Primary Care Physicians in Delaware 2008 prepared for Delaware Department of Health and Social Services Division of Public Health by Tibor Tóth, Ph.D. Center for Applied Demography & Survey Research College of Human Services, Education and Public Policy University of Delaware Newark, Delaware 19716 Tel: 302-831-3320 October, 2008 Overview In 1995, the Division of Public Health began an effort to measure the number and spatial distribution of primary care physicians practicing in Delaware. The objective was to identify medically underserved areas and to understand any existing or developing trends that could impact the supply of primary care services. The method chosen to gather the information was a mail survey combined with telephone follow-up of non-respondents. Subsequent surveys were conducted in 1995, 1997, 1998, 2001, 2006, and now in 2008. Each time the survey instrument was refined and shortened with the objective of reducing the burden on the responding physician and improving the quality and relevance of the data gathered. As responses were received, they would either replace information supplied by the physician at an earlier date or in the case of a first time respondent, the responses would extend the coverage of the database. At the same time, responses from physicians in prior years, who no longer had an active Delaware license as determined from the state license file, were eliminated from the database. The resulting database, upon which this report is based, contains information gathered from 1995 through 2008 from physicians who currently hold a Delaware medical license and provide clinical medical services in Delaware. Delaware currently has 4,283 physicians licensed to practice clinical medicine in Delaware. Of those, 2,271 have a Delaware address, but it does not mean they are active or that they have a Delaware practice. Similarly, physicians living in other states may have an active practice in Delaware. For the purposes of updating the database and producing this report, 2,422 physicians were contacted. This includes all physicians licensed in Delaware with an address in Delaware and physicians licensed in Delaware living within 60 miles of the state. Of those contacted, 1,051 responded to the survey and 978 provided usable data. Based on the database that combines survey results from 2008 with the results over the previous five rounds of the survey, the number of physicians with an active practice in Delaware is estimated at approximately 2,255. This total is used to produce all estimates presented throughout this report. Primary care physicians are the focus of this report. This group includes physicians practicing in five specialties: family practice, general practice, internal medicine, pediatrics, and obstetrics/gynecology. After weighting for non-respondents, the number of primary care physicians is estimated at 863. Not all physicians practice full-time. Others practice full-time but do not deliver direct patient care on a full-time basis. To give a more realistic view of the primary care physicians available, full time equivalents (FTE) were calculated. A physician who was engaged in delivering primary care directly to patients 40, or more hours per week was defined as a full-time primary care physician. Anything less than 40 hours was considered as less than full-time. For each four hours less than 40 hours 0.1 FTE was deducted. Anything more than 40 hours was considered only as full-time.1 In other words, a physician delivering 60 hours per week of primary care was still counted as one full-time equivalent physician. 1.Federal Register/Vol.45, No.223/ Monday, November17, 1980, Part IV Department of Health and Human Services, 42 CFR Part 5, p.76002. Finally, it is important to note that the estimates provided here exclude the foreign doctors with J-1 visas who are permitted to practice primary care for three years.2 Doctors with J-1 visas were removed from the analysis based on a list received from the Division of Public Health. A J-1 Exchange Visitor visa allows international medical graduates (IMG) the opportunity to obtain residency training at an American medical training institution which agrees to sponsor him/her. The graduate must return to his/her home country for a minimum of two years upon completing the residency program before he/she can apply for re-entry to the US. A J-1 visa waiver allows an IMG to remain in the US without having to return to his/her home country for the two-year period. In order to receive a J-1 visa waiver, an IMG must obtain employment to practice medicine full-time in a federally designated health professional shortage area or a medically underserved area. Physicians who obtain waivers are required to practice in these shortage areas for a minimum of three years. While these physicians have an impact on access to care, they cannot be counted since they are not required to remain in the area upon completing their three-year waiver requirement. 2.Federal Register/Vol.45, No.223/ Monday, November17, 1980, Part IV Department of Health and Human Services, 42 CFR Part 5, p.76002. The current number of primary care physicians in Delaware by county of practice. The number of physicians is provided along with estimates of full-time equivalents (FTE). Given Delaware’s population of 873,772,3 there are about 1,187 persons served by each full-time equivalent primary care physician in 2008. For the three counties, the estimates are 1,718 for Kent County, 1,059 for New Castle County, and 1,310 for Sussex County. 3.Annual Population Projections, Delaware Population Consortium, Version 2007.0, October 23rd, 2007, Delaware Observations The Delaware Physicians Survey in its sixth round provides timely and up to date insights into the primary care profession across Delaware. The data collected allows the estimation of the number of active primary care physicians in the State, along with the full time equivalent count, demographic characteristics, practice attributes and spatial distribution of Delaware’s primary care physicians. A summary of the selected findings is presented here: - In general, there are a sufficient number of primary care physicians in Delaware (1,187:1, down from 1,278:1 in 2006) although their location and specialty is probably not optimal. - While today, there are sufficient numbers of physicians, their numbers are at the upper range of what is desirable (1,250:1). Both Kent County (1,718:1 up from 1,575:1 in 2006) and Sussex County (1,310 down from 1,565:1 in 2006) are above that target. - Almost 60% of Delaware’s physicians went to high school in the region; over half of them graduated from a medical school in the region, and 75% of them completed their medical residency in the region. - Eighty-eight percent of primary care physicians are accepting new patients but the proportion accepting new Medicare and Medicaid patients (70-65%) is much lower. - Sixty percent of primary care physician’s time is devoted to serving Medicare and Medicaid patients while these populations represent less than 20% of the population. - Wait times for appointments vary significantly between established and new patients and by county. New Castle County’s primary care physicians report that established patients have to wait on average about 16 days for an appointment. Kent County’s physicians report that new patients have to wait about 21 days for an appointment. - About 47% of primary care physicians employ non-physician services from advanced practice nurses, physician assistants, and others. - About 1% of Delaware’s primary care physicians do not belong to any managed care network. The rate of physicians that do not belong to any managed care network is highest in Kent County (5%). - Primary care physicians are fairly well distributed in sub-areas of Delaware’s counties. The only exception to this finding is for OBGYNs that tend to be located in close proximity to hospitals. Printed copies of tables, graphs, and charts can by obtained by contacting: Delaware Division of Public Health Family Health and Systems Management 417 Federal Street Dover, Delaware 19901 (302) 744-4555 http://www.dhss.delaware.gov/dhss/dph/chca/fhsmhome.html