Erin Fraher

The Physicians Foundation awarded a grant to UNC to support its work with FutureDocs, a nonpartisan, taxpaying institution that helps address the physician shortage crisis by working to identify, encourage and mentor students who wish to devote their lives to the service of humanity as physicians, medical scientists, technologists, engineers and mathematicians. Erin Fraher, PhD, Assistant Professor, UNC Family Medicine discusses how this organization has partnered with Physicians Foundation to promote the UNC FutureDocs Forecasting tool.

Q: Please tell us a bit about The FutureDocs Forecasting Tool and how it works.

The FutureDocs Forecasting Tool is an interactive, user-friendly, web-based model that forecasts the supply of physicians, use of physician services and capacity of the physician workforce to meet future demand.
FutureDocs offers data and direction on how to meet the future demand for health services at the sub-state, state and national levels. Users can see projections for 35 physician specialties in 293 regions for 19 types of healthcare services through the year 2030. Forecasts can be downloaded on the fly and customized to be displayed as maps and charts. The model provides a series of “what-if” scenarios that show the effect that changes in retirement, hours worked, graduate medical education positions and use of NPs and PAs will have on the capacity of the workforce to meet future demand.

Q: How is this tool helping those working in the healthcare sector address imbalances in the supply and distribution of physicians?

The health system is undergoing a period of transformative change. Health systems, hospitals, physician offices, specialty societies and policymakers need rigorous data on how the demand for healthcare services and supply of physicians in their local region is expected to change in the future.

The model is groundbreaking because it allows users to see the number of visits that will be needed for 19 different types of healthcare services at the state and sub-state level and compares that to the capacity of the projected numbers of physicians. Armed with this information, stakeholders are using the model to determine which service lines should be expanded and what types of physicians to recruit to meet forecast shortages. The model provides important information about geographic disparities in workforce supply that are being used to target recruitment and retention efforts and to inform state- and national-level discussions about where, and in what specialties, to expand graduate medical education. Since the model was launched in July 2014, nearly 5,000 unique users have accessed the projections.

Q: What does this tool do to advance healthcare workforce modeling?

The grant from the Physicians Foundation enabled our team to create a disruptive innovation in workforce modeling. Traditional workforce models ask “how many doctors do we need?”, consider few “what if” scenarios, provide only national level data and lack a friendly and interactive user interface. Our model starts with a different question: “what will the population’s needs for healthcare services be and how can those needs be met by different workforce configurations in states and regions?”

The goal of the model is to engage stakeholders in redesigning the delivery of healthcare services and the composition of the workforce to meet future demand. A key innovation is the model’s plasticity matrix which maps physician supply to demand and recognizes that the demand for healthcare services may be met by different specialties in different localities. The model is the first workforce projection that considers the effect that physician migration—both after residency training and during their career—will have on the ability of the workforce to meet future demand. The model’s web-based interface allows the user to interact with the data in “real time” and see the projections in customized maps and charts.

Q: Please share a few examples which demonstrate how FutureDocs have answered specific questions.

The FutureDocs model has been used by a diverse group of stakeholders in the U.S. and internationally to inform workforce planning efforts. In the policy realm, MedPAC and HRSA have used data from the model to consider how best to target Graduate Medical Education (GME) funding to meet the healthcare needs of the population. Various physician specialty organizations have partnered with the FutureDocs team, including the American Pediatric Surgical Association, the American College of Surgeons, the American Society of Nephrology, and The Chartered Society of Physiotherapy in the U.K. These groups have used the  model to determine whether the supply of providers in their specialty will be sufficient to meet future demand and to identify the impact that changes in the number of physicians in training may have on the future workforce (published results can be found here).

State policy makers have also benefited from using the FutureDocs model. For example, stakeholders in North Carolina worked with the FutureDocs team to evaluate whether the state needed a new medical school in Charlotte. The team used the model to demonstrate the effect that different scenarios – adding a new medical school in Charlotte, increasing the number of graduate medical education positions and increasing the deployment of Nurse Practitioners and Physician Assistants – would have on the physician workforce in Charlotte and the rest of the state.

Q: What additional developments or improvements to this tool do you hope to see in the future?

We are constantly seeking ways to improve the model as we work with physician groups, healthcare delivery systems and policy makers. We are developing tutorials to assist stakeholders in harnessing the power of the model to inform state and national policymaker’s efforts to address workforce shortages. We are improving the visibility of the model by adding a new function that allows users to share data from the model on social media. This new functionality will enable users to post findings on Twitter and Facebook and will give even more visibility to the Physicians Foundation’s investment in improving workforce planning and policy.

Q: Why is it important for The Physicians Foundation to give these kinds of grants?

This grant has been essential to provide an alternative source of information about physician workforce needs now and in the future. Data from the model have been used by Congressional staffers, national policy makers at the Health Resources and Services Administration (HRSA), the Medicare Payment Advisory Commission (MedPAC), the General Accounting Office (GAO), state policy makers and medical societies, hospitals and health systems, physician specialty societies, and a range of other stakeholders with vested interests in the physician workforce.

As conflicting reports emerge describing physician shortages, the model has been a critical source of up-to-date, evidence-based forecasts about which types of health services will face shortages in which geographies. The funding has advanced the science of health workforce planning through the development of new, innovative, state-of-the-art methodologies. These include the model’s plasticity matrix, the algorithms predicting where physicians will move after residency training and during their career, and the methodology that identifies the specialties and geographies in which policy makers should expand graduate medical education.