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Wisconsin AHEC Health Workforce Data Brief

www.ahec.wisc.edu/workforce -‐1-‐ June 2015

Psychiatrists This map shows the distribution of psychiatrists under age 65 who were licensed in Wisconsin as of 3-‐15-‐2012. Included are psychiatrists with specialties in adult or child psychiatry, geriatric psychiatry, and alcoholism and chemical dependency. In addition to psychiatrists with an office-‐based practice, the data includes those who work only in hospital or residential facility settings, and those primarily engaged in administration, teaching and research. The map locates these physicians in the zip code of their address of record with the Department of Safety and Professional Services (DSPS). For physicians under age 65, this is presumed to be within the service area of the physician’s practice, if not the specific practice location. Comparison to information provided in the 2011/12 Wisconsin Physician Survey and linked to the licensure data supports this assumption for physicians in rural areas and most other parts of the state. In the sub-‐areas of central Milwaukee, however, there is more variation between a physician’s address of record and primary practice location. The map also does not reflect the fact that many psychiatrists practice in multiple locations. The Wisconsin Health Service Area (HSA) geography overlays the zip code information on the map. The Health Service Areas were developed by Wisconsin AHEC for health workforce data analysis. They also provide a useful geography for monitoring local program outcomes related to health workforce development and population health status. Each Wisconsin HSA consists of a hub city with healthcare services and surrounding municipalities. With some exceptions (in northern Wisconsin and border communities) each service area has a population of at least 10,000, with most of the service area population within 30 minutes travel time of the hub city. While most hubs include a hospital, inclusion of a municipality in a service area is determined by travel time to the hub, not actual hospital or clinic utilization data. A zip code version of the service areas has also been developed. For more information on the development of the service area geography, see Introduction to Wisconsin Health Service Areas, www.ahec.wisc.edu/healthserviceareas . The website also has maps and data related to the HSAs available for download. Psychiatrists make up approximately 5.0% of physicians in Wisconsin. Nationally, psychiatrists accounted for 4.8% of professionally active physicians in 2012. [AAMC, 2012 Physician Specialty Data Book] At the conclusion of the 2011/12 physician license renewal cycle in Wisconsin, there were 731 psychiatrists with an active license and DSPS address in the state. Another 323 psychiatrists maintained a Wisconsin license but had an address outside the state. Survey responses indicated that approximately 8% of these psychiatrists based outside Wisconsin see patients on a regular basis in Wisconsin. Including these psychiatrists in neighboring states, the overall population to provider ratio for psychiatrists professionally active in Wisconsin was 7513:1 in 2012. There are significant disparities in distribution within Wisconsin, however, with the ratio ranging from well over 30,000:1 in rural areas to under 10,000 in metro and urban areas of the state. Nationally, the ratio in 2012 was approximately 8072:1 [AAMC]. Overall about 91% of Wisconsin-‐based psychiatrists provide patient care. They are supplemented by those physicians from neighboring states who practice in Wisconsin in a regular basis, yielding an overall estimate of 682 psychiatrists providing patient care in person in Wisconsin in 2012. Of these psychiatrists providing patient care, about 79% (or 71% of all psychiatrists) provide office-‐based patient care. The remainder practice exclusively in the hospital or other institutional setting.



DEMOGRAPHICS 731 psychiatrists with an active license and DSPS address in Wisconsin as of 3-‐15-‐2012. Degree

MD 710 (97.1%) DO 21

Gender

Female 250 (35.9%) Male 447 Undisclosed 34

Age

Average age 53.6 75 and over 36 (4.9%) 65-‐74 113 (15.5%) 55-‐64 194 (26.5%) 45-‐54 211 (28.9%) 35-‐44 135 (18.5%) 35 and under* 42 (5.7%) *Does not represent a full age cohort -‐ many individuals age 25-‐34 are still completing their medical residency training.

