Saturday, January 7, 2017

Child neurology supply and demaind

Recommended by a colleague

Dall TM, Storm MV, Chakrabarti R, Drogan O, Keran CM, Donofrio PD, Henderson
VW, Kaminski HJ, Stevens JC, Vidic TR. Supply and demand analysis of the current
and future US neurology workforce. Neurology. 2013 Jul 30;81(5):470-8.

This study estimates current and projects future neurologist supply and demand under alternative scenarios nationally and by state from 2012 through 2025.
A microsimulation supply model simulates likely career choices of individual neurologists, taking into account the number of new neurologists trained each year and changing demographics of the neurology workforce. A microsimulation demand model simulates utilization of neurology services for each individual in a representative sample of the population in each state and for the United States as a whole. Demand projections reflect increased prevalence of neurologic conditions associated with population growth and aging, and expanded coverage under health care reform.
The estimated active supply of 16,366 neurologists in 2012 is projected to increase to 18,060 by 2025. Long wait times for patients to see a neurologist, difficulty hiring new neurologists, and large numbers of neurologists who do not accept new Medicaid patients are consistent with a current national shortfall of neurologists. Demand for neurologists is projected to increase from 18,180 in 2012 (11% shortfall) to 21,440 by 2025 (19% shortfall). This includes an increased demand of 520 full-time equivalent neurologists starting in 2014 from expanded medical insurance coverage associated with the Patient Protection and Affordable Care Act.
In the absence of efforts to increase the number of neurology professionals and retain the existing workforce, current national and geographic shortfalls of neurologists are likely to worsen, exacerbating long wait times and reducing access to care for Medicaid beneficiaries. Current geographic differences in adequacy of supply likely will persist into the future.

From the article

The average wait in 2012 for new patients to see a neurologist (34.8 business days) and for follow-up visits (30.0 days) was higher than in 2010 (28.1 days for new and 25.6 for follow-up visits).1,2 Other studies report average wait for new patient visits of 24.1 days for neurosurgery, 20.3 for family practice, 16.8 for orthopedic surgery, and 15.5 for cardiology.3,4 In 2012, 39% of children's hospitals reported vacancies of 12 months or longer for child neurologists, and child neurology ranked as one of the most short-handed specialties, with average wait times of 45 business days….

The Medical Group Management Association's (MGMA) 2010 Physician Compensation and Production Survey reports that adult neurologists in group practices average 2,205 ambulatory encounters annually (n = 383 neurologists in 118 practices).22 MGMA also reports an annual average 515 hospital encounters. Child neurologists average 1,851 ambulatory encounters per year (n = 38 neurologists in 19 practices) and 380 hospital encounters per year (n = 29 neurologists in 16 practices)…

Taking into account changing demographics and associated increase in prevalence of neurologic conditions, the national shortfall rises from 11% (the overall shortfall reflecting 10% for adult and 20% for child neurologists) in 2012 to 16% in 2025. With the impact of PPACA, the shortfall rises to 19% by 2025. Even if one assumed that supply and demand currently were in equilibrium at the national level, demand is projected to grow faster than supply.

The above findings suggest the nation could readily use an additional 10% adult neurologists, and based on average wait time the current shortfall of child neurologists is substantially greater. For modeling purposes, we assume a 10% shortfall of adult neurologists and a 20% shortfall of child neurologists…

A comparison of the various supply and demand scenarios projected suggests that even under the most optimistic supply scenario national provider shortfalls are likely to persist. For adult neurology under the baseline scenarios, the national shortfall is projected to grow. While supply of child neurologists is growing at a slightly faster rate than is demand, a shortfall is projected to persist through 2025. State-level shortages are projected to persist and grow more severe over time...

This study highlights a current substantial national shortfall of neurologists, especially pediatric neurologists, and even greater shortfalls in select states.

[Comment and response] Racette BA, Holtzman DM, Dall TM, Drogan O. Supply and demand analysis of the current and future US neurology workforce. Neurology. 2014 Jun 17;82(24):2254-5.

While Dall et al. understand US neurology workforce needs, we contend that the estimates of the current neurology workforce may be overly optimistic due to the research, education, and administrative commitments of neurology faculty in academic medical centers. For example, the authors estimated that Missouri has 365.9 neurologist providers and an estimated need of 379.6 neurologist providers. Washington University School of Medicine has 122 of the neurology providers in Missouri. However, these 122 faculty represent only 34.7 clinical neurology full-time employee (FTE) providers. These revised figures, likely an underestimate, demonstrate that Missouri actually has 26% fewer neurology provider FTEs than are needed to meet the estimated current demand. Adjusting for actual neurology provider FTEs across the United States, particularly in academic medical centers, would demonstrate a more desperate picture of the state of the US neurology clinical workforce in 2013…

[Response] When projecting state-level supply and demand, we made the simple assumption that the proportion of professional time spent in nonpatient activities is constant across states. To the extent that neurologists in a particular state average more (less) than the national average time spent in non–patient care activities, our supply estimates will overstate (understate) total supply in that state…

While our estimates of supply and demand for each state are best estimates given the data available from national sources, the comments by Drs. Racette and Holtzman highlight that workforce analysts and neurologists in a particular state or community are best positioned to have a clear understanding of the workforce situation in the state or community in which they work.

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