.S. population demographics and growth persist, we need up-to-date projections to develop practical solutions to address patient access issues,” said physician Alan Plummer, the vice president of The Physicians Foundation, which funded the effort.

The tool is also helpful for journalists looking to analyze what’s happening in their specific coverage areas, whether it’s a metropolitan region or the entire country. The most interesting story the data tells is not that the nation overall faces a physician shortage, said Fraher of the development team.

“The model suggests that the much bigger issue is the disparities between geographies in the capacity of the workforce to meet projected demand,” she said. “This goes against many of the current articles journalists are writing.”

The fuller story of the physician shortage issue lies in the uneven distribution of health workers. The country overall might not have a shortage of doctors — as evidenced by viewing an all-state line chart — yet the patchy geographic distribution leads to shortfalls in some areas and surpluses in others, something that’s visible with the state-by-state map.

At the national level, even mental health services aren't in short supply throughout the entire 2011-2030 period under the tool’s baseline scenario. But the map view of distinct regions shows many areas of shortage and some of surplus for mental health care.

Since the model was launched several months ago, some media outlets are already using the tool to support and build upon their health coverage.

Just last week, this Forbes opinion piece used the tool to highlight the projected shortage of general internists nationwide over the next 20 years.

The Triangle Business Journal in North Carolina took a more localized view, using the data to determine “[t]he Raleigh area is facing a larger shortage of preventative care doctors by 2020 than the Durham and Chapel Hill areas, though is still projected to be in better balance than many other areas in the state, particularly Charlotte.”

Below are a few of the key findings that could be localized to your coverage area, as well as possible searches that could spur stories:

• General internal medicine in the United States is projected to experience a 12 percent decline in full-time providers between 2011 and 2030. How does this change by geographic area? What areas are the hardest hit within your state or coverage area? What areas still have a surplus?

• The number of mental health visits exceeded provider capacity in the majority of areas in 2011, and these geographic disparities are projected to become more pronounced by 2030.  Again, tailor this finding to your coverage area.

• Take a look at how Medicaid expansion has affected states’ health care needs with and without Medicaid expansions by adjusting that filter. The baseline scenario beginning in 2011 does not take the ACA into account, so this will need to be adjusted.

• The data is localized to tertiary service areas, which typically include several counties and can be identified by a zip code search. (These are based on the Dartmouth Institute for Health Care Policy and Clinical Practice’s hospital referral regions.) Run a variety of searches for specialties in your region and see how the projected demand varies over time. Which specialties will have a surplus? Shortage? What are the outliers?

• Run the same searches but change factors such as physician retirement rates, or the amount of nurse practitioners/physician assistants. You can increase these roles by 3 or 6 percent and see how that affects overall supply – this could be particularly useful if your state is debating a scope of practice expansion.

• The tool could be especially relevant in articles surrounding the debate over expanding graduate medical education (GME). The model includes a scenario that redistributes GME slots instead of increasing positions. Take a look at how changing the distribution will affect physician levels in various specialties.

• The flip side of the decline in general internal medicine is the nationwide increase in the supply of internal medicine subspecialties, such as allergy and immunology, endocrinology, gastroenterology, geriatrics, nephrology, oncology, pulmonology, and rheumatology. The model predicts that full-time oncologists in the U.S. will grow by approximately 80 percent between 2011 and 2030. How will internal medicine subspecialties grow in your coverage areas? Contrast the growth in the supply of internal medicine subspecialties in your coverage area with changes in general internal medicine supply in your area. How could this increasing sub-specialization affect patient care?