Wisconsin AHEC Health Workforce Data Brief
Primary Care Physician Retirement
This map shows, for each Health Service Area, the percentage of primary care physicians under age 65 as of 1 -‐1-‐2012 who will have reached a ge 65 by 2021. Physician counts are based on a data set of all physicians licensed in Wisconsin a s o f 3 -‐15-‐ 2012. Primary care physicians are those who listed their practice specialty a s general practice, family m edicine, internal m edicine, pediatrics, medicine-‐pediatrics or geriatrics, without a medical subspecialty. Many of the physicians identified as primary care in the licensure record may in fact be working exclusively a s hospitalists or in urgent care or residential facility settings only. Others may have significant a dministrative, teaching a nd research responsibilities. For purposes o f these retirement estimates, all primary care physicians were included regardless of principal work setting.
Physician location reflects the city listed in the address of record in the licensure file. For physicians under a ge 65, this is presumed to reflect the service area of the physician’s practice, if not the specific practice location. Comparison to information provided o n a survey linked to this same group of physicians at the time o f licensure in 2011-‐12 supports this a ssumption for rural areas and most other parts of the state. In the sub-‐areas o f c entral M ilwaukee, however, there is more variation between a physician’s a ddress o f record and primary practice location.
Primary Care Physician Retirement Overall, Wisconsin physicians begin reducing patient care hours around a ge 55, but many work past a ge 65. Closer analysis o f primary care physician data indicates that the group continuing to practice after age 65 offsets to some extent the group reducing hours prior to age 65. (See Wisconsin Physician Workforce Report, October 2012, at www.ahec.wisc.edu/workforce .) Age 65 provides a consistent marker for a n initial projection of physician retirement, since that information is available for all physicians in the 2011/12 licensure data set a nd would be available in any similar data set drawn at a future date.
The Wisconsin Health Service Areas were developed by Wisconsin AHEC for health w orkforce data analysis. The H ealth Service Areas also provide a useful geography for monitoring local program outcomes related to health w orkforce development a nd population health status. Each Wisconsin HSA c onsists of a hub city with healthcare services and s urrounding municipalities. With some exceptions (in northern Wisconsin a nd border communities) each s ervice a rea has a population of at least 10,000, with most of the s ervice area population within 30 minutes travel time of the hub city. While most hubs include a hospital, inclusion of a municipality in a s ervice a rea is determined by travel time to the hub, not actual hospital or clinic utilization data. A zip c ode version of the s ervice areas has also been developed. For more information on the development of the s ervice area geography, s ee Introduction to Wisconsin Health Service Areas, www.ahec.wisc.edu/healthserviceareas . The w ebsite also has maps and data related to the HSAs available for download.
If a typical physician has a 35 y ear career (from the conclusion of residency training at about age 30 until about age 65), and there is an even distribution of the c urrent workforce by a ge, one would expect a bout 10/35ths o f the workforce to retire each decade, or 28.6%. This is what we might expect for the state a s a whole. However, In the smaller service areas, an even a ge distribution is less likely, a nd the retirement of one physician will have a m uch larger impact on access to care particularly if the area a lready has a high population to physician ratio. In Wisconsin, 75 Health Service Areas will have more than 30% of physicians reaching age 65 between 2012 and 2021. Many of these areas are already experiencing shortages.
