Family Medicine Vital Signs

By Susan Cochella, MD, MPH

Erin Fraher, PhD, MPP, and her team at the University of North Carolina have developed a data-driven tool that Utah can use to deliver more value by strategically planning the healthcare workforce. I learned about her work from a colleague on an advisory board in Florida when I asked if anyone is using data to plan workforce, knowing that it’s not just about how many doctors we have, but about what they do and where they do it. My colleague hooked me up with Erin. I learned that she is a PhD researcher within the Family Medicine Department at UNC, tasked with creating and sharing data to inform health workforce planning for North Carolina and nationally. In NC, groups come to her and she helps them decide whether or not a dental school, for example, is needed in their area. Nationally she leads one of six federally funded (HRSA) teams to rethink how we plan our workforce. And this expertise makes her able to help me think about Utah’s health workforce need. She also collaborates with educators, employers and policy makers all over the US and helps them match supply of health care services to demand for those services using health workforce data.

If you have a computer, go to her team’s “futuredoc” tool:

Let’s take one minute to generate a map of Utah with supply/demand projections for circulatory services. Click “The Model”, “Line Chart”, “Tertiary Service Area” and “All TSAs”. Enter 84108 in “Search for TSA by zip code”, which will get you into our tertiary service area (based on Dartmouth’s hospital referral regions (HRRs), which are geographic areas logically identified to be catchments for healthcare services). Click “Shortage or Surplus”, “All”, select “Circulatory”, click “Supply Per Visits”. Then hit the “Apply” button. You will get a line chart generated from local visit demand and specialty FTE supply forecasts.

Supply/demand ratio for Circulatory Visits in Utah

This chart suggests that in our area, we have more supply of circulatory services than we have demand for those services, and the supply is projected to decrease. That doesn’t necessarily mean we have too many cardiologists, though given the magnitude it is certainly possible. Rather, it means that considering all of the various providers who commonly provide circulatory services (based on national data, this includes primary care), we may have more than we need.

Now check out Pregnancy/Childbirth services.

Supply/demand ratio for Pregnancy/Childbirth Visits in Utah

We have 0.75 providers available for every visit needed. That’s not enough. And it is decreasing. Last, look at Mental (refers to mental health services). This is a critical area in Utah because, while we don’t smoke or drink a lot, we have high rates of depression, suicide, and domestic violence.

Supply/demand ratio for Mental Health Visits in Utah

Unfortunately our supply/demand ratio for mental health services is even worse than pregnancy/childbirth, at 0.7 providers per needed visit. Even worse, it is precipitously decreasing.

OK, this feels depressing. But I don’t want to create more need for mental health services by depressing everyone about our workforce, so let’s keep things in perspective. If these workforce imbalances are present now, they probably have been for a long time, so this problem isn’t new. What’s new is that we’re becoming aware of it, which is a good thing.

Stepping back, we can ponder important questions.  What does this data mean? And what tools do we have to provide needed services to our population? This is where Erin taught me about the concept of workforce plasticity, which refers to the versatility of providers within the health care system. What variety of services can one provider deliver, depending on the need for those services? It’s about matching services supplied by providers to needs for services requested by the population. Maybe some of our oversupplied services are being provided by people who could deliver other more needed services too. Do the economics of the system support versatility? Do the resources available to us allow us to redeploy people in different ways? How can we advocate for shifts in the economics or other structures that would help us better match the supply to the demand?

I don’t know everything that is possible, but I do know that amazing and interesting things happen in Utah. We are inventive, collaborative, and ambitious. If these tools can help us find ways to better match our services with our population’s current and future needs, I’d like to help facilitate that. I think I’ll schedule another call with Erin.

Susan Cochella, MD, MPH is a Clinical Professor in the Department of Family & Preventive Medicine in the University of Utah School of Medicine.