The
LACK OF EVIDENCE of an
EMERGENCY PHYSICIAN
Workforce Shortage in Florida Barbara Langland Orban, PhD
David Orban, MD, FACEP In 2012, the Department of Health initiated a survey to assess the state’s current and future physician workforce needs and prepared a report on the physician workforce in Florida. Every year since, a summary analysis of the Physician Workforce Survey is completed. Physicians are required to complete the survey every two years when they renew their medical license. This report helps policymakers make informed decisions about Florida’s current and future physician workforce and access to care. The 2017 Workforce Report includes the following key points:
• A total of 66,988 physicians re-
newed their medical license during 2016 and 2017 and responded to the workforce survey. • Nearly two-thirds (61.9%) of physicians are age 50 years or older. • Of the 14 specialty categories, all but one specialty (emergency medicine) has more than 25% of physicians age 60 and older. • On-average, emergency physicians are significantly younger than Florida physicians at-large (45 vs. 55). • Emergency physicians are notably concentrated in coastal areas and in areas containing medical schools and large population centers. • Florida is below the national median of active primary care physicians of 9.1 per 10,000 population, having only 7.7 primary care physicians per 10,000 population (defined as general internal medicine, family medicine and pediatrics). (AAMC 2016 State Physician Workforce 26
Data Book)
• In 16 of Florida’s 67 counties, over 20% of primary care physicians plan to retire in the next five years.
New medical schools have opened in Florida, and existing schools have expanded since 2010 to meet increased demand. However, this has created more applicants for a limited amount of Florida residency slots. For each available slot, a residency program may have hundreds of applicants. The shortage in primary care is especially compounded by Florida’s lack of primary care residency slots. In 2012, for example, New York offered about 1,500 residency slots in internal medicine. In Florida, there were just 482. Similar disparities in training numbers were found in pediatrics, family practice, general surgery, psychiatry and obstetrics (physicians willing to perform deliveries), and the annual Florida Physician Workforce Report has projected major shortfalls citing these as “critical shortage specialties.” The 2013 Florida legislative session resulted in the passage of SB 1520, which repealed the Community Hospital Education Act (s.381.0403, Florida Statutes) and established the Statewide Medicaid Residency Program. The state has offered incentives to create more residency positions, providing $80 million in recurring state and matching funds in 2013 to create a program that funds new residency slots. In 2015, legislators provided $100 EMPULSE WINTER 2019
million to give participating community hospitals $150,000 for every residency position created in a “critical shortage specialty,” but restricted to hospitals that did not previously have residency programs. The Agency for Health Care Administration provides the funds to hospitals based on certain criteria and a formula for calculating each participating Medicaid hospital’s portion. The Physician Workforce Advisory Council has continued to provide guidance to both the Department of Health and the Agency for Health Care Administration, as requested, to assure compliance with the Statewide Medicaid Residency Program as enacted by SB 1520. The original draft of SB 1520's during the 2013 legislative session followed a template of similar bills in 12 other states facing similar physician shortages and listed only the six “critical shortage specialties” (internal medicine, family medicine, pediatrics, psychiatry, OB/GYN, general surgery) as eligible for funding new residencies. As the Florida bill made its way through the various Senate committees, emergency medicine was oddly added to the list of “critical shortage specialties,” making Florida the only state to add EM to the new residency funding list. HCA Healthcare and others have brought more residency positions to Florida and other parts of the country by turning community hospitals into teaching hospitals. In the next five years, HCA plans to expand its residency positions in Florida from 767 to 2,115. The hospital chain received state incentives through the Statewide
