Primary Care Physician Workforce Needs: National and Montana Perspectives Roger W. Bush, MD Program Director Internal Medicine Program Billings Clinic Montana HealthCare Forum December 8, 2014

Learning Goals: Primary Care Physician Workforce for MT  Problem Scope  What do we have?  What do we need?  How do we get it?  Potential Solutions:  More Medical School Graduates?  More Regional Graduate Medical Education?  More distributed GME training?

Problem Scope: PCP Workforce in MT

Montana  4 th largest state  44 th in population  56 counties (population/sq. mile)  1- urban (>50/sq. mile)  10-rural ( 6-50/sq. mile)  45-frontier ( < 6/sq. mile)

Primary Care in Montana  11/56 counties without a primary care physician  19,635 residents in those counties  33/56 counties with fewer primary care physicians than national average  308,648 residents in those counties

Montana Physician Demographics  MT physicians age 60 or older 31.2%, 3 rd oldest in the nation  National average 27.6%  2,297 practicing physicians rd in total physicians per capita

Barriers to recruiting to rural and remote  Lack of spousal employment  Lack of cultural activities  Insufficient housing  Poor-quality schools  Inadequate compensation JAMA Rosenblatt 2006

More Medical Students?

More AAMC Medical Schools?

Billings Clinic Internal Medicine Residency Class of 2017

More Regional Graduate Medical Education?

Medicare GME cap per 100,

Medicare GME Payment per Person, 2010

Medical Education in Montana  WWAMI 30 matriculates yearly  WICHE 6 matriculates yearly  55 MD allopathic matriculates yearly from Montana  MT 14.3 MD medical students per 100,000  US average 25.7

GME in Montana- 47 th nationally per capita  MFMR- Billings FM residents yearly -70 % retention rate  Family Medicine Residency of Western Montana residents Missoula -3 residents Kalispell  Billings Clinic Internal Medicine Residency residents yearly

Future Strategies to Improve the Physician Workforce Needs in Montana  Robust, Focused Medical Student Pipeline  AHEC  Underrepresented prospects in medicine  Workforce driven WWAMI expansion  Focused Scholarship opportunities  GME expansion  Grow Existing Primary Care Residency Sizes  Psychiatry  Pediatrics, Surgery, Ob/GYN???  Recruitment and retention  Loan repayment, other incentives