By Anna Miller
At first glance, the physician workforce in Washington, D.C. looks robust: about one licensed physician for every 60 residents. That’s far higher than the nationwide ratio of about one doctor for every 300 Americans.
But a new survey of the city’s licensed physicians and physician assistants paints a different picture.
According to a report compiling the survey results, more than 40 percent of physicians licensed to practice in the District don’t actually practice there. And of those who do practice in the city, only about two-thirds provide clinical care for more than 20 hours a week. The results were similar for the city’s licensed physician assistants: only 53 percent practice in the District for more than 20 hours a week.
The report was released at a D.C. Board of Medicine Symposium in GW’s Jack Morton Auditorium last Wednesday.
“This is an issue that is of great importance to physicians, physician assistants, as well as those of us who are engaged in the important role of public health in ensuring that our citizens in the District can lead healthy, productive lives,” said Lynn Goldman, dean of GW’s School of Public Health and Health Services in her welcoming remarks.
The event, which brought together area health professionals, academics, hospital administrators and local government workers, was co-sponsored by SPHHS and the School of Medicine and Health Sciences. Alan Wasserman, chair of SMHS's Department of Medicine, also welcomed participants.
The workforce survey was conducted between October 2010 and February 2011 as an optional and anonymous part of the license renewal process, which all physicians and physician assistants must go through every two years to maintain their privileges in D.C. About 75 percent of those who applied for renewal participated in the survey, including 6,945 physicians and 388 physician assistants.
In addition to gathering basic demographic and educational information, the survey asked physicians and physician assistants about their location, specialty, plans for the future and use of electronic health records and social media.
The resulting report, which was authored by Rachelle Pierre-Mattheiu, a GW emergency medicine health policy fellow and a Board of Medicine health policy fellow, describes a local workforce that is racially and ethnically similar to doctors across the United States with one exception. Nineteen percent of District doctors are African American or black; in the United States, they represent only 4 percent of the workforce. Among the physician assistants surveyed, 30 percent were African American or black, compared with a 3 percent national proportion. Although the racial and ethnic composition of the survey respondents met or exceeded national norms, it did not reflect the diversity of the general D.C. population, the report noted.
The specialty distributions for both physicians and physician assistants appear to be similar to national estimates except in family practice, a specialty with significantly fewer D.C.-based providers. Internal medicine, general pediatrics and psychiatry were the most popular specialties among the city's practicing physicians; for the physician assistants, emergency medicine and general internal medicine topped the charts.
According to the report, nearly 40 percent of physicians and more than 60 percent of physician assistants work in hospital-based practices, and even those not affiliated with hospitals are clustered around them. More physicians reported practicing in Northwest D.C. than any other quadrant of the city--a finding that reawakens concern about access to care in some of the city's most underprivileged areas, particularly east of the Anacostia River.
Mohammad Akhter, director of the D.C. Department of Health, said the main purpose of the report is to start a dialogue.
“Until we find out where the people are, what they’re doing and who they’re serving, we can’t begin to plan for our own city, we can’t begin to identify where the gaps are in what kind of services we need,” he said.
Ed Salsberg, director of the National Center for Healthcare Workforce Analysis and health policy lecturer at SPHHS, delivered the symposium’s keynote address, which discussed national trends, challenges and potential solutions to what he called an inevitable “clash” between the need for both more providers and reduced health care spending.
Mr. Salsberg said he expects physician assistants and nurse practitioners to play a greater role in care delivery in part because their professions are growing “relatively rapidly.”
He also predicted that states will also be reevaluating their scopes of practice for non-physician health care workers and promoted interprofessional training and practice. “We think the answer is teams,” he said.
Mr. Salsberg also stressed the need for redistribution of providers, particularly those who practice primary care, and called for similar data collection methods across states and professions.
“We will need data, analysis and research to inform decision-making and ensure access,” he said.
The D.C. Board of Medicine plans to conduct another survey during in 2012. “The minute we got the results, we had 10 more questions,” said Janis Orlowski, chair of the D.C. Board of Medicine, who presented the report. “This is the first time we’ve done the survey, but it won’t be the last because we understand how important it can be in planning for the future.”