Pam Danner, MBAFormer Program Director, West Texas AHEC

Steve Shelton, PA, MBAProgram Director, East Texas AHEC

The landscape…In 2007, Texas ranked 43rd with 157 physicians per

100,000 population-the same as it had in 2000, while leading the nation in population growth (Texas Medical Association)

In 2007, Texas had fewer residency slots than New York, California and Pennsylvania and the numbers funded by Medicare are capped (TMA)

The number of graduates seeking family medicine has dropped 27% from 2002-2007 (Association of American Medical Colleges)

The AAMC predicts a shortage of 124,00 – 159,000 physicians by 2025. This prediction is “pre-reform” which is anticipated to increase the shortage by as much as 25% (AAMC)

The ProcessGarnered “political” support

State partnersResidency Programs

Developed the InstrumentLiterature review, previous state agency surveys

IRBUniversity of Texas Medical Branch at GalvestonTexas Tech University Health Sciences CenterDeveloped the survey

Political SupportInterested parties

The legislatureTrade organizationsPolicy planners

The IRBFormal IRB reviewExempt status

Major Goals of the SurveyTo assess the background and educational

experiences of primary care resident physicians (family medicine and internal medicine) at State of Texas residency programs

Assess resident physicians expectations and desired work environment

Evaluate opportunities for AHEC to better meet residents’ need for information about available practice support resources, particularly related to medically underserved opportunities.

Objectives of the SurveyDetermine what residents previous experience in rural

and medically underserved communities has beenDetermine what residents are seeking in practice locationDetermine what physician residents are seeking in

practice relationships with other providers and organizations

Determine what residents familiarity is with federal programs available to support or enhance rural or underserved practice

Compare and contrast different desires and expectations based on demographic characteristics

Determine types of resources that residents would find most beneficial in finding practice opportunity and in establishing practice

Survey Methodology2 Methodologies, one survey documentPaper survey, administered at voluntary

resident meetingsOn-line

The SurveyGeneral demographic informationPlace of residency history and spouse

residenceClinical training experiencePractice preferences

Call, size, ancillaries, etc.Knowledge of clinic designationsPreference in employment or private practice

Cont.Knowledge of loan repayment programsCurrent sponsorship levelCurrent job seeking methodsRate community attributesInterest in working with underserved

Survey Response364 resident physicians responded, 49% male, 51% female

Response cont.34% indicated they had lived in a community of

less than 20,000 20% graduated from high school in a rural area50% had no training in a rural setting as part of

medical educationLess than 20% did in residency training51% familiar with rural health clinics, 41%

knew about FQHCs or CHC14% would consider practice in an RHC or

FQHC

Practice Location Preference68% interested in practicing in community

over 50,000Only 10% indicated a preference for a

community less than 20,00035% preferred practicing within 50 miles of

urban community27% had no preference for proximity to

urban

Practice Arrangement Preference64% prefer a group practice arrangement74% preferred call no more than once per

week71% considered hospital privileges essential85% preferred hospital professional staffs of

more than 1085% will consider interdisciplinary practice

with a physician assistant or nurse practitioner

17% will consider providing OB services

Employment vs. Private Practice75% indicated a preference for an

employment arrangementDefined salaryDefined Benefits

Loan Repayment12% are involved in loan repayment

commitment situations39% would be interested in loan repayment

programs77% would accept multi-year contracts for

practice entry75% need financial assistance to enter

practice

Employment Search45% will seek employment on their own18% will use a search firm21% will use on-line employment methods44% waited until their second or third year of

residency to see employment options54% would consider practice in underserved

community

Important Community AttributesResponses ranked on a 5 point scale with 5

being most importantLow crime/safety/security – 4.45Friendliness of community – 4.39Quality of schools – 4.3Travel time to work – 4.12Cost of living – 4.08Availability of basic shopping – 4.06

Community attributes of moderate importanceAmenitiesRecreationAvailability of other physicians for peer

supportEmployment opportunities for spouse

Lesser important community attributesBeing near where spouse grew upSmall communityCommunity engagement opportunitiesLarge community size

FindingsMost residents did not have learning

opportunities in rural settingsMost are unfamiliar with practice models

common in rural areas or used with underserved populations even though more than half were interested in serving the underserved

Most do not desire practice opportunity consistent with traditional private practice situationLimited call, etc.

Findings ContinuedLoan repayment is very appealingSafety, security, friendliness, school quality,

travel time, etc are important

Formal RecommendationsEducate, encourage and incentivize communities of

advantages to sponsorship of future health professionals

Use rural and small community experiences for learning to familiarize career decision makers of practice opportunities

Develop emphasis or special focus programs to address unmet healthcare workforce needs in rural and other underserved areas

Expand loan repayment programsIncorporate more practice development information

into primary care residency programsAllow for employment of phsicians

Opportunities for Texas AHEC ProgramsIncrease program areas which promote

training with underserved populations (CHCs, RHCs, Rural sites)

On-line employment match sites should “work”

Increase partnership work with rural communitiesHealthMATCH, HealthFind

Real outcomes for TexasPhysician Employment BillPush to increase residency training sites

AHEC asked to be involved and have a voice!