American Academy of Allergy Asthma and Immunology Report on the Allergy and Immunology Physiciann Workforce, 1999-2009/10 March 2012 Prepared by: The Center for Health Workforce Studies School of Public Health University at Albany, State University of New York One University Place, Suite 220 Rensselaer, NY 12144-3445 (518) 402-0250 (518) 402-0252 (fax) http://chws.albany.edu/ Jean Moore, Director The Center for Health Workforce Studies is a not-for-profit research organization whose mission is to provide timely, accurate data and conduct policy-relevant research about the health workforce. The Center's work assisttss health, professional, and education organizations; policy makers and planners; and other stakeholders to understand issues related to the supply, demand, distribution, and use of health workers. Preface The prevalence of asthma and allergy-related disorders in the U.S. continues to increase. Allergies affect as many as 50 million people in the U.S.1 More than half of the U.S. population tests positive to one or more allergens.2 The annual economic cost of asthma is 19.7 billion dollars. Direct costs make up 14.7 billion dollars of that total, and indirect costs such as lost productivity add another 5 billion dollars. Moreover, approximately 34 million people in the U.S. have been diagnosed with asthma.3 Asthma is responsible for 13 million missed school days per year and 10 million missed work days per year.4 Medical expenses associated with asthma increased from 48.6 billion dollars in 2002 to 50.1 billion dollars in 2007. About 2 in 5 (40%) uninsured people with asthma could not afford their prescription medicines and about 1 in 9 (11%) insured people with asthma could not afford their prescription medicines.5 Finally, asthma accounts for 217,000 emergency room visits and more than 10 million physician office visits per year.6 Despite the breadth of asthma and allergy-related disorders in the U.S., a relatively small population of physicians practices in the medical specialty of Allergy and Immunology (A/I). In 1998, the American Academy of Allergy, Asthma and Immunology (the Academy) commissioned an investigation of the workforce issues surrounding the specialty. The investigation was a response to several disturbing trends anecdotally noted by stakeholders in the A/I community. The most notable trend was that while the total number of physicians in the U.S. had increased steadily for more than 40 years, between 1990 and 1998, the number of physicians training in A/I fellowship programs had declined from 322 to 214, a decrease of 34 percent. This decline in production coincided with a rapid rise in asthma and allergy-related disorders and growth in public concern and initiatives to prevent and treat asthma and allergic conditions. Concerns about competition with physicians in other specialties, such as otolaryngology, pulmonology, and dermatology, as well as the primary care physicians (pediatricians, family physicians, and internists) due to increased managed care penetration reinforced the need to examine the A/I physician workforce systematically and comprehensively, focusing on trends in fellowship training, A/I physician practice, and plans to leave practice. The Center for Health Workforce Studies (the Center) conducted the investigation of the production, supply, demand, and distribution of the A/I physician workforce beginning i in 1998. Through a series of reports, culminating in a summary report, The Allergy and Immunology Physician Workforce 2000,7 the Center described the current state of the specialty, made projections of the supply of A/I physicians and demand for A/I services in the future, and developed a number of recommendations to respond to the projected shortfall of A/I physicians in the future. One of the recommendations made in the comprehensive assessment of the adequacy of the supply of A/I physicians was to update the data on A/I physician supply, demand, and production periodically. In 2004/05, the Academy did so. Once again, the Center conducted the follow-up investigation. Using a very similar survey instrument, the Center collected data on A/I physician practice in the U.S. One notable change that had occurred was that the estimated number of A/I physicians practicing in the U.S. had declined slightly since 1999. However, those who were practicing were working longer hours than they had in the past, in effect, compensating for their decreased numbers. The other notable trend was a dramatic reversal of the decline in new A/I physician production observed in the 1990s, from 205 to 244 between 1999 and 2003.8 The increased effort and the increased rate of production of new A/I physicians were not enough, however, to completely reduce the long-term forecast of shortage, although they did reduce the forecast shortage.9 Five years later, in 2009, the Academy sought to update the previous work again. Using a very similar survey instrument to collect information on A/I physician practice in the U.S., the Center was engaged to update the previous assessments. The current report describes the findings from the update of the comprehensive assessment of the A/I physician workforce, including a national survey of practicing A/I physicians. Comparisons are drawn between the data collected in 2009/10 and those collected in 2004 and 1999. The previous reports suggested that A/I was going to face the difficulties of a dwindling supply and growing demand for A/I services. Five years later, how has the A/I physician supply changed in order to cope with the situation? This report documents many of the workforce changes that have occurred in the specialty over the past five years. The goal of the report is to develop an understanding of how the A/I physician workforce has changed, continues to change, and may change in the future. The work described in this report was conducted by the Center for Health Workforce Studies at the School of Public Health, University of Albany, State University of New York. This report was authored by Gaetano J. Forte, Director of Information ii Management at the Center. The views expressed in this report are those of the Center for Health Workforce Studies and do not necessarily represent positions or policies of the School of Public Health, the University at Albany, the State University of New York, or the American Academy of Allergy, Asthma and Immunology. The Center was established in 1996. It is a not-for-profit research organization whose mission is to provide timely, accurate data and conduct policy-relevant research about the health workforce. The Center's work assists health, professional, and education organizations; policy makers and planners; and other stakeholders to understand issues related to the supply, demand, distribution, and use of health workers. Today the Center is a national leader in the field of health workforce studies. It supports and improves health workforce planning and access to quality health care through its collection, tracking, analysis, interpretation, and dissemination of information about health professionals at the national, state, and local levels. Additional information about the Center can be found at http://chws.albany.edu. Questions about this report or the Center should be directed to Mr. Forte at 518-402- 0250 or [email protected]. March 2012 iii Acknowledgments The Center wishes to acknowledge the American Academy of Allergy, Asthma and Immunology’s Workforce Committee, co-chaired by Dr. N. Franklin Adkinson and Dr. Stephen McGeady, for its helpful review and comments on earlier versions of this report as well as thoughtful guidance throughout the project. The Center also wishes to acknowledge Sheila Heitzig, Director of Practice and Policy, at the Academy for her help in coordinating this project. The project would not have been possible without the financial support of the Academy. The Center wishes to acknowledge the physicians who took the time to participate in the study and respond to our survey. Finally, the Center wishes to acknowledge Lyrysa Smith, Center editor, for her work in producing this report. iv Table of Contents EXECUTIVE SUMMARY ........................................................................................................ ES-1 1. NUMBER OF PRACTICING A/I PHYSICIANS .................................................................................... ES-1 2. DEMOGRAPHIC CHARACTERISTICS OF A/I PHYSICIANS .................................................................... ES-1 3. EDUCATION, TRAINING, AND CERTIFICATION OF A/I PHYSICIANS ...................................................... ES-2 4. GEOGRAPHICAL DISTRIBUTION OF A/I PHYSICIANS BY CENSUS DIVISION ............................................ ES-3 5. A/I PRACTICE CHARACTERISTICS................................................................................................. ES-4 A) Practice Organization ................................................................................................... ES-4 B) Productivity ................................................................................................................... ES-4 C) Practice Capacity ........................................................................................................... ES-5 D) Medical Aspects of Practice .......................................................................................... ES-6 E) Practice Satisfaction .....................................................................................................