The Cost of Losing a PhysicianThe Cost of Losing a Physicianin a Rural Communityin a Rural Community
ByByGerald A. DoeksenGerald A. Doeksen
Regents Professor and DirectorRegents Professor and DirectorNational Center for Rural Health National Center for Rural Health
WorksWorksPresentation at Hawai’i State Office of Rural Health Meeting, “Achieving Quality Through Change,” October 24-26, 2007,
Waikoloa, Hawai’i
H
W Rural Health WorksR National Center for
Objectives:Objectives:I.I. To provide three tools useful in To provide three tools useful in
measuring physician needs and impacts measuring physician needs and impacts on a Local Economyon a Local Economy
1)1) Estimate the number of primary care Estimate the number of primary care physicians a rural area can supportphysicians a rural area can support
1)1) Estimate the economic impact of a Estimate the economic impact of a rural physician on local economyrural physician on local economy
1)1) Project needs for specialists in a rural Project needs for specialists in a rural areaarea
II.II. To estimate economic impact of Kaua’i To estimate economic impact of Kaua’i Veterans Memorial Hospital & West Veterans Memorial Hospital & West Kaua’i Clinics on local economyKaua’i Clinics on local economy
1)1) Estimate the number Estimate the number of primary care of primary care physicians a rural physicians a rural area can supportarea can support
I.I. To provide three tools useful in To provide three tools useful in measuring physician needs and impacts measuring physician needs and impacts on a Local Economyon a Local Economy
TotalAge Population Visit Rate Visits Population Visit Rate Visits Visits
Under 15 882 2.5 2,205 833 2.4 1,999 4,20415-24 782 1.2 938 751 2.2 1,652 2,59025-44 1,270 1.5 1,905 1,203 3.2 3,850 5,75545-64 1,089 3.3 3,594 1,135 4.2 4,767 8,36165-74 310 6.0 1,860 357 6.4 2,285 4,14575+ 207 7.7 1,594 319 7.1 2,265 3,859Total 4,540 12,096 4,598 16,818 28,914
Local Primary Care Physician Office Visits (58.9%) 17,030
Male Female
Annual Primary Care Physician Office VisitsGenerated in the Example Medical Service Area
PRIMARY MEDICAL SERVICE AREA
Usage Level 70% 80% 90% 100%
Primary Care Visits 11,921 13,624 15,327 17,030
Number of Primary Care Physicians 2.4 2.8 3.1 3.5
Primary Care Physician Shortage 0.4 0.8 1.1 1.5
Primary Care Physician Office Visits and PhysicianShortages for Different Local Usage by Residents
in the Example Medical Service Area
2)2) Estimate the economic Estimate the economic impact of a rural impact of a rural physician on local physician on local economyeconomy
I.I. Three tools useful in measuring physician Three tools useful in measuring physician needs and impacts on a Local Economyneeds and impacts on a Local Economy
Physician Office ImpactsPhysician Office Impacts
EmploymentEmployment 4 4
Wages, Salaries and Wages, Salaries and BenefitsBenefits
$287,000$287,000
Total Clinic RevenueTotal Clinic Revenue $394,000$394,000
Physician Impact onPhysician Impact onLocal Hospital Inpatient & Outpatient Local Hospital Inpatient & Outpatient
Visits,Visits,Employment, and Wages, Salaries & Employment, and Wages, Salaries &
BenefitsBenefits
No. of Inpatient VisitsNo. of Inpatient Visits 134134
Inpatient RevenueInpatient Revenue $457,000$457,000
Outpatient RevenueOutpatient Revenue $295,000$295,000
Total Hospital RevenueTotal Hospital Revenue $752,000$752,000
EmploymentEmployment 1313
Wages, Salaries, and Wages, Salaries, and BenefitsBenefits
$435,000$435,000
Summary of Physician ImpactSummary of Physician Impactfrom Clinic and Hospital Activitiesfrom Clinic and Hospital Activities
EmploymeEmploymentnt
Wages, Salaries, Wages, Salaries, and Benefitsand Benefits
TotalTotalRevenueRevenue
ClinicClinic 44 $287,000$287,000 $394,000$394,000
HospitalHospital 1313 $435,000$435,000 $752,000$752,000
TotalTotal 1717 $722,000$722,000$1,146,00$1,146,00
00
EstimateSecondary
Impacts
Households
Industry
Basic
ServicesGoods &
$
Inputs
Products
Inputs
$ $
$
$
Services
$ $
Labor
Community Economic System
EmploymentEmployment
Multiplier Total Impact
Clinic 4 1.38 6Hospital 13 1.38 17Total 17 23
Wages, Salaries, and Benefits
Income Multiplier Total Impact
Clinic $287,000 1.16 $333,000Hospital $435,000 1.28 $556,000Total $722,000 $889,000
RevenueOutput
Multiplier Total Impact
Clinic $394,000 1.37 $540,000Hospital $752,000 1.32 $993,000Total $1,146,000 $1,533,000
Total Physician Impact
IN SUMMARYIN SUMMARY
