The State of Primary Care Physician Workforce - All States

January 2019

The State of Primary Care Physician Workforce

Robert Graham Center Research Report

policy@

The State of Primary Care Physician Workforce

The primary care physician (PCP) workforce is integral to the U.S. healthcare system. In order to address primary care workforce shortages and distribution challenges, stakeholders at the state level need accurate information on their respective PCP workforce. With greater demands on the health system and projected PCP shortages, advocates and policymakers must be equipped with the tools to address these challenges. Up to date and relevant data is needed for informed policy decisions.

To meet this need, the Robert Graham Center created The State of Primary Care Physician Workforce series to equip state and national policymakers and practitioners with state-level information on primary care physician characteristics. Using comprehensive national data, we describe the landscape of the primary care physician workforce in all 50 states and District of Columbia. This series highlights age, gender, training origin, migration, and distribution of physicians, all in context of the states' census division and national averages.

The State of Primary Care Physician Workforce: Alabama

Background

In the United States, primary care physicians (PCPs) currently represent less than one-third of the total physician workforce.1 States are under increasing pressure to create solutions that bolster the number of physicians practicing primary care in both rural and urban settings.2 This factsheet characterizes the primary care physician workforce in Alabama.

We used data mainly from the 2018 American Medical Association (AMA) Physician Masterfile. Physicians were classified as primary care if their primary specialty is family medicine, internal medicine, pediatrics, general practice or geriatrics. We restricted our counts to PCPs in direct patient care. With Centers for Medicare and Medicaid Services data, we identified PCPs that work mainly as hospitalists and excluded them from our analysis. Finally, we used additional data sources to identify osteopaths excluded from the AMA Masterfile.

Current Workforce

In 2018, Alabama had 2,774 PCPs in direct patient care, of which 1,203 were family physicians. In other words, 43% of its primary care workforce consisted of family physicians, compared to 38% in the East South Central Census Division and 38% nationwide. On a per capita basis, there were about 57 PCPs per 100,000 persons in Alabama, compared to 65 per 100,000 in the East South Central and 76 per 100,000 in the U.S. as a whole. The state's family medicine workforce was 38% female, which was less than the percentage nationwide (45%). Consistent with national trends, younger family physicians were more likely to be female than their older counterparts. About 47% of family physicians were over the age of 55, more than the nationwide percentage of 44%.

.

Robert Graham Center:

TELEPHONE: 202.331-3360

Policy Studies in Family Medicine and Primary Care

FAX: 202.331-3374

1133 Connecticut Avenue, NW, Suite 1100

E-MAIL: policy@

Washington, DC 20036

WEB: graham-

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or policy of the AAFP.

Alabama

Characteristics of Family Physicians and PCPs

Percent over 55 Years (PCP)

47

Percent Female (FP)

38

Percent Osteopaths (FP)

8

Percent International Medical School Graduates (FP)

10

Distribution of PCPs

Percent Total State Population Rural

24

Percent Family Physicians Rural

21

Percent Total State Population in Underserved County**

34

*US Census Bureau East South Central Census Division States: AL, KY, MS, TN

**Underserved counties had a population to PCP ratio greater than 2,000:1.

East South Central*

46 38 8 8

32 28 36

Nation

44 45 12 12

14 14 18

In 2018, about 10% of family physicians in the state were international medical school graduates and 8% were trained as osteopaths. While 24% of Alabama's population lived in rural counties, 21% of family physicians work in these counties. Approximately 34% of Alabama's residents live in underserved counties with more than 2,000 persons per PCP.

Future Workforce

Evidence indicates that physicians are more likely to practice in the state in which they completed residency.3 National PCP deficits have stimulated the growth of instate residency programs to replenish the aging generation of physicians leaving the workforce. Understanding current primary care residency programs can help Alabama assess its future primary care workforce to meet the health care needs of its population.

There are 8 family medicine residency training programs in Alabama. Nationally, the number of family physicians graduating from the Accreditation Council for Graduate Medical Education-accredited programs declined from 3,225 in 2005 to 2,970 in 2012, then increased to 3,383 by 2017. Trends for Alabama over the same period are shown in the adjacent figure.

Between 2011 and 2017, the state produced a total of 345 family physicians; of these, 185 (54%) stayed in-state. The loss of state-trained family physicians is offset by the inmigration of 68 family physicians trained in other states. Through elevated support of family medicine residency programs, Alabama can work to replenish the PCP pipeline practicing in local communities.

Published December 2018. More details about our methods are available at .