In all, 46.9% of active psychiatrists in Wisconsin were age 55 or older in 2012. This compares to 56.7% for the nation as a whole [AAMC, 2012 Physician Specialty Data Book}. The youngest full ten-‐year cohort of psychiatrists in practice (ages 35-‐44) barely exceeds those moving into full retirement (ages 65-‐74) and represents 69.5% of the cohort aged 55-‐64 and only 64.0% of the cohort aged 45-‐54. If current patterns continue, the number of physicians entering the practice of psychiatry in Wisconsin over the next ten years will fall considerably short of the number retiring or scaling back their practice in anticipation of retirement.

Specialty (according to information on file with DSPS and updated at time of license renewal in 2012) 551 Psychiatry 151 Psychiatry|Psychiatry-‐Child 22 Psychiatry|Psychiatry-‐Alcoholism-‐Chemical Dependency 2 Psychiatry|Family Practice 3 Psychiatry|Geriatrics 2 Psychiatry|Research Date of first Wisconsin license

less than 3 years after medical school 285 (39.0%) (likely to have completed medical residency in Wisconsin) 3-‐10 years after medical school 309 (42.3%) (started practice in Wisconsin shortly after completion of medical residency) more than 10 years after medical school 137 (18.7%)

Nationally, 56% of psychiatrists practice in the state where they completed GME [AAMC, 2012]



Medical School

MCW 95 (13.0%) UW 126 (17.2%) Other US 372 (50.5%) Canada 3 (0.4%) International 135 (18.5%)

Other US Medical Schools, detail 32 Illinois 10 Iowa 11 Michigan 11 Minnesota 308 All other states International Medical School Graduates (IMG) detail 8 “Offshore” schools in the Caribbean 15 Other Central & South America 16 Europe 3 Africa 6 Middle East 3 Korea, China, Japan 59 India, Pakistan 23 Philippines 0 Indonesia, Malaysia, Southeast Asia 1 Australia, New Zealand

For comparison, in the nation as a whole, 30.3% of psychiatrists are international medical graduates. [AAMC 2012 Physician Specialty Data Book]

PATIENT CARE A survey conducted during the Sept-‐Oct 2011 (MD) and Jan-‐Feb 2012 (DO) license renewal periods provides additional demographic information, information on geographic distribution, current practice characteristics and future practice plans. Of the 1054 psychiatrists licensed by Wisconsin, a total of 390 psychiatrists completed the survey or an overall response rate of 37.0%. Of the 731 psychiatrists with an address in Wisconsin, 269 (36.8%) completed the survey. Survey responses were weighted according to age, gender, location and specialty to provide estimates for the state as a whole. See the October 2012 Wisconsin Physician Workforce Report (available at www.ahec.wisc.edu/workforce) for information on the weighting process and other technical details.

HOURS OF PATIENT CARE Based on the responses of Wisconsin-‐based physicians to the 2011/12 Wisconsin Physician Survey, we can estimate that approximately 80% of psychiatrists providing patient care are fulltime (32 hours or more per week). For all Wisconsin-‐based psychiatrists providing patient care, the statewide average is 1923 hours of patient care annually, over an average of 46 weeks per year.

