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May 04, 2009
The supply of available doctors in Michigan is decreasing, according to findings from the 2008 Michigan Department of Community Health Survey of Physicians. About 62 percent of physicians providing patient care in Michigan report their practice is full or nearly full, compared to 42 percent of physicians in 2005.
There are other serious issues affecting the supply of physicians in Michigan. The number of new primary care physicians has just barely kept pace with the number of primary care physicians leaving the workforce in the past few years. And the percentage of physicians who plan to discontinue practice within the next 10 years is increasing.
About a third (34 percent) of active physicians are primary care doctors whose specialty is in family practice, general medicine, internal medicine, or general pediatrics. This percentage has not changed since 2005. Just 47 percent of active physicians plan to practice medicine for one to 10 more years, compared to 41 percent of physicians surveyed in 2007.
Michigan Department of Community Health (MDCH) Director Janet Olszewski sees the trends in the latest survey data as a call for action. "These numbers reflect the growing problem of access to care for Michigan's population. The department has undertaken a number of initiatives to address access issues, but it will take a concerted effort with all of our partners in the healthcare education and delivery systems, as well as policy makers at the state and national level, to assure that we can meet the future health care needs of our citizens in the future."
Dr. Gregory Holzman, chief medical executive for MDCH, said improving the distribution of physicians, by both geographic area and specialty, has to be part of the solution. "The mal-distribution of physicians is a major national problem. We can continue to produce more doctors, but if we fail to address the distribution issues, we will continue to have access problems."
Carol Callaghan, coordinator of the Michigan Primary Care Consortium staffed by MDCH, is particularly concerned with the findings on primary care. "We know from numerous studies that access to primary care is the key to improving our healthcare system. Unless we have adequate numbers of primary care physicians and put primary care at front and center of our healthcare system, we can expect higher costs and poorer health outcomes in the years ahead."
The 2008 survey findings also show that the percentage of physicians providing care to Medicaid patients is declining, and availability of services for patients with low incomes is limited.
About 85 percent of physicians report they currently provide care to Medicaid patients, compared to 87 percent of the physicians surveyed in 2007 and 89 percent in 2006. On average, physicians who provide patient care spend 9 percent of their time with patients who pay on an income-adjusted fee scale, but half of physicians who provide patient care do not spend any time with patients who pay on a sliding fee scale.
Dr. William Wadland, chairman of Family Medicine at Michigan State University's College of Human Medicine, agrees the data suggest critical shortages for primary care in Michigan, especially with the decrease in access for Medicaid patients and the medically uninsured and underinsured. "Michigan needs to advocate for new pathways to promote primary care education and career choice, especially among physicians trained and retained in Michigan. For citizens of Michigan to obtain comprehensive care that leads to the best outcomes, we need a combination of excellent primary care and access to specialty care."
The survey's most positive findings include a significant increase in physicians' use of computers and other technology to transmit and store health care information. Numerous studies suggest that use of such technology by physicians leads to significantly lower health care costs and improved access to care.
The Michigan Healthcare Workforce Center (MHWC) is an information resource of the Bureau of Health Professions at the Michigan Department of Community Health. It's designed to gather, review, and disseminate information on issues related to the healthcare workforce. Public Sector Consultants Inc., a Lansing public policy research firm, conducted the survey and prepared the report for the MHWC. Responses to the detailed survey questionnaire were received from 4,546 fully licensed physicians in Michigan.
Additional details about the physician workforce are contained in the full report, Michigan Department of Community Health Survey of Physicians, Survey Findings 2008, available online at www.michigan.gov/mhwc under Licensee Surveys.