The Aging
g g of the Rural Dentist and
Primary Care Physician Workforce:
Are Some Locations More Vulnerable than
Others?
Mark Doescher, MD, MSPH, Director
Meredith Fordyce, PhD, Research Scientist
Susan Skillman, MS, Deputy Director
WWAMI Rural Health Research Center
University of Washington
Acknowledgments
This University of Washington WWAMI Rural
H lth R
Health
Research
hC
Center
t study
t d was ffunded
d db
by th
the
Office of Rural Health Policy, Health Resources
and Services Administration
Administration, Department of
Health and Human Services
Why is This Study Important?
Why is this Study Important?
• Large numbers of “baby boomer” dentists and
physicians are approaching traditional
retirement
ti
t age.
• This is occurring at a time in which:
– ffewer new dentists
d ti t and
d physicians
h i i
are choosing
h
i
the generalist specialties that form backbone of
the rural p
physician
y
workforce.
– the aging U.S. population requires more dentist
and physician services.
Why is this Study Important?
• As the baby-boom generation advances into
old age, the need for complicated dental and
medical
di l services
i
will
ill iincrease.
• For example, elderly people are much more
likely to retain their teeth than a generation
ago, so they will require much more care than
in the past
past.
Why is this Study Important?
• Familyy p
physicians
y
have a mean retirement age
g
of 65.0 years (and a median age of 63.7 years).
• Retirement age may be lower for dentists, e.g.,
intended retirement is 62 years.
• Historically, female physicians retire four years
earlier than their male counterparts
Why is this Study Important?
• Many rural areas already face shortages of
generalist dentists (GDs) and primary care
physicians (PCPs).
• The additional strain that impending dentist
and PCP retirement will cause in rural areas
is not well understood.
Goals
• To begin e
exploring
ploring the impact of an aging rrural
ral
GD and PCP workforce, this study identifies
rural locations with high proportions of these
professionals nearing retirement age.
• This study is the first national study to quantify
the extent to which the problem of rural GD
and PCP shortages may be exacerbated by an
aging workforce.
Study Design
• Cross-sectional prevalence study of GDs and
PCPs
• Generalist
G
li t D
Dentists
ti t (GD
(GDs))
– general practice
– pediatric dentistry
• Primary Care Physicians (PCPs)
– family/general
yg
p
practitioners
– general internists
– general pediatricians
Study Design
• Near-retirement age GDs and PCPs are
defined as those 56 or older.
• Young GDs and PCPs are defined as those
39 or younger
Study Design
• National -,, state-,, and county-level
y
analyses
y
performed.
• Locations were categorized by the
proportions o near-retirement providers.
• Locations in the upper percentiles of the
distribution were classified as “high-risk”
high-risk
areas.
Study Design
Data sources
1.
1
2.
3
3.
4.
2008 ADA Masterfile
2005 AMA and AOA Masterfiles
2005 and 2008 Area Resource Files
2005 and 2008 Claritas population
estimates
Study Populations
• We identified 10,977 rural GDs and
27,681
,
rural PCPs who were
– clinically active;
– not in residency training;
– not federally employed; and
– aged 74 or younger
younger.
Rural/Urban Designations
• Metropolitan
• Non
Non-Metropolitan
Metropolitan Overall
•N
Non-Metropolitan
M t
lit Adjacent
Adj
t tto M
Metro
t
• Micropolitan
p
not Adjacent
j
• Remote Non-Core
Analyses
• Analyses presented today are
descriptive.
