Kentucky Institute of Medicine™

COMPREHENSIVE STATEWIDE PHYSICIAN WORKFORCE STUDY

The Comprehensive Statewide Physician Workforce Study is available for download here.

Executive Summary

Access to healthcare services is vital to the health of all Kentuckians and the economic well-being of the Commonwealth. An adequate number of physicians, including an appropriate distribution of specialists by discipline and geography, is critical to ensuring that care is available.

National projections of physician supply have varied, from an oversupply just 10 years ago, to what analysis now confirms, the likelihood of a significant shortage of doctors in the near future (4-7, 13, 20). This is due to several factors, such as physicians retiring earlier, lifestyle changes among younger practitioners, more doctors entering administrative medicine, the aging of the population and the subsequent management of chronic diseases, concerns about litigation, managed care, and the ability of Americans to afford more care. The Centers for Disease Control reports that hospital and doctor visits have surged by 20% over the past five years (3).

For decades Kentucky has suffered a chronic shortage of physicians, particularly in rural portions of the State, creating a situation that, along with residents’ poor lifestyle choices, has resulted in unfavorable health status (3, 23). Unfortunately, there is not a quick fix for this physician shortage. Even if all the barriers that have prevented a sufficient and well-dispersed supply of physicians were suddenly to disappear, the task of recruiting and educating an ample cohort of doctors would take years to accomplish.

Now is a prudent time to begin assessing physician requirements and medical education needs for the year 2020 and beyond (5, 13, 20). This is especially true considering that ongoing population shifts could soon necessitate physicians spending more than one-third of their time treating elderly patients. The healthcare workforce is also aging, with many physicians expected to retire at a time when demand for services is on the rise (14).

At the recommendation of the Kentucky Medical Association Physician Workforce Committee, the Rural Kentucky Medical Scholarship Fund asked the Kentucky Institute of Medicine (KIOM) to conduct an in-depth study of the State’s need and demand for physicians in the coming years. KIOM examined trends in Kentucky’s population and changing physician characteristics to determine how these forces are likely to influence the State’s number of active physicians by specialty by the year 2020.

With Kentucky’s more than four million population and 8,981 active physicians, it has a ratio of 213.5 active physicians per 100,000 population compared to that of 267.9 for the US (1, 3, 11, 17). Kentucky’s current ratio ranks as the 32nd lowest among the 50 states. Kentucky now needs 2,298 more active physicians to bring it to the 2007 US ratio, assuming the US ratio constitutes an adequate supply of physicians. The results of this workforce study first assumed an increase in the number of Kentucky physicians to the level of physicians nationally. After making this adjustment, projections were made to 2020 of the likely supply of physicians and numbers required to meet need and demand if current population and economic trends continue (16).

It is projected that the supply of Kentucky active physicians will be 12,846 by 2020 (see Table 1) if recruitment and retention of physicians improves, the trend toward fewer hours worked and earlier retirement lessens, and output from State medical schools increases so as to bring Kentucky close to the US physician-to-population ratio in the next 3-5 years.

Using the Physicians Requirement Model (PRM) with the US ratio, by 2020 13,422 Kentucky active physicians are required to meet the projected need to guarantee access to healthcare based on existing standards of need.

Table 1
Kentucky Physicians Estimation and Projections
Year 2007 Total 2020 Change 2007-2020
Supply Trends 8,981 12,846 43.0%
Need 8,981 13,422 49.4%
Demand 8,981 14,989 66.9%

This number increases to 14,989 active physicians required for the State to accommodate both need and optional services that might be demanded by a better educated, more prosperous, and somewhat older population on average with the baby boom generation making up a sizable segment of the total population (14-17).

For the past 10 years the average annual growth in active physicians for Kentucky is 2.4%. If Kentucky continues to attract active physicians at a rate of 2.4% per year, this would add 3,243 physicians by 2020, but the Commonwealth would still need 622 more active physicians to reach the projected supply requirement, 1,198 to meet need, and 2,765 to meet demand, or an increase ranging from 7-30%.

To address the shortage of Kentucky’s physician workforce, this report proposes strategies to increase the State’s supply of physicians, improve the diversity of its physician workforce, address the uneven distribution of physicians, increase physician productivity, and facilitate more effective workforce planning (13, 19, 20).

KIOM Task Force Members

Bob Arnold, Executive Director / CEO
Kentucky Association of Counties (KACO)

Benny Ray Bailey, PhD
Executive Director
East Kentucky Health Services Center, Inc.

Daniel J. Callan, DO/MPH-TM
Assistant Professor of Clinical Medicine
Chair, Department of Family Medicine
Pikeville College School of Osteopathic Medicine

Baretta R. Casey, MD, MPH
Director, UK Center for Excellence in Rural Health

Danny M. Clark, MD, President
Kentucky Board of Medical Licensure

Michael Gayheart, Center Director
Southeast AHEC

William Hacker MD, FAAAP, CPE
Acting Undersecretary for Health
Cabinet for Health and Family Services

V. Faye Jones, MD
Department of Pediatrics
University of Louisville School of Medicine

Lucy Juett, Center Director
South Central AHEC

Kathy C. Long, CEO
Marshall County Hospital

Jennifer NeSmith, MBA
VP for Physician Services & Marketing
Gateway Regional Health System / Mary Chiles Hospital

James C. Norton, PhD, Associate Dean
AHEC and Community Outreach
University of Kentucky College of Medicine

Steve Nunn, Attorney
Glasgow, Kentucky

David Saxon, PhD
Premedical Advisor from Morehead State University
Professor of Biology
Biological & Environmental Science

F. Douglas Scutchfield, MD
Peter P. Bosomworth Professor of Health Services Research and Policy
University of Kentucky College of Public Health

Susan Starling, President/CEO
Marcum and Wallace Memorial Hospital

Daniel W. Varga, MD
Chair, KMA Physician Workforce Committee
Kentucky Medical Association

Bill Wagner, Executive Director
Family Health Centers of Louisville
Family Health Centers, Inc.

R. Brent Wright, MD, Director
Glasgow/Barren County Family Medicine Residency

Advisory Staff

Emery A. Wilson, MD, Director
Office of Health Research & Development
University of Kentucky College of Medicine

David A. Gross, Director
Research, Marketing and Community Engagement
Center for Excellence in Rural Health
University of Kentucky

Kevin Kainulainen
Staff Support Associate
UK Office of Rural Health Policy

Michael E. Samuels, DrPH
Endowed Chair/Distinguished Scholar in Rural Health Policy
Professor of Family and Community Medicine
University of Kentucky College of Medicine

Elmer T. Whitler, MA, MPA, Director
Research, Technology and Workforce Planning
Center for Excellence in Rural Health
University of Kentucky

Linda M. Asher, Executive Director
Kentucky Institute of Medicine