Average hours/week 41.8 hours

Median 40 hours

Mode 40 hours

Average weeks worked in the past year 46.0 weeks

Median 48 weeks

Mode 48 weeks

Average patient care hours per year 1923 hours



Distribution of hours of patient-‐related care, by setting

Hospital 30.2%

Emergency Room 1.4%

Office-‐based Care 56.7%

Telemedicine 0.9% Nursing Home or Extended Care

Facility 3.2%

Home Visits 0.1%

Corrections 3.7%

Other Pt Care 3.8%

Total hours of patient care 1,311,383 hrs

Office-‐based care only 56.7% 744,866 hrs TELEMEDICINE Of the 323 respondents to the 2011/2012 re-‐licensure survey with an address outside Wisconsin, 1% indicated that they provide patient care to Wisconsin patients via telemedicine. Among Wisconsin-‐based respondents to the survey, about 8% indicated that they provided care via telemedicine in addition to an office-‐based practice. Practice in this area is changing rapidly and a carefully worded question on this topic in 2015 would likely show increasing numbers engaged in treating patients face-‐to-‐face via telemedicine. POPULATION-‐TO-‐PROVIDER RATIO With an estimated 46,113 psychiatrists nationwide [AAMC, 2012], the national population to provider ratio for psychiatrists is 6783:1 for all professionally active psychiatrists using January 2012 population estimates. Our estimate of Wisconsin’s population-‐to-‐provider ratio for psychiatrists is 7513:1 for all professionally active psychiatrists. For psychiatrists providing patient care, the ratio is 8339:1, ranging from over 36,000:1 in rural areas to well under 10,000:1 in Madison and Milwaukee. Exclusion of facility-‐based patient care hours (hospital, corrections, residential care facilities for special populations) reduces the patient care hours by 43.2% and would increase the population-‐to-‐provider ratio for the general population to 14,681:1. A population to psychiatrist ratio of 10,000:1 is frequently estimated to be the minimum necessary to meet population needs. Opinions differ, and the calculation also depends upon the number of other mental health personnel and how they are utilized, as well as the availability of tele-‐psychiatry services. The Health Resources and Services Administration (HRSA) uses 30,000:1 (20,000:1 where high needs are indicated) as the population to psychiatrist ratio necessary to designate an area as a Mental Health Professions Shortage Area (HPSA). An estimated 212 psychiatrists are needed to eliminate current Mental Health HPSAs in Wisconsin, more than in any other state as of April 2014. [ http://kff.org/other/state-‐indicator/mental-‐health-‐care-‐health-‐professional-‐shortage-‐areas-‐hpsas/#notes ]

The National Health Service Corps uses 40 hours/week and 45 weeks per year as the standard for 1 FTE, counting no more than 40 hours per week for an individual provider. Using that standard, the effective FTE is 363 psychiatrists and the effective population-‐to-‐provider ratio for the state as a whole becomes 15,684:1. Overall population-‐to-‐provider ratio, all professionally active psychiatrists: 7513:1 Population-‐to-‐provider ratio, patient care psychiatrists, @ 1FTE=1923 hours, 682 FTE providers 8339:1 Population-‐to-‐provider ratio, office-‐based care only, @1 FTE=1923 hours, 387 FTE providers 14,681:1 Population-‐to-‐provider ratio using NHSC standard, @1 FTE=1800 hours, 363 FTE providers 15,684:1 The population to provider ratios in the service area tables on the next page reflect Wisconsin-‐based psychiatrists under age 65 only and assume that all of a psychiatrist’s time is in the same region or size of community as the psychiatrist’s address of record in the licensure data. In reality, however, psychiatrists often travel to many different locations, in different counties, to provide care. This is especially true of psychiatrists working with public health agencies to provide services to special populations. Over half of psychiatrists with an office-‐based practice in Wisconsin indicated that they practice at 2 or more sites.



Service Area Regions

For convenience in summarizing certain kinds of data, service areas are grouped into 17 regions around the closest source of tertiary care. With the exception of Rhinelander in northern Wisconsin, each region includes a city of greater than 50,000, or is adjacent to a metropolitan area in a neighboring state (Duluth, Minneapolis, Dubuque). Note that each region may include metro, urban and rural service areas. Summary data by region may obscure significant within-‐region variation.

Service Area Urban and Rural Types The service areas are identified by type using data on urban density from the 2010 U.S. Census. Urban Area (UA) and Urban Cluster (UC) population data was used to classify the service areas as "Metro" (> 50% of the population in UAs), "Urban" (<50% UA but >60% in UAs or UCs), "Mixed" (40% to 60% living in UAs and UCs), and "Rural ( <40% UA and UC population). Areas with high numbers of health professionals engaged in administration, research and teaching are identified for separate analysis.

For Health Service Area documentation and maps, see Introduction to Wisconsin Health Service Areas at www.ahec.wisc.edu/healthserviceareas Table 1. Wisconsin-‐based Psychiatrists, by Region Region Population1

