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A Snapshot of Care

At first glance, the physician workforce in Washington, D.C. looks robust: about one licensed physician for every 60 residents. That’s far higher than the nationwide ratio of about one doctor for every 300 Americans.  

But a new survey of the city’s licensed physicians and physician assistants paints a different picture.  

According to a report compiling its results, which was released at a D.C. Board of Medicine Symposium at GW’s Jack Morton Auditorium, Sept. 28, over 40 percent of physicians licensed to practice in the District don’t actually practice there. And, of those who do practice in the city, only about two-thirds provide clinical care for more than 20 hours a week. The results were similar for the city’s licensed physician assistants: only 53% practice in the District for more than 20 hours a week.  

“This is an issue that is of great importance to physicians, physician assistants, as well as those of us who are engaged in the important role of Public Health in ensuring that our citizens in the District can lead healthy, productive lives,” said Lynn Goldman, M.D., M.P.H., dean of the Milken Institute School of Public Health (formerly the GW School of Public Health and Health Services) in her welcoming remarks.  

The event, which brought together area health professionals, academics, hospital administrators, and local government workers was co-sponsored by the MISPH and the School of Medicine and Health Sciences (SMHS). Alan Wasserman, chair of SMHS's Department of Medicine, also welcomed participants.  

The workforce survey was conducted between October 2010 and February 2011 as an optional and anonymous part of the license renewal process, which all physicians and physician assistants must go through every two years to maintain their privileges in D.C. About 75 percent of those who applied for renewal participated in the survey. 

In addition to gathering basic demographic and educational information, the survey asked physicians and physician assistants about their location, specialty, plans for the future, and use of electronic health records and social media.  

The resulting report, which was authored by Rachelle Pierre-Mattheiu, M.D., a GW emergency medicine health policy fellow and a board of medicine health policy fellow, describes a local workforce that is racially and ethnically similar to doctors across the United States with one exception. Nineteen percent of District doctors are African American or black; in the United States, they represent only 4 percent of the workforce. Among the physician assistants surveyed, 30 percent were African American or black, compared with a 3 percent national proportion. While these numbers are encouraging, they are still not reflective of the District’s diverse population, said Janis Orlowski, M.D., chair of the Board of Medicine, who presented the report.

The specialty distributions for both physicians and physician assistants appear to be similar to national estimates except in family practice, a specialty with significantly fewer D.C.-based providers. Internal medicine, general pediatrics and psychiatry were the most popular specialties among the city's practicing physicians; for the physician assistants, emergency medicine and general internal medicine topped the charts. Contrary to tradition, most physician assistants reported involvement in a non-primary care specialty.

According to the report, nearly 40 percent of physicians and more than 60 percent of physician assistants work in hospital-based practices, and even those not affiliated with hospitals tend to be clustered around them. More physicians reported practicing in Northwest DC than any other quadrant of the city — a finding that reawakens concern about access to care in some of the city's most underprivileged areas, particularly east of the Anacostia River.  

The release of the report comes at a critical time, when the nation’s healthcare system prepares for the 32 million more people who will have health insurance by 2019 as a result of the Patient Protection and Affordable Care Act. These anticipated new patients — plus the increased healthcare needs of a population that is getting bigger and older — are challenging health care professionals and administrators nationwide to find new ways to serve more patients without sacrificing quality.    

The report, whose “main purpose is to start the dialogue,” is the first step in that process, said Mohammad Akhter, M.D., M.P.H., director of the DC Department of Health, who delivered opening remarks at the symposium.  “Until we find out where the people are, what they're doing and who they’re serving, we can't begin to plan for our own city, we can’t begin to identify where the gaps are in what kind of services we need,” he said.

Ed Salsberg, director of the National Center for Healthcare Workforce Analysis and lecturer of Health Policy at the MISPH, delivered the symposium’s keynote address, which discussed national trends, challenges, and potential solutions to what he called an inevitable “clash” between the need for both more providers and reduced healthcare spending.  

Salsberg said he expects physician assistants and nurse practitioners to play a greater role in care delivery in part because their professions are growing “relatively rapidly.” Currently, the national ratio of nurse practitioners and physician assistants to physicians is two to nine, but the ratio of new providers each year is five to three.   

Salsberg predicted that states will also be reevaluating their scopes of practice for non-physician health care workers and promoted interprofessional training and practice, saying, “we think the answer is teams.” 

He also stressed the need for redistribution of providers, particularly those who practice primary care.  “Even if we train and educate enough health care professionals, it doesn’t mean we are getting them to the areas that need them the most,” he said.  

Salsberg called not only for more data, but also for similar data collection methods across states and professions. “We will need data, analysis and research to inform decision-making and ensure access,” he concluded.

The D.C. Board of Medicine plans to conduct another survey during the next license renewal cycle in 2012. “The minute we got the results, we had ten more questions,” said Orlowski. “This is the first time we’ve done the survey, but it won’t be the last because we understand how important it can be in planning for the future.”

To view a PDF of the report, click here.