p
Results
Number of 2008 Generalist Dentists
Metropolitan
NonN
Metropolitan
Adjacent to
Metro
Micropolitan
not Adjacent
Remote
Non-Core
NonMetropolitan
Overall
All Dentists
92,743
7,469
3,039
1,727
12,235
GD
GDs
75 999
75,999
6 777
6,777
2 603
2,603
1 652
1,652
10 977
10,977
Dentist Type:
Number of 2005 Primary Care
Physicians
Metropolitan
NonN
Metropolitan
Adjacent to
Metro
Micropolitan
not Adjacent
Remote
Non-Core
NonMetropolitan
Overall
All Physicians
517,859
35,132
15,357
7,127
57,616
PCP
PCPs
178 331
178,331
17 191
17,191
6 220
6,220
4 270
4,270
27 681
27,681
Physician
Type:
Percentage of 2008 Dentists and 2005
Physicians
Aged 56 Years or Older
Provider
Type:
Metropolitan
NonMetropolitan Micropolitan
Adjacent to
not
Metro
Adjacent
Remote
Non-Core
NonMetropolitan
Overall
GDs
37.6%
42.7%
40.4%
43.9%
42.3%
PCP
PCPs
25 5%
25.5%
26 9%
26.9%
28 0%
28.0%
28 9%
28.9%
27 5%
27.5%
Percentage of Generalist Dentists Aged 56 Years or
Older and Aged
g 39 or Younger,
g 2008
50%
40%
44%
43%
42%
40%
38%
30%
20%
15%
15%
15%
N M
Non‐Metro
L
Large Rural
R l
17%
15%
10%
0%
M
Metro
> 56 years old
< 39 years old
SSmall
ll
Rural
IIsolated
l d
Small
Rural
Percentage
g of Primary
y Care Physicians
y
Aged
g 56 Years
or Older and Aged 39 or Younger, 2005
30%
28.9%
28.0%
27.5%
26.9%
25.5%
25%
22.5%
20.8%
20.5%
20%
20.0%
20.2%
15%
Metropolitan
Non-Metropolitan
Non
Metropolitan
Overall
³ 56 years old
² 39 years old
Non-Metropolitan
Non
Metropolitan Micropolitan
Adjacent to Metro Not Adjacent
Remote
Non-Core
4
2008 Rural County Characteristics by “Near
NearRetirement GD” Upper Decile and “No GD” Status
Near
Retirement
GD (n=297)
No GD (n=335)
Other Rural
(n=1419)
White
89.3%
85.2%
87.6%
Low Education county*
26.6%
30.5%
24.4%
Persistent Poverty county
14.5%
24.4%
18.1%
Population Loss county*
32.0%
44.8%
20.2%
Retirement Destination county *
15.8%.
8.9%
14.2%
Population density*
44 9/sq mi
44.9/sq.mi.
11 8/sq mi
11.8/sq.mi.
51 1/sq mi
51.1/sq.mi.
GDs per 100K population †
20.5
N/A
24.3
* p<0.01
† p<0.001
2005 Rural Countyy Characteristics byy “NearRetirement PCP” Upper Decile and “No PCP” Status
Near
Retirement
PCP (n=184)
No PCP (n=166)
Other Rural
(n=1514)
White
83.5%
85.5%
85.2%
Low Education county*
34.2%
20.5%
22.9%
Persistent Poverty county†
25.5%
15.7%
15.2%
Population Loss county*
38.6%
48.2%
20.9%
Retirement Destination county †
10.3%.
7.8%
15.1%
Population density*
22 2/sq mi
22.2/sq.mi.
34 5/sq mi
34.5/sq.mi.
49 8/sq mi
49.8/sq.mi.
PCPs per 100K population †
37.9
N/A
57.8
* p<0.01
† p<0.001
Conclusions
Conclusions
• Nationally, rural counties have a significantly higher
proportion of GDs and PCPs nearing retirement age.
Conclusions
• Recent trends in career choice and practice location
indicate that shortages arising from provider attrition
will grow.
Conclusions
• Rural counties with near-retirement
near retirement GDs were
characterized by:
– Population loss
• Rural counties with near-retirement PCPs were
characterized by:
– High rates of poverty
– low levels of educational attainment
– Population loss
– Low population density
– Low PCP densityy
Conclusions
• Rural counties in which no GDs/PCPs were identified
have:
- Low socioeconomic status
– High rates of population loss
– Low population density
Potential Solutions
• Bolster the numbers of graduates entering
rural practice:
– Improve K-12 and college student preparation for
rurall h
health
l h care careers
– Adopt admissions policies that serve rural health
care needs
– Expand rural health care training opportunities as
core educational curricula
– Provide financial and life
life-style
style support for
practicing rural GDs and PCPs.
Potential Solutions
• Accurate data are needed to identify rural
communities most at risk for shortages due to
GD and/or PCP retirement.
• Once high risk communities are identified,
impending
p
g GD or PCP retirement-related
shortages could be mitigated by…