Child Psychiatrists under age 65

All WI-‐based Psychiatrists under age 65 as of 1-‐1-‐12

Overall Population to Psychiatrist (<age 65) ratio

Green Bay 428,055 9 26 16,464:1 Sheboygan 196,867 3 16 12,304:1 Appleton 293,325 5 22 13,333:1 Oshkosh 162,242 3 15 10,816:1 Fond du Lac 172,043 1 9 19,116:1 Milwaukee 1,328,682 43 185 7,182:1 Waukesha 274,040 10 31 8,840:1 Southeast 469,599 5 25 18,784:1 Madison 667,420 30 142 4,700:1 Janesville 246,150 4 16 15,384:1 Southwest 66,166 -‐ 2 33,083:1 La Crosse 290,009 8 29 10,000:1 Eau Claire 352,965 4 21 16,808:1 West Central 174,159 -‐ 5 34,832:1 Superior 69,465 -‐ 2 34,733:1 Rhinelander 114,310 1 6 19,052:1 Wausau 381,489 4 30 12,716:1 Statewide totals 5,686,986 130 582 9,771:1 Table 2. Wisconsin-‐based Psychiatrists, by Service Area Type Service Area Type Service Area

Population1 Child Psychiatrists under age 65

All WI-‐based Psychiatrists under age 65 as of 1-‐1-‐12

Overall Population to Psychiatrist (<age 65) ratio

Type 1a: Metro, academic 647,023 48 194 3,335:1 Type 1b: Metro, all other 2,990,734 70 300 9,969:1 Type 2: Other Urban 555,454 3 31 17,918:1 Type 3: Mixed-‐L, hub > 10,000 232,775 4 21 11,085:1 Type 4: Mixed-‐M, hub <10,000 211,040 1 7 30,149:1 Type 5: Rural-‐M, hub >2500 775,372 2 21 36,922:1 Type 6: Rural-‐S, hub < 2500 274,588 2 8 34,324:1 ALL METRO & URBAN (74% of pop) 4,193,211 121 525 7,987:1 ALL MIXED (8% of pop) 443,815 5 28 15,851:1 ALL RURAL (18% of pop) 1,049,960 4 29 36,206:1 STATEWIDE TOTAL 5,686,986 130 582 9,771:1 12010 U.S. Census



RETIREMENT PATTERNS Overall, Wisconsin physicians begin reducing patient care hours around age 55, but many work past age 65. The group continuing to practice after age 65 offsets the impact of the group reducing hours prior to age 65. (See the October 2012 Wisconsin Physician Workforce Report (available at www.ahec.wisc.edu/workforce). Specific retirement patterns do vary by specialty, but age 65 provides us with a consistent marker for an estimate of active physician FTE and an initial projection of physician retirement, since that information is available for all physicians in the licensure data set and would be available in any similar data set drawn at a future date. If a typical physician has a 35-‐year career (from the conclusion of residency training at about age 30 until age 65), and there is an even distribution of the current workforce by age, one would expect about 10/35ths of the workforce to retire each decade, or 28.6%. This is what we might expect for the state as a whole. However, In the smaller service areas, an even age distribution is less likely, and the retirement of one physician will have a much larger impact on access to care particularly if the area already has a high population to physician ratio. Psychiatrists in Wisconsin as a whole are older than the average for all Wisconsin physicians. Combined with the severe current shortages in many areas of the state, and the low numbers of young physicians entering residency training programs in psychiatry over the last several years, retirements in the next decade are likely to make access to mental health services in many areas of Wisconsin even more difficult than at present. Projected Psychiatrist Retirement, by Region Region Population1 WI-‐based Psychiatrists

under age 65 as of 1-‐1-‐12 Psychiatrists reaching age 65 between 2012 and 2016 (5 yrs) 2021 (10 yrs) 2026 (15 yrs)

Green Bay 428,055 26 5 9 11 Sheboygan 196,867 16 1 5 7 Appleton 293,325 22 -‐ 3 10 Oshkosh 162,242 15 6 7 12 Fond du Lac 172,043 9 3 3 5 Milwaukee 1,328,682 185 27 61 97 Waukesha 274,040 31 3 8 14 Southeast 469,599 25 5 11 16 Madison 667,420 142 18 46 64 Janesville 246,150 16 3 7 12 Southwest 66,166 2 -‐ -‐ -‐ La Crosse 290,009 29 1 11 14 Eau Claire 352,965 21 2 9 13 West Central 174,159 5 -‐ -‐ 3 Superior 69,465 2 -‐ 1 1 Rhinelander 114,310 6 1 2 2 Wausau 381,489 30 6 11 16 Statewide totals 5,686,986 582 81 194 297 Projected Psychiatrist Retirement, by Service Area Type Service Area Type Service Area

