V. Health Manpower & Health Services Inventory

A. Health Manpower

The following section discusses the current supply of health care providers in the service area as well as the spectrum of health care services available to the community. The issue of physician over-supply or under-supply has been a growing concern for many communities and cities in California. Experts predict that California's population growth will slow, thereby generating a substantial excess supply of physicians. According to the UCSF Center of Health Professionals, "If California's population grows at the rate projected by the California Department of Finance, by the Year 2020 the state will have at least 18% more physicians than its population requires." UCSF has also identified that primary care physicians are poorly distributed across the state with an excess supply in many urban regions and an inadequate supply in many rural communities.

There are a variety of physician demand measurements. The measurements, which are reported by many organizations, generally vary, in some cases significantly, depending upon the statistical methodology used. Furthermore, conditions in the market can also significantly impact the supply and demand for physicians. The degree of managed care penetration in a community will impact the demand for primary care versus specialists, as well as the practice patterns within the physician office, thus affecting office visit volumes and therefore the number of physicians required to serve the population.

In Table 5.1, the Lompoc providers have been identified by primary care and by specialty for both in-area and out-of-area (Lompoc) and compared to the United States ratio of physicians per 100,000 population. According to these national ratios, there are significant negative variances per 100,000 population. For primary care physicians the negative variance is 23.3 while the negative variance is 55.3 for all specialists. This assumes, however, that the national ratios are applicable to Lompoc. Factors such as established patterns of patient outmigration may significantly reduce physician demand within a specific service area. This is particularly true for rural areas where national norms may be less relevant than in urban areas. At the very least, comparing local physician supply with national norms provides a tool for making broad local judgements about physician demand and supply.

In Table 5.2, the Lompoc physician to population ratios are compared to three sets of ratios or benchmarks developed by Longshore and Simmons for markets which have been penetrated by managed care organizations.

The first set, or average rate, is the average of rates produced by several other studies of physician demand. The moderate rate represents physician demand for health plans that utilize integrated networks. The maximum rate represents physician demand in staff/group model HMOs or health plans.

For Lompoc, which has a fairly high level of managed care penetration, the most relevant benchmark is the average rate due to the fact that there is no integrated network (of the type discussed by Longshore and Simmons), nor is there a staff/group model HMO. In comparing these rates, the Lompoc population results in a negative variance of 5.6 primary care physicians and 11.0 specialists, a much different picture than presented in the previous table.

Table 5.2: Estimated Physician Workforce Requirements Under a Managed Care Environment

Longshore+Simmons Benchmarks   Average Rate* Moderate Rate* Maximum Rate* Ratio per 100,000 Pop. Variance Primary Care 48.0 55.9 65.9 42.4 (5.6)   Medical Specialties   Allergy-Immunology 1.3 1.2 1.5 0.4 (0.9) Cardiology 2.6 2.5 3.0 1.9 (0.7) Dermatology 2.3 2.2 2.6 1.1 (1.2) Endocrinology 0.8 0.7 0.9 - (0.8) Infectious Diseases 0.7 0.7 0.8 - (0.7) Nephrology 0.7 0.7 0.8 0.4 (0.3) Neurology 1.4 1.3 1.6 1.9 0.5 Oncology/Hematology 1.9 1.8 2.2 0.8 (1.1) Psychiatry 4.1 4.0 4.7 1.1 (3.0) Pulmonary Medicine 1.2 1.1 1.3 - (1.2) Rheumatology 0.6 0.5 0.7 - (0.6) Surgical Specialties             Gastroenterology 1.6 1.5 1.8 - (1.6) General Surgery 5.7 5.4 6.5 7.5 1.8 Neurosurgery 0.6 0.6 0.7 - (0.6) Ob/Gyn 10.3 9.9 10.7 6.4 (3.9) Opthamology 3.4 3.2 3.8 3.9 0.5 Orthopedic Surgery 4.8 4.6 5.4 5.6 0.8 Otolaryngology 2.8 2.6 3.1 3.4 0.6 Plastic Surgery 0.4 0.4 0.5 0.2 (0.2) Thoracic Surgery 0.5 0.4 0.5 - (0.5) Urology 2.7 2.5 3.0 1.9 (0.8) Hospital-Based Specialties   Anesthesiology 5.5 5.2 6.3 5.6 0.1 Emergency Medicine 5.4 5.1 6.1 7.5 2.1 Pathology 2.4 2.3 2.7 1.9 (0.5) Radiology 6.4 6.1 7.2 5.6 (0.8) Other       2.1 2.1 Total All Specialties~ 70.1 68.5 80.5 59.1 (11.0)   Total All Physicians 118.1 124.4 146.4 101.5 (16.6)

* All figures represent full time equivalent physicians per 100,000 * Average Rate = L+S Average of other studies. Moderate Rate = L+S/Weiner's rates for integrated network plans. Maximum Rate = L+S/Weiner's rates for staff/group model HMOs. ~ Totals do not add, due to rounding. Source: Forecasting the Effects of Health Reform on U.S. Physician Workforce Requirement, J.P. Weiner Dr.P.H., JAMA 7/20/94; Physician resource planning must keep pace with evolving markets, Lomkamp and Simmons, Health Care Strategic Management, March 1995.

In Table 5.3, the ratio of Lompoc primary care physicians to the population is one physician for every 2,792 persons after adjusting for the greater than 65 year old population. This age adjusted population incorporates the need to inflate the population figures to account for the greater needs of the population over 65. Typically, managed care organizations use a multiplier factor of 3 for populations aged 65 or over. In order to compare this ratio to a benchmark, the benchmark must be converted to a physician to population ratio. The "average rate" benchmark of 48 Primary Care Physicians per 100,000 population in Table 5.2 is equal to a physician to population ratio of 1:2,083 or one physician for every 2,083 persons. Based on this physician to population benchmark, Lompoc is in need of 7.8 additional primary care physicians, a physician demand of 30.8 versus the current supply of 23.

Table 5.4 calculates the need for full-time primary care physicians taking into account the impact of Physician Assistants or Nurse Practitioners working in Lompoc. For this calculation, each mid-level practitioner is assigned a value of .5 FTE primary care physicians. Factoring the mid-level practioner supply results in a primary care provider negative variance of 5.8.

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