From TMA GME Stakeholder Forum

2. The factors contributing to health workforce’s availability and shortage are many and change rapidly over time Geographic distribution: distances between providers, patients, and resources Age distribution and distribution among specialties Payers and the economics & psychic rewards of practices Educational capacity Retention Ethnic and racial distribution

3. Physicians*, Registered Nurses, and Dentists** per 100,000 Population in Texas and the U.S., 1998 and 2007 Texas United States 2007 2004 2007 2004 2007 2005 Physicians Registered Nurses Dentists +11,202 +19,072 +42,464 +39,819 +2,317 +2,139 + values = the number needed to bring the Texas ratio up to parity with the US ratio and is not an indication of demand * Direct Patient Care Physicians ** General Dentists Note: 1998 US Registered Nurse Ratio extrapolated from 1996 and 2000 data 1998 1998 1998 Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, April 2008

4. Medical Workforce Dynamics Direct Patient Care (DPC) in Texas 2002 - 2007 left TEXAS 1,287 inactive 2,646 left DPC 1,516 entered Fed. settings 319 inactive Fed. settings practiced in another state not DPC (883 of these were residents) 862 1,340 236 367 not licensed in Texas 6,094 Status In 2002: Status In 2007: 2002 DPC = 33,094 2007 DPC = 37,177 Remained in DPC 27,311 Gained 9,866 Lost 5,783 research, locum tenens, other 15 locum tenens, other 83 Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, April 2008

5. Location of Medical School Direct Patient Care (DPC) in Texas 45.1 % 44.8 % 2002 2007 31.5 % 32.0 % 23.4 % 23.3 % Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, April 2008

6. The Profile of Change: 2002 and 2007 Texas Direct Patient Care Physicians (DPC) Increases in Female and Hispanic Physicians NOTE: Includes active, direct patient care, non-Federal physicians. Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, April 2008

7. The Profile of Change: DPCs Who Exited and Entered Texas Between 2002 and 2007 Proportionally, more male exiting and more younger and URM doctors entering NOTE: Includes active, direct patient care, non-Federal physicians. Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, April 2008

8. Texas Direct Patient Care Physicians Aged 30-39, 40-49, 50-59 1997 and 2007 20,000 15,000 10,000 5,000 0 5,000 10,000 15,000 20,000 1997 2007 * Includes active, direct patient care, Non-Federal physicians 6,622 10,137 6,291 10,313 10,491 7,668 Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, April 2008

9. There are marked differences in the way physicians are distributed among the Texas Public Health Regions

11. Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, April 2008

12. Rural Counties Metropolitan Counties Border Patient-Care Physicians -- 2002-2007 2002 DPC: 2,207 2007 DPC: 2,468 1,761 Remained in border (DPC) Texas Non-Border Counties Texas Border Counties 126 124 left Texas – 77 left DPC – 51 became inactive - 154 entered Fed. Setting – 36 other - 2 new licensees - 394 from another state – 56 entered DPC – 57 became active - 14 left Fed. Setting – 30 residents/fellows - 32 Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, April 2008

13. Active DPC Physician Retention (1997 Cohort) Non-Border and 32 Border Texas Counties Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, April 2008

14. Physician Retention (1993 Cohort) Non-Border and 43 Border Texas Counties Non-Border Border

15. Population Change in Texas Counties, 2000-2005 Source: Prepared from U.S. Bureau of the Census, 2005 County Estimates by Texas State Data Center, The University of Texas at San Antonio

17. Labor market processes as a function of physician characteristics. Characteristics of practice environments affecting recruitment and retention. Processes of recruitment, survival, migration of physicians within the state and in sub-areas of the state. Evolving population-based demand based on projections of population growth by characteristics related to demand for health-care services. Identification of interventions that can increase supply of services areas where they are most needed. What are the factors affecting “optimal” physician workforce distribution

18. It is necessary to complement shortage data with reliable and current information on practice location, service area, race/ethnicity/age of providers and of the population in need of health care These data are strategically important for planning realistic, location-targeted training options and a sustainable educational capacity that would effectively address the Texas health challenges Conclusions