Suggested Citation: Stephen Petterson, Elizabeth Wilkinson, A.C. Kessler, Courtney Stone, Andrew Bazemore. The State of Primary Care Physician Workforce. Washington, D.C.: The Robert Graham Center, 2018.

1. American Medical Association (AMA). AMA Physician Masterfile. . Accessed July 20, 2018. 2. Petterson S, McNellis R, Klink K, Meyers D, Bazemore A. The State of Primary Care in the United States: A Chartbook of Facts and Statistics. January 2018. 3. Health Resources and Services Administration Bureau of Health. State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025. November 2016. .

The State of Primary Care Physician Workforce: Alaska

Background

In the United States, primary care physicians (PCPs) currently represent less than one-third of the total physician workforce.1 States are under increasing pressure to create solutions that bolster the number of physicians practicing primary care in both rural and urban settings.2 This factsheet characterizes the primary care physician workforce in Alaska.

We used data mainly from the 2018 American Medical Association (AMA) Physician Masterfile. Physicians were classified as primary care if their primary specialty is family medicine, internal medicine, pediatrics, general practice or geriatrics. We restricted our counts to PCPs in direct patient care. With Centers for Medicare and Medicaid Services data, we identified PCPs that work mainly as hospitalists and excluded them from our analysis. Finally, we used additional data sources to identify osteopaths excluded from the AMA Masterfile.

Current Workforce

In 2018, Alaska had 617 PCPs in direct patient care, of which 394 were family physicians. In other words, 64% of its primary care workforce consisted of family physicians, compared to 40% in the Pacific Census Division and 38% nationwide. On a per capita basis, there were about 83 PCPs per 100,000 persons in Alaska, compared to 81 per 100,000 in the Pacific and 76 per 100,000 in the U.S. as a whole. The state's family medicine workforce was 51% female, which was more than the percentage nationwide (45%). Consistent with national trends, younger family physicians were more likely to be female than their older counterparts. About 38% of family physicians were over the age of 55, less than the nationwide percentage of 44%.

.

Robert Graham Center:

TELEPHONE: 202.331-3360

Policy Studies in Family Medicine and Primary Care

FAX: 202.331-3374

1133 Connecticut Avenue, NW, Suite 1100

E-MAIL: policy@

Washington, DC 20036

WEB: graham-

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or policy of the AAFP.

Alaska

Characteristics of Family Physicians and PCPs

Percent over 55 Years (PCP)

38

Percent Female (FP)

51

Percent Osteopaths (FP)

18

Percent International Medical School Graduates (FP)

3

Distribution of PCPs

Percent Total State Population Rural

32

Percent Family Physicians Rural

36

Percent Total State Population in Underserved County**

5

*US Census Bureau Pacific Census Division States: AK, CA, HI, OR

**Underserved counties had a population to PCP ratio greater than 2,000:1.

Pacific*

43 48 8 12

6 7 11

Nation

44 45 12 12

14 14 18

In 2018, about 3% of family physicians in the state were international medical school graduates and 18% were trained as osteopaths. While 32% of Alaska's population lived in rural counties, 36% of family physicians work in these counties. Approximately 5% of Alaska's residents live in underserved counties with more than 2,000 persons per PCP.

Future Workforce

Evidence indicates that physicians are more likely to practice in the state in which they completed residency.3 National PCP deficits have stimulated the growth of instate residency programs to replenish the aging generation of physicians leaving the workforce. Understanding current primary care residency programs can help Alaska assess its future primary care workforce to meet the health care needs of its population.

There is just one family medicine residency training program in Alaska. Nationally, the number of family physicians graduating from the Accreditation Council for Graduate Medical Education-accredited programs declined from 3,225 in 2005 to 2,970 in 2012, then increased to 3,383 by 2017. Trends for Alaska over the same period are shown in the adjacent figure.

Between 2011 and 2017, the state produced a total of 80 family physicians; of these, 47 (59%) stayed in-state. The loss of state-trained family physicians is offset by the inmigration of 52 family physicians trained in other states. Through elevated support of family medicine residency programs, Alaska can work to replenish the PCP pipeline practicing in local communities.

Published December 2018. More details about our methods are available at .

Suggested Citation: Stephen Petterson, Elizabeth Wilkinson, A.C. Kessler, Courtney Stone, Andrew Bazemore. The State of Primary Care Physician Workforce. Washington, D.C.: The Robert Graham Center, 2018.

