ASU/UA study: physician workforce outpaces population growth, still inadequate

An in-depth study just completed by Arizona State University's W. P. Carey School of Business, in partnership with researchers at the University of Arizona College of Medicine, looks at trends and the influences that either attract or discourage physicians from practicing in Arizona. The study was conducted by the Health and Disability Research Group of the School of Health Management and Policy at the W.P. Carey School.

The report, part one of a two-part study, reviews the current physician workforce situation, tracking trends in the number, specialty, and geographic distribution. The result is a comprehensive review of Arizona's supply of physicians and the mix of physician specialties. The productivity of physicians is the subject of Part II.

Researchers found that while the physician workforce in Arizona increased by 51 percent between 1994 and 2004, and outpaced the state's population growth, the physician to population ratio is, at 208, still far below the national average of 283 physicians for every 100,000 people. "The study presents an evidence-based depiction of the factors that drive the demand for physician services. It's also an accurate depiction of the present Arizona practicing physician population and a view of the forces which influence physicians in their choice of specialty and practice setting. These insights will enable a rational assessment to predict what the Arizona physician workforce needs will be," said co-principal investigator, Michael Grossman, MD, University of Arizona Health Sciences Center.

The majority of physicians practice in Arizona's two most populated counties, but the physician workforce increased in all counties between 1992 and 2004. Approximately 86 percent of the state's physicians practice in Maricopa and Pima counties, home to the state's two largest metro areas. Ratios range from a high of 277 physicians to every 100,000 people in Pima County, to a low of 48 to 100,000 in rural Apache County.

About 90 percent of Arizona's allopathic physicians graduated from medical schools outside the state. The addition of two new medical schools and the planned expansion of the University of Arizona College of Medicine will boost the number of physicians trained in the state, but only about half of those students are expected to enter practice in Arizona.

The number of physicians receiving specialty residency training in Arizona has increased modestly, from 1,010 in 1992 to 1,076 in 2004. While some training programs in the state have closed, those closures have been balanced by new programs, including those at Mayo Clinic Scottsdale, which has increased its specialty residency training programs.

Co-principal investigator, Mary E. Rimsza, MD, FAAP, Arizona State University, noted, "Arizona's physician to population ratio is far less than the national average and due to the small number of Arizona medical school graduates each year, our rapidly growing population relies on the immigration of physicians trained in other states for over 90 percent of our physician workforce."

The time lag between increased medical school enrollment and the point when practicing physicians enter the workforce means newly minted physicians will come online between 2011 and 2019. Enrollment increases in 2006, for example, won't result in an increase in practicing physicians until students have completed their residency training in five to 13 years.

Key to physician retention is the site of residency training, a major influence on a physician's choice of where to practice. Residency training ranges from three to eight years and during that time, residents establish ties to the community and develop professional relationships, factors in the physician's decision to stay in Arizona or move on.

The study's principal investigators are William G. Johnson, PhD, Professor of Economics, Mary E. Rimsza, MD, FAAP, Research Professor, both of the Health and Disability Research Group in the School of Health Management and Policy at Arizona State University's W. P. Carey School of Business, and Michael Grossman, MD, MACP, Associate Dean for Graduate Medical Education and Executive Director, Arizona Medical Education Consortium (AzMEC), University of Arizona Health Sciences Center.

Study sponsors are the Flinn Foundation, St. Luke's Health Initiatives, and BHHS Legacy Foundation.

To download a copy of the full report, click on Workforce Study.

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For more information:

"Doctor Shortage in Burgeoning U.S. Southwest," National Public Radio, 07/14/2005

"Arizona physician-population ratio below national average," Business Journal, 06/13/2005

"Will the doctor be in for you"? East Valley Tribune, 06/14/2005

"No quick fixes for doctors shortfall," East Valley Tribune, 06/19/2005