June 2014 Endocrine Clinical Workforce: Supply and Demand Projections Prepared for: The Endocrine Society Co-sponsored by: Association of Program Directors in Endocrinology, Diabetes, and Metabolism Submitted by: The Lewin Group Copyright © 2014 by the Endocrine Society, 2055 L Street, NW, Suite 600, Washington, DC 20036. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the internet, or transmitted in any form, by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission of the publisher. For permission to reuse material, please visit press.endocrine.org/page/permissions; https://www.copyright.com; or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of uses. For more information, individual or institutional purchases, please contact Society Services by telephone at 202-971-3646 or 888-363-6762; e-mail: [email protected]. Rights to translate and reproduce Endocrine Society publications internationally are extended through a licensing agreement on full or partial editions. To request rights for a local edition, please contact Ray Thibodeau, Content Ed Net LLC, by Phone: (USA) 267-895-1758 or e-mail: [email protected] Endocrinology Workforce Report Table of Contents EXECUTIVE SUMMARY .............................................................................................................................. 1 I. INTRODUCTION ................................................................................................................................ 6 Overview of Workforce Studies Regarding Endocrine Workforce .............................................. 6 1. Incidence and Prevalence of Endocrine Disorders ................................................................... 7 2. Endocrinology Workforce ......................................................................................................... 8 II. METHODOLOGY .............................................................................................................................. 10 III. RESULTS PART I: SUPPLY OF ENDOCRINOLOGISTS .............................................................................. 15 A. Current Workforce ....................................................................................................................... 15 1. Demographic Characteristics ................................................................................................. 15 2. Hours of Work and Visit Capacity ......................................................................................... 21 3. Empirical Definition of a “Full-Time Equivalent” Endocrinologist .................................... 25 4. Income Level of Endocrinologists ........................................................................................... 25 B. Factors Affecting Supply ............................................................................................................ 27 1. Trends in Fellowship .............................................................................................................. 27 2. Trends in Attrition ................................................................................................................. 30 C. Supply Projections ....................................................................................................................... 33 IV. RESULTS PART II: DEMAND FOR ENDOCRINOLOGISTS ....................................................... 39 A. Current Demand .......................................................................................................................... 39 B. Factors Affecting Demand .......................................................................................................... 42 1. Indicators of Excess Demand ................................................................................................. 44 2. Wait Time ............................................................................................................................... 45 3. Population Projections ........................................................................................................... 45 C. Demand Projections ..................................................................................................................... 47 V. RESULTS PART III: ENDOCRINOLOGIST SUPPLY AND DEMAND PROJECTIONS ....... 50 VI. DISCUSSION ...................................................................................................................................... 58 A. Strengths ........................................................................................................................................ 60 B. Limitations .................................................................................................................................... 60 C. Suggestions for Endocrinology Supply and Demand Data ................................................. 61 VII. CONCLUSION .................................................................................................................................... 62 APPENDIX: ENDOCRINOLGIST SURVEY, 2012, CONDUCTED BY THE LEWIN GROUP ................................................................................................................................. 63 i Copyright © 2014 by the Endocrine Society DM # 554926 Endocrinology Workforce Report EXECUTIVE SUMMARY The Endocrine Society commissioned The Lewin Group to undertake a workforce study of clinical endocrinologists. The purpose of the study was to better understand the factors affecting the supply and demand of endocrinologists, to quantify the factors where possible, to project the likely evolution of the workforce, and to assess the implications of the results. The work was guided by a panel of endocrinologists who were knowledgeable about the medical workforce and could give guidance and expertise on the subject. A survey of the endocrinology workforce and a literature review contributed to the knowledge foundation for the study. The literature identified that demand is exceeding supply due to a number of factors related to age and obesity. Diabetes and age-related conditions were the major contributors to the demand side of the equation. In 2010, the U.S. physician workforce began focusing its attention on the Patient Protection and Affordable Care Act (PPACA), increasing health care access and coverage for at least 30 million people not previously covered. The effect of the PPACA on the demand for endocrinology services is incorporated into this analysis. Endocrinologist Supply As of 2011, there were 5,496 board certified adult endocrinologists and 1,016 pediatric endocrinologists, a total of 6,512 board certified endocrinologists age 70 or less.1 Of these board certified endocrinologists, we estimate that approximately 4,841 adult endocrinologists and 893 pediatric endocrinologists were engaged in clinical practice in 2011.2 An additional 4,000 physicians report some role in endocrinology and nutritional services, primarily in diabetes management. Reproductive endocrinologists were not included in this analysis. The mean age of adult endocrinologists in 2011 was 51 and the median age was 48. The mean age of pediatric endocrinologists was about 50 in 2011 and the median age was about 48.5. About 62 percent of adult endocrinologists are male, while only about 49 percent of pediatric endocrinologists are male. Approximately one-quarter of endocrinologists are international medical graduates. Younger women entering endocrinology are replacing older male colleagues. The study baseline assumption was that the number entering adult endocrinology each year is constant at 280 board certified endocrinologists and the number entering the pediatric workforce was constant at 73.3 Similar to most physician specialists, the geographic distribution of endocrinologists is predominately metropolitan-based with concentrations east of the Mississippi River, the west coast, and with smaller concentrations in the Midwest, Texas and Florida. There is minimal distribution of endocrinologists in the northern tier states. A survey of endocrinologists for this study reported that, of those over age 50, 12 percent were working part-time. The median salary (excluding benefits) of full-time endocrinologists who 1 American Medical Association Master File extract, 2011. 2 To be engaged in clinical practice, their primary activity, as reported in the AMA Master File, could not be research or administration, and they could not be classified as inactive. In addition of those in office based practice, we did include those who were hospital staff, those who were medically teaching, and those with no classification in the count of those engaged in clinical practice. 3 These new entrants are assumed to be distributed between clinically active activities and non-clinical activities at the same rates and ages as historical cohorts. 1 Copyright © 2014 by the Endocrine Society DM # 554926 Endocrinology Workforce Report reported more than one year in medical group practice was $211,400. The mean number of adult out-patient visits per annum was approximately 3,000 with a range of 2,754 to 3,661.4 Endocrinologist Demand A major factor affecting the anticipated demand for health care services is the aging population. In 2010,