Overview of the State of Medicine Report
No discussion of health care marketplace forces in 2008 and beyond can escape mentioning one all-encompassing factor: Demand.
The relationship between ever-increasing demand and increasing pressures on Pennsylvania’s health care work force, hospitals, and infrastructure is explored in the 2007 edition of the Pennsylvania Medical Society’s “State of Medicine in Pennsylvania” report.
Increasing demand for health care services is a certainty in the US during the next few decades, due in large part to the aging baby boomer generation, an increased use of technology, and changes in the way people perceive, access and use health care.
The report examines population growth and aging, trends in physician office and emergency visits, and demand for physician services in connection with hospital services.
This analysis also includes aspects of the medical practice environment that are most directly impacted by increased demand and compares Pennsylvania’s experience to the rest of the nation. The report considers the physician work force and issues surrounding physician efficiency, productivity, and supply.
Perhaps one the most actionable findings of “The State of Medicine in Pennsylvania” are trends surrounding the need for recruitment and retention of existing and future physicians.
Rather than providing recommendations or solutions, this report spotlights trends, supported by data, which are central to discussions about shoring up Pennsylvanian’s access to health care.
Following are brief summaries of some of the major trends identified in this report:
- Declining physician work force
The total number of active patient care physicians in Pennsylvania is less than previously thought (less than 25,000). In terms of physicians per 10,000 elderly persons, Pennsylvania ranks 37th. In addition, the Pennsylvania physician work force is composed of increasing numbers of part-time physicians and older physicians and decreasing numbers of young physicians.
- Declining physician recruitment and retention
Pennsylvania has difficulty recruiting and retaining physicians-in-training from Pennsylvania residency programs, as well as retaining permanent physicians. Residency retention has dropped from 60 percent in 1992 to approximately 22 percent in 2006.
- Medical students’ preferences for specialties
Pennsylvania medical school enrollment is healthy and growing. A substantial portion of the increase can be attributed to increases in osteopathic medical school enrollments. However, medical school graduates focus on higher paying specialties in order to handle their large medical education debt burden and maximize returns on their investment of time and money. In addition, the state’s unresolved medical liability climate may deter some students from practicing here.
- Declining physician insurance reimbursement
Across the nation physicians’ insurance reimbursement levels are declining, moving closer to Pennsylvania’s still lower payment levels. Pennsylvania’s reimbursement for evaluation and management services have improved slightly over the past several years. Pennsylvania still has among the poorest payment in the nation from commercial insurance and Medicaid, at least for E&M services.
- Increasing physician work loads
Comparative analysis of inpatient days per physician, outpatient visits per physician, and surgeries per physician suggest that the work loads of Pennsylvania physicians and surgeons are substantially higher than work loads of their counterparts nationally. Previously stated trends (e.g. more demand for health care, an aging physician work force) would further increase physician work load and could make physician recruitment and retention even more difficult.
- Unpredictable medical liability climate
The professional liability situation in Pennsylvania has improved somewhat, but average payouts per physician in Pennsylvania remain high—double the national average and four to six times higher than in most favorable physician liability states.
The Society strongly encourages a collaboration of state government and public and private stakeholders and policymakers to review and discuss the implications of these trends, and looks forward to working within this coalition.
This study was commissioned and funded by the Pennsylvania Medical Society and published in 2007 with data from governmental and non-governmental sources. The chief researcher was Stephen Foreman, PhD, JD, MPA, Associate Professor of Health Economics and Allied Health at Robert Morris University.
Last Updated: 8/1/2008