2017 HSC Section 2 - Practice Management
pressures from payers to remain competitive. Reim- bursement systems are changing under the Current Pro- cedural Terminology and International Classification of Diseases systems toward bundling procedures and disease-based and/or patient outcome strategies. 17 The practice of otolaryngology and many other sur- gical specialties continues to rapidly change. New proce- dures, not anticipated even 20 years ago, are now performed by a variety of surgical specialists. The practi- ces of head and neck oncologic and endocrine surgery, skull base surgery, neuro-otology, and pediatric otolaryn- gology have continued to develop, increasing the scope and demand for otolaryngologists. New technology and procedures, along with changes in surgical training pathways and certification, have resulted in changing referral patterns and a redistribution of surgical specialties. This rapidly changing landscape requires a compre- hensive systematic analysis to assess the current strength of the otolaryngology workforce, not only in sheer numbers but in type of practice, distribution, and productivity. The current patient need for otolaryngology services must be assessed, and the current infrastruc- ture of health care delivery and patient access must be analyzed. These are the building blocks to begin to make predictions of future need. The use of predictive models can then be developed and tested to guide us in the numbers needed and the way we train our students and residents. The goal is to guarantee our ability to deliver quality otolaryngology health care to the US population. Models for Future Prediction This article elected to use the Clinical Specialty Supply Model to estimate otolaryngology future work- force numbers. This is arguably one of the simpler for- mulas to use and is not the only way a specialty should assess their future workforce. Kim et al. 9 proposed three models to calculate demand to make a “best estimate” for the future. The first two methods used data obtained from the ACS Health Policy Research Institute’s publica- tion, The Surgical Workforce in the United States , which draws mainly from the AMA Physician Master File and AAMC Data Warehouse. Method 1: Demand was extrapolated into the future based on a continuation of the number of otolaryngolo- gists per 100,000 population over the period 2004–2008 (current demand ratio). It depended solely on population growth. Method 2: Demand was estimated by maintaining the per capita supply of otolaryngologists from the past 5 years (2004–2008) but only for the insured population (current insured demand ratio). It assumed a gradual increase in coverage, achieving full coverage in 2020, as the Congressional Budget Office assumes a reduction in the uninsured population by 32 million by 2019. 18 Method 3: Demand was extrapolated using two models described by Cooper et al. 19,20 The first was based on the established historical relationship between gross domestic product (GDP) and health care spending. They assumed that for every 1.0% growth in inflation-
adjusted GDP, the demand for physician services would increase by 0.5%. GDP was extrapolated at a historical average growth rate of 4.4%. The second model was con- structed based on predicted demand of the stated health care reform goals (growth to decline from its historic lev- el of 2.5% above GDP to 1.0% above GDP between 2010 and 2020). Regardless of which model is used, there is a signif- icant gap between supply and demand for all years, with an increasing gap through 2025. This gap persisted despite manipulation of the extrapolation data to include an increase in number of residents trained, decreased resident training time, adjustments to current physician workload, or the addition of nurse practitioners and PAs. The gap increased markedly when expansion of care sec- ondary to the ACA was factored. A number of online tools have been developed to forecast the future workforce. Examples are the AMA’s Health Workforce Mapper (http://www.ama-assn.org/ ama/pub/advocacy/state-advocacy-arc/health-workforce- mapper.page) and the FutureDocs Forecasting Tool (https://www2.shepscenter.unc.edu/workforce/). These tools give the user the ability to manipulate estimates of supply and demand for health care services for many types of services for different geographic regions at var- ied future periods. Forecasting Methods and Implementing Policy Based on These Predictions The work of forecasting the future heath care needs of a population is complex. Many unknowns conspire to make this process a difficult task, but physician input and accurate workforce planning are essential to ensure a supply of physicians adequate to meet the US popula- tion’s future health care needs. Two unprecedented unknowns are the effects of the ACA and America’s aging population. The ACA is expected to expand health insurance coverage to an esti- mated 30 to 47 million previously uninsured persons over the next few years. 21 At the same time, physician shortages are expected to worsen across the nation. According to the AAMC, a shortage of more than 90,000 doctors, including 45,000 primary care physicians and 46,000 surgeons and specialists, is likely to occur in the next 10 years. It is estimated that approximately one-third of phy- sicians could retire in the next decade, contributing to the concern that the current supply of physicians will not be able to meet the growing demand for care. 22 It is also believed that the US population is expect- ing and using health care more than in the past. Work- force planning today must take into account the increasing demand on health care services per capita. In an analysis in Health Affairs , 23 Grover and Niecko- Najjum predict that physician workforce proposals that rely exclusively on implementing new models of care or changing the distribution of medical specialties to address shortages are likely to fail in meeting the health care needs of a growing, aging population unless the number of physicians is increased. The authors believe
Hughes et al.: Otolaryngology Workforce Analysis
Laryngoscope 126: October 2016
21
Made with FlippingBook flipbook maker