Population1 WI-‐based Psychiatrists under age 65 as of 1-‐1-‐12

Psychiatrists reaching age 65 between 2012 and 2016 (5 yrs) 2021 (10 yrs) 2026 (15 yrs

Type 1a: Metro, academic 647,023 194 29 (15%) 65 (34%) 94 (48%) Type 1b: Metro, all other 2,990,734 300 38 (13%) 96 (32%) 156 (52%) Type 2: Other Urban 555,454 31 4 (13%) 13 (42%) 18 (58%) Type 3: Mixed-‐L, hub > 10,000 232,775 21 6(29%) 9 (43%) 13 (62%) Type 4: Mixed-‐M, hub <10,000 211,040 7 1 (14%) 2 (29%) 2 (29%) Type 5: Rural-‐M, hub >2500 775,372 21 2 (10%)) 5 (24%) 9 (43%) Type 6: Rural-‐S, hub < 2500 274,588 8 1 (12%) 4 (50%) 5 (62%) ALL METRO & URBAN (74% of pop) 4,193,211 525 71 (13.5%) 174 (33%) 268 (51%) ALL MIXED (8% of pop) 443,815 28 7 (25%) 11 (39%) 15 (54%) ALL RURAL (18% of pop) 1,049,960 29 3 (10%) 9 (31%) 14 (48%) STATEWIDE TOTAL 5,686,986 582 81 (14%) 194 (33%) 297 (51%) 12010 U.S. Census Projected retirement rates: Assuming a 35 year career beginning at age 30 and an even age distribution across all age groups, for the state as a whole the expected percent of individuals reaching age 65 would be as indicated below. Higher rates are bolded in the table. Note that service areas with less than 7 psychiatrists could not have a consistent 5 yr retirement rate, even under ideal circumstances. 5/35 = 14% 10/35 = 29% 15/35 = 43%



ADDITIONAL INFORMATION ON PSYCHIATRISTS ACTIVE IN WISCONSIN Source: 2011/12 Wisconsin Physician Survey

The 2011/12 Wisconsin Physician Survey was conducted in conjunction with required biennial MD and DO license renewal from September 2011 through February 2012. The survey itself was not required, but each individual renewing the license was directed to the survey. The overall response rate was 29%. More psychiatrists completed the survey than was typical for the physician population as a whole, with a response rate of 37%. In order to assess the quality of the survey sample, it was compared to information from a variety of other sources, including American Association of Medical Colleges (AAMC) workforce reports, the American Medical Association (AMA) website, and information provided by the Wisconsin Medical Society from its member database. A data set for all Wisconsin licensed physicians drawn at the same time made it possible to make a direct comparison on the key variables of age, gender, specialty, medical school and current location. Responses were determined to be broadly representative of the Wisconsin physician population as a whole, with a few exceptions: compared to the total Wisconsin physician population, the response rate was slightly higher for women physicians, primary care physicians and psychiatrists; the response rate for surgeons, international medical graduates and physicians age 40-‐59 was slightly lower; and survey participation was slightly lower in the western and west central regions. The proportion of Wisconsin medical school graduates was about the same in the survey sample as in the physician population as a whole. To compensate for potential over-‐ or under-‐sampling of physicians with certain characteristics, survey results were weighted for age, gender, specialty and location. The weighting method used does not assume independence across variables, but looks at their joint probability distribution. For the full report on the survey, and technical notes on the weighting procedure, see the October 2012 Wisconsin Physician Workforce Report available at www.ahec.wisc.edu/workforce . The population of psychiatrists active in person in Wisconsin in 2012 is estimated to be 757, including 731 with an address of record in Wisconsin and 26 with an address in another state. Of these, an estimated 682, or 91%, were providing patient care.