www.ahec.wisc.edu/workforce
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Wisconsin AHEC Health Workforce Data Brief
The a ge of the current workforce is just o ne factor in predicting future supply. Change in retirement patterns (working longer or retiring earlier), decrease in average hours worked, or a n increase in the number of Wisconsin residency positions are also important considerations. Demand will be influenced by demographic c hange, expanded insurance coverage, a nd c hanges in the organization o f healthcare delivery, including increased use o f physician a ssistants a nd advanced practice nurses. For more information on the potential impact of a ll these factors, see Projection of Physician Supply and Demand in Wisconsin through 2025 a t www.ahec.wisc.edu/workforce . Chart A, below, shows the distribution of Wisconsin physicians by a ge as of 1-‐1 -‐2012. C hart B shows status (full time, part-‐time, no patient care) of primary care physicians, based o n responses to the 2011/12 Wisconsin Physician Survey. C hart C maps the number of physicians reaching a ge 65 by the year 2021 compared to the c urrent population to provider ratio in each service area. Tables 1 and 2 summarize potential retirement patterns over the next 15 years by region and by urban or rural service area type. C hart D a nd Table 3 show these patterns in 5 y ear increments through 2036. C hart E compares the projected retirement for primary care physicians to the number of physicians graduating from Wisconsin primary care residencies through 2036. Table 4 provides information on potential retirement patterns for each service area. Population to physician ratios in a ll tables a nd c harts use the 2010 U.S. Census totals for Wisconsin a s a base. Chart A
Chart B
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Wisconsin AHEC Health Workforce Data Brief
Chart C
Service Areas with high population to provider ratio and high potential retirement 2012-‐2021 Type 1: M etro Type 2: Other Urban Type 3: M ixed-‐L, hub > 10,000 Type 4: M ixed-‐M, hub 2500 Type 6: Rural-‐S, hub < 2500
www.ahec.wisc.edu/workforce
Grafton, Janesville, Sheboygan, Burlington, Watertown, Waupun Menomonie c ity, Monroe Columbus, M t. Horeb, Oconto, Reedsburg, Antigo, Arcadia, Baldwin, Boscobel, C hilton, Darlington, Kewaunee, New London, New Richmond, Oconto Falls, Portage, Pulaski, Shawano, Stanley, Sturgeon Bay, Wisconsin Dells, Adams , Alma, Alvin/Tipler, Bay City, Cornell, Crandon, Cumberland, D urand, Eagle River, Florence, Hillsboro, Hurley, New Glarus, Phillips, Shell Lake, Whitehall
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Wisconsin AHEC Health Workforce Data Brief
Service Area Regions
Service Area Urban and Rural Types For convenience in summarizing certain kinds of data, service areas are grouped into 17 regions around the closest source of tertiary care. With the exception of Rhinelander in northern Wisconsin, each region includes a city of greater than 50,000, or is adjacent to a metropolitan area in a neighboring state (Duluth, Minneapolis, Dubuque). N ote that each region may include metro, urban and rural service areas. S ummary data by region may obscure significant within-‐ region variation.
The service areas are identified by type using data on urban density from the 2010 U.S. Census. Urban Area (UA) and Urban Cluster (UC) population data was used to classify the service areas as "Metro" (> 50% of the population in U As), "Urban" (60% in UAs or U Cs), "Mixed" (40% to 60% living in U As and U Cs), and "Rural ( 10,000 232,775 269 22 (8%) 63 (23%) 104 (39%) Type 4: M ixed-‐M, hub 2500 775,372 430 65 (15%) 166 (39%) 226 (53%) Type 6: Rural-‐S, hub < 2500 274,588 153 24 (16%) 56 (37%) 76 (50%) ALL METRO&URBAN (74% of pop) 4,193,211 4031 418 (10%) 1007 (25%) 1606 (40%) ALL MIXED (8% of pop) 443,815 444 48 (11%) 124 (28%) 187 (42%) ALL RURAL (18% of pop) 1,049,960 583 89 (15%) 222 (38%) 302 (52%) STATEWIDE TOTAL 5,686,986 5058 555 (11%) 1353 (27%) 2095 (41%) *Projected retirement rates: Assuming a 35 year career beginning at age 3 0 and an even age distribution across all age groups, for the state as a whole the e xpected % of individuals reaching age 65 would be as indicated below. Higher rates are bolded in the table. Note that service areas with less than 7 physicians could not h ave a consistent 5 yr retirement rate, even under ideal circumstances.
www.ahec.wisc.edu/workforce
5yr/35 = 14%
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10yr/35 = 29%
15yr/35 = 43%
June 2015
Wisconsin AHEC Health Workforce Data Brief
Chart D
Table 3. Number of primary care physicians in current workforce reaching age 65 in the years indicated Metro Urban Mixed-‐L, hub≥10,000 Mixed-‐M, hub