1. American Medical Association (AMA). AMA Physician Masterfile. . Accessed July 20, 2018. 2. Petterson S, McNellis R, Klink K, Meyers D, Bazemore A. The State of Primary Care in the United States: A Chartbook of Facts and Statistics. January 2018. 3. Health Resources and Services Administration Bureau of Health. State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025. November 2016. .

The State of Primary Care Physician Workforce: Arizona

Background

In the United States, primary care physicians (PCPs) currently represent less than one-third of the total physician workforce.1 States are under increasing pressure to create solutions that bolster the number of physicians practicing primary care in both rural and urban settings.2 This factsheet characterizes the primary care physician workforce in Arizona.

We used data mainly from the 2018 American Medical Association (AMA) Physician Masterfile. Physicians were classified as primary care if their primary specialty is family medicine, internal medicine, pediatrics, general practice or geriatrics. We restricted our counts to PCPs in direct patient care. With Centers for Medicare and Medicaid Services data, we identified PCPs that work mainly as hospitalists and excluded them from our analysis. Finally, we used additional data sources to identify osteopaths excluded from the AMA Masterfile.

Current Workforce

In 2018, Arizona had 4,001 PCPs in direct patient care, of which 1,713 were family physicians. In other words, 43% of its primary care workforce consisted of family physicians, compared to 40% in the Mountain Census Division and 38% nationwide. On a per capita basis, there were about 57 PCPs per 100,000 persons in Arizona, compared to 69 per 100,000 in the Mountain and 76 per 100,000 in the U.S. as a whole. The state's family medicine workforce was 42% female, which was less than the percentage nationwide (45%). Consistent with national trends, younger family physicians were more likely to be female than their older counterparts. About 44% of family physicians were over the age of 55, equal to the nationwide percentage of 44%.

.

Robert Graham Center:

TELEPHONE: 202.331-3360

Policy Studies in Family Medicine and Primary Care

FAX: 202.331-3374

1133 Connecticut Avenue, NW, Suite 1100

E-MAIL: policy@

Washington, DC 20036

WEB: graham-

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or policy of the AAFP.

Arizona

Characteristics of Family Physicians and PCPs

Percent over 55 Years (PCP)

44

Percent Female (FP)

42

Percent Osteopaths (FP)

17

Percent International Medical School Graduates (FP)

13

Distribution of PCPs

Percent Total State Population Rural

5

Percent Family Physicians Rural

7

Percent Total State Population in Underserved County**

12

*US Census Bureau Mountain Census Division States: AZ, CO, ID, MT, NM, NV, UT, WY

**Underserved counties had a population to PCP ratio greater than 2,000:1.

Mountain*

40 42 15 8

15 18 17

Nation

44 45 12 12

14 14 18

In 2018, about 13% of family physicians in the state were international medical school graduates and 17% were trained as osteopaths. While 5% of Arizona's population lived in rural counties, 7% of family physicians work in these counties. Approximately 12% of Arizona's residents live in underserved counties with more than 2,000 persons per PCP.

Future Workforce

Evidence indicates that physicians are more likely to practice in the state in which they completed residency.3 National PCP deficits have stimulated the growth of instate residency programs to replenish the aging generation of physicians leaving the workforce. Understanding current primary care residency programs can help Arizona assess its future primary care workforce to meet the health care needs of its population.

There are 9 family medicine residency training programs in Arizona. Nationally, the number of family physicians graduating from the Accreditation Council for Graduate Medical Education-accredited programs declined from 3,225 in 2005 to 2,970 in 2012, then increased to 3,383 by 2017. Trends for Arizona over the same period are shown in the adjacent figure.

Between 2011 and 2017, the state produced a total of 280 family physicians; of these, 135 (48%) stayed in-state. The loss of state-trained family physicians is offset by the inmigration of 149 family physicians trained in other states. Through elevated support of family medicine residency programs, Arizona can work to replenish the PCP pipeline practicing in local communities.

Published December 2018. More details about our methods are available at .

Suggested Citation: Stephen Petterson, Elizabeth Wilkinson, A.C. Kessler, Courtney Stone, Andrew Bazemore. The State of Primary Care Physician Workforce. Washington, D.C.: The Robert Graham Center, 2018.

1. American Medical Association (AMA). AMA Physician Masterfile. . Accessed July 20, 2018. 2. Petterson S, McNellis R, Klink K, Meyers D, Bazemore A. The State of Primary Care in the United States: A Chartbook of Facts and Statistics. January 2018. 3. Health Resources and Services Administration Bureau of Health. State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025. November 2016. .

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