Additional Demographic Information for Psychiatrists Active in Wisconsin Race/Ethnic/Cultural Heritage (unweighted)

American Indian or Alaskan Native 1.5%

Asian:

East Asian (origins in Japan, China or Korea) 1.9%

South Asian (origins in India or Pakistan) 5.6% Southeast Asian (origins in Thailand, Cambodia, Laos,

Vietnam, Burma/Myanmar, Malaysia) 0.4% Filipino 3.7%

Other Asian 1.1%

Black or African American 0.7%

Hispanic, Latino 1.9%

Native Hawaiian or other Pacific Islander

White 83.5%

Other 1.5%

Able to communicate with patients in language other than English? (unweighted)

Yes 24.7%

Detail, as % of those responding “yes”:

American sign language

North American Indian language

Spanish 21.7%

Other European languages 37.7%

Asian languages 17.4% African languages 1.4%

Arabic 1.4%

Hindi 21.7%

All other 13.0%

Citizenship status

Native born U.S. citizen 82.6%

Naturalized U.S. citizen 14.9%

Permanent Resident] 2.5%

Temporary (H-‐1B) or Exchange (J-‐1) visa

Other

Where first licensed

Wisconsin 41.3%

another state 57.9%

NR 0.9%

Where attended high school (multiple response item)

Wisconsin 31.4%

Another state 54.7%

Another country 14.1% Size of hometown community

town or city < 50,000 37.9%

suburb in metro area 20.1%

city 50,000-‐500,000 19.9%

large city (> 50,000) 21.6%

nr 0.5%



Medical Residency Training for Psychiatrists Active in Wisconsin Location of initial residency training position: All psychiatrists in Wisconsin

Completed residency program in Wisconsin 42.6%

Completed residency program in another state 50.0%

Residency program in Canada 0.9%

In another country 1.5%

no response 5.0% Graduates of MCW & UWSMPH only (30.2% of those currently practicing in WI)

Completed residency program in Wisconsin 68.6% Completed a residency program outside the state and

returned to Wisconsin to practice 30.6%

Portion of all psychiatrists practicing in WI who completed both UME and GME in Wisconsin 21.0%

Initial medical residency

Family Medicine 1.6%

Internal Medicine 1.7%

Internal Medicine-‐Peds 0.2%

Neurology 0.3%

Pediatrics 1.8%

Psychiatry 92.9%

Surgery 0.5%

Other 0.3%

Did not complete 0.0%

none listed 0.5%

Current Status, Work Setting and Practice Specialty for Psychiatrists Active in Wisconsin Current status

Provide patient care in WIsconsin

full time 71.9%

part time 18.3% Provide pt care via telemedicine from location outside

the state

full time

part time 0.4%

Working in WI, but not providing pt care

full time 0.6%

part time 1.2%

Providing pt care in another state

full time 1.2%

part time

Physician in WI, but not active in medicine 0.3%

Other, not counted as patient care 0.7%

Not currently active 5.3%

Principal work setting

Hospital 32.5%

Office 44.4%

Residential facility 6.8%

Teaching, research, other 10.9%

Does not apply-‐not currently active 5.3%

Principal practice specialty

Psychiatry 21.4%

Psychiatry-‐Adult 57.6%

Psychiatry-‐Child & Adolescent 16.0%

Psychiatry-‐Geriatric 2.2%

Psychiatry-‐Other 2.0%

Addiction Medicine 0.5%

General Internal Medicine 0.3% Percent patient care time in principal specialty (if Psychiatry)

none 0.5%

20% or less 1.3%

25% -‐ 40% 1.1%

45%-‐60% 7.3%

65%-‐80% 11.0%

85% or more 69.5%

not applicable-‐no patient care 7.7%

nr 1.7% Practicing as a hospitalist (acutely ill hospitalized patients only)?

Yes 13.5%



Practice Locations of Psychiatrists Active in Wisconsin Number of practice locations in Wisconsin

1 50.4%

2 21.5%

3 8.0%

4 4.5%

5 1.7%

more than 5 2.4%

no response/no patient care 11.4% Do you also provide patient care in another state?

Yes, but only via telemedicine 2.8%

Yes, in person 3.6%

Both in person and via telemedicine 0%

No 83.3%

no response/no patient care 10.2%

Do you personally provide mental health services in the outpatient setting at any of your practice locations?

Yes 71.4% of all psychiatrists

79.2% of psychiatrists providing patient care Number of practice locations for psychiatrists providing care in the outpatient setting (71.4% of all psychiatrists)

1 48.0%

2 23.6%

3 8.9%

4 5.2%

5 1.5%

6 2.5%

nr 10.2%

Principal Practice Setting Principal practice setting

Non-‐federal hospital and adjacent outpatient clinics 31.0% VA or military hospital and associated outpatient

facilities 9.0% Free standing clinic/health center/urgent care

clinic/ambulatory surgery center 15.1%

Individual private practice 12.1% Nursing home or other non-‐hospital extended care

facility 2.9%

Correctional facility 3.8% State/local health dept or other public/community

health setting, including free clinics 15.3%

Other 9.5%

no response 1.2% Clinical setup at principal practice setting

Single physician practice 13.4% Single physician practice that shares expenses with

other physician practices 2.7%

Single specialty group practice 30.0%

Multi-‐specialty group practice 32.1%

Locum Tenens 0.2%

Other (specify) 19.7%

no response 2.1% Are any of the following advanced practice providers a part of your practice group at this location? (multiple response item)

PA 21.7%

NP 42.0%

CNM 5.2%

Are you a salaried employee at your principal practice location?

Not a salaried employee 25.9%

Salaried employee with a practice I own or co-‐own 5.4% Salaried employee with a corporation or practice that I

do not own 14.9%

Salaried employee of a managed care organization 1.6%

Salaried employee of a hospital 13.8%

Salaried employee of a university or teaching institution 8.2%

Federal employee 8.1%

State government employee 12.0%

Salaried employee of another type of organization 7.3%

no response 2.8% Number of physicians at this practice location

1 physician 19.0%

2-‐5 physicians 22.3%






More than 100 14.5%

no response 1.6% Do you also provide medical oversight through a collaborative agreement with a physician assistant or nurse practitioner-‐managed practice at another location?

Yes 5.9%



Other Professional Activities Other professional activities (multiple response item)

Research 8.0%

Teaching-‐classroom 15.8%

Teaching-‐clnical setting 37.5%

Administration in a private practice 5.9% Administration in a medical school, hospital, health

plan, nursing home 16.9%

Medical examiner 0.4%

Board of health 0.3%

Medical adviser to public or community heath agency 7.1%

Other 7.7%

None of the above 0.5%

Hours/week in these other activities during past 12 months?

Total hours in other professional activities 4063

Psychiatrists providing patient care 682

Average hours/week other activities 7 hrs (from page 3)

Average hours/week patient care 42 hrs

Average total hours/week for psychiatrists providing patient care 49 hrs

Future Plans

PSYCHIATRISTS CURRENTLY PROVIDING PATIENT CARE IN WISCONSIN (91% of all psychiatrists active in WI) How much longer are you planning to maintain your patient care practice ?

Less than 2 years 1.2%

2-‐5 years 17.1%

6-‐10 years 17.7%

11-‐15 years 18.0%

16-‐20 years 15.3%

21-‐25 years 11.2%

26-‐30 years 11.4%

More than 30 years 7.7%

nr 3.1%

Plans for pt care practice in next two years (multiple response item)

Continue patient care at current level of activity 86.8%

Increase patient care hours 2.8%

Significantly reduce patient care hours 5.3%

Temporarily stop providing patient care in WI 0.3%

Retire with the next 2 years 0.6%

Relocate to a different practice in WI 2.0%

Relocate to a practice outside WI 2.6%

Other/uncertain 2.4%

nr

PSYCHATRISTS WHO ARE PROFESSIONALLY ACTIVE IN WISCONSIN, BUT NOT PROVIDING PATIENT CARE (3% of WI psychiatrists) Current place of employment

Patient care facility 46.7%

State or local health dept or other government agency 7.3%

University academic or research facility 4.5%

Healthcare business or corporation 22.0%

Non-‐healthcare business or corporation

Other 9.0%

Locum tenens 10.5%

Plan to provide pt care in WI in the future?

Currently seeking a position 10.5%

Plan to return within next 2 years

Plan to return withing next 5 years

Plans are uncertain 58.8%

Not planning to return to patient care in WI 30.7%

PSYCHIATRISTS WHO ARE WISCONSIN-‐BASED, BUT NOT CURRENTLY ACTIVE IN MEDICINE (6% of WI psychiatrists) If not currently active, indicate work status

Retired 60.6%

Permanently disabled

Working in another field & no plans to return

unemployed, seeking work in medicine

unemployed, seeking work in another field

Taking time out & planning to return* 32.4%

*When planning to return to practice Currently seeking a position 16.8%

Return within 2 years 69.6%

Return within 5 years

Plans uncertain 13.6%

* Planning to return to practice in WI? Plan to return to patient care in WI 83.2%

Plan to return to WI, but not to patient care

No immediate plans to return to WI 16.8%



Psychiatrists maintaining a Wisconsin license, but not residing or providing care in person in the state

Of the 323 psychiatrists licensed by Wisconsin in 2012 who had a DSPS mailing address in another state, an estimated 8% were actually providing patient care in Wisconsin. Of the remaining 297, survey results indicate that about 10% are retired and the remaining 90% are professionally active. Compared to psychiatrists in Wisconsin, these out-‐of-‐state psychiatrists are less likely to have graduated from high school in Wisconsin, less likely to have graduated from UWSMPH or MCW, and more likely to have completed a residency outside the state. The out-‐of-‐state group is slightly more diverse, with 3.6% Hispanic/Latino and 21% non-‐white (compared to 2% Hispanic and 16% non-‐white for psychiatrists in Wisconsin). There is a higher proportion of males in this group (70% compared to 64% for Wisconsin). The psychiatry specialty mix is about the same as the Wisconsin group, but the out-‐of-‐state group is more likely to be employed in a state or local health department or government agency. A higher proportion of the out-‐of-‐state psychiatrists indicate they have a hospital-‐based acute care practice . The average age is about the same, and in all other respects, the out-‐of-‐state group is similar to those practicing in Wisconsin.

Current status

Provide patient care in another state:

full time 67.8%

part time 18.2%

Not currently active 11.5%

Provide care for patients in WI via telemedicine from location outside the state:

full time 0.9%

part time 1.6% Principal work setting

Hospital 34.7%

Office 43.7%

Residential facility 1.9%

Teaching, research, other 19.7% Practicing as a hospitalist (acutely ill hospitalized patients only)?

Yes 25%

Current place of employment

Patient care facility 50.5%

State or local health dept or other govt agency 19.1%

University academic or research facility 3.9%

Healthcare business or corporation 4.9%

Non-‐healthcare business or corporation

Other 21.6% Plan to provide pt care in WI in the future?

Currently seeking a position 4.1%

Plan to return within next 2 years 2.9%

Plan to return withing next 5 years 2.6%

Plans are uncertain 60.2%

Not planning to return to patient care in WI 28.7%

nr 1.5% Trained in Wisconsin?

Completed undergraduate medical education at UW or MCW 20.7%

Completed residency training in Wisconsin 31.7%

Completed both UME and GME in Wisconsin 7.7%

Background on the Wisconsin Physician Survey The 2011/12 Wisconsin Physician Survey was funded with a State Health Care Workforce Development (SHCWD) planning grant from the Bureau of Health Professions/HRSA/DHHS. The grant was awarded to the Area Health Education Centers (AHEC) program at the University of Wisconsin School of Medicine and Public Health, in partnership with the Department of Workforce Development (DWD). Nancy Sugden, Assistant Dean at the UWSMPH and Director of the Wisconsin AHEC program served as Principal Investigator. The Wisconsin Medical Examining Board approved implementation of the survey as part of the 2011-‐12 MD and DO license renewal process. DWD and the Department of Safety and Professional Services (DSPS) coordinated implementation of the survey, using an outside vendor (Chamberlain Research Consultants) to program and host the survey online. The Office of Economic Advisors at DWD serves as custodian of the data. Any conclusions or interpretations set forth in this paper do not necessarily reflect the interpretation or opinion of the Department of Workforce Development or the Office of Economic Advisors.

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