ONE RURAL PHYSICIAN GENERATES:ONE RURAL PHYSICIAN GENERATES:
2323 JOBSJOBS
$889,000$889,000 WAGES, SALARIES & WAGES, SALARIES & BENEFITSBENEFITS
$1,533,000$1,533,000 TOTAL REVENUETOTAL REVENUE
THIS IS A HUGE IMPACT
3)3) Project needs for Project needs for specialists in a rural specialists in a rural area:area:
I.I. Three tools useful in measuring physician Three tools useful in measuring physician needs and impacts on a Local Economyneeds and impacts on a Local Economy
Estimate Medical Specialty Estimate Medical Specialty Physician Service NeedsPhysician Service Needs
Estimate Surgical Specialty Estimate Surgical Specialty Physician Service NeedsPhysician Service Needs
Example ApplicationExample Application
Need for Need for Medical Specialty Physician Medical Specialty Physician
ServicesServicesMedical SpecialtyMedical Specialty Population/Physician Population/Physician
RatioRatio
AllergyAllergy 94,00094,000
CardiologyCardiology 26,00026,000
GastroenterologyGastroenterology 41,00041,000
Hem/OncologyHem/Oncology 47,00047,000
NephrologyNephrology 65,00065,000
NeurologyNeurology 41,00041,000
PulmonaryPulmonary 59,00059,000
RheumatologyRheumatology 86,00086,000
Need for Need for Surgical Specialty Physician Surgical Specialty Physician
ServicesServicesSurgical SpecialtySurgical Specialty Population/Physician Population/Physician
RatioRatio
ENTENT 35,00035,000
GeneralGeneral 13,00013,000
Ophthalmology Ophthalmology 27,00027,000
OrthopedicOrthopedic 17,00017,000
UrologyUrology 34,00034,000
Example of Example of Medical Specialty Physician Services Medical Specialty Physician Services
based on Market Service Population of based on Market Service Population of 9,1389,138
Medical SpecialtyMedical Specialty Number of Specialists Number of Specialists (FTEs)(FTEs)
AllergyAllergy .10.10CardiologyCardiology .36.36GastroenterologyGastroenterology .22.22Hem/OncologyHem/Oncology .20.20NephrologyNephrology .14.14NeurologyNeurology .22.22PulmonaryPulmonary .16.16RheumatologyRheumatology .11 .11
Surgical SpecialtySurgical Specialty Number of Specialists Number of Specialists (FTEs)(FTEs)
ENTENT .08.08GeneralGeneral .62.62OphthalmologyOphthalmology .35.35OrthopedicOrthopedic .48.48UrologyUrology .24.24
Example of Example of Surgical Specialty Physician Services Surgical Specialty Physician Services based on Market Service Population of based on Market Service Population of
9,1389,138
Estimated Days Per WeekEstimated Days Per Week
% FTE% FTE
.10.10
.20.20
.30.30
.40.40
.50.50
.60.60
Days/Days/weekweek
1/21/2
11
1 1/21 1/2
22
2 1/22 1/2
33
Example PhysicianExample PhysicianSpecialty Clinic ScheduleSpecialty Clinic Schedule
SpecialistSpecialist
General SurgeonGeneral Surgeon
Orthopedic Orthopedic SurgeonSurgeon
CardiologistCardiologist
OphthalmologistOphthalmologist
UrologistUrologist
Days per WeekDays per Week
33
2 1/22 1/2
1 1/21 1/2
1 1/21 1/2
11
II.II. To estimate the To estimate the economic impact of economic impact of Kaua’i Veterans Kaua’i Veterans Memorial Hospital and Memorial Hospital and West Kaua’i Clinics on West Kaua’i Clinics on the local economythe local economy
Medical Service Area
Kauai Veterans Memorial Hospital and West Kauai Clinics
Zip CodeZip Code
Area2000
Census2000 ESRI
2006 ESRI
% Chg
2011 ESRI
% Chg
96705 Eleele 1,955 2,161 2,353 2,478
96716 Hanapepe 2,475 2,649 3,032 3,245
96741 Kalaheo 6,277 5,299 5,660 5,918
96747 Kaumakani 607 542 555 572
96752 Kekaha 2,930 3,231 3,330 3,437
96765 Lawai n/a n/a n/a n/a
96769 Makaweli 638 638 622 636
96796 Waimea 2,205 1,663 1,725 1,781
17,087 16,183 17,277 6.8% 18,067 4.6%
Medical Service Areas by Zip Code Population for
Populations
Total MSA
Kauai Veterans Memorial Hospital
Indicator Kauai County State of Hawai'i United States
Per Capita Income (2005) $29,101 $34,489 $34,471
Unemployment Rate (2006) 2.3% 2.4% 4.6%
Unemployment Rate (July 2007) 2.8% 2.9% 4.9%
% of All People in Poverty (2004) 8.6% 9.0% 12.7%% of Under Age 18 in Poverty (2004) 10.4% 10.8% 17.8%
Transfer Dollars as Percentage ofTotal Personal Income (2005)
Economic Indicators for Kauai County, the State of Hawaii, and the Nation
16.7% 12.8% 14.9%
Dollars % of Dollars % of Employment Categories ($1,000) Total ($1,000) Total
Total transfer payments ($1,000) 302,946 100.0% 5,603,084 100.0% Govt payments to individuals 290,780 96.0% 5,363,384 95.7% Ret & disab ins benefit pymts 114,592 37.8% 2,202,523 39.3%
Medical pymts 131,753 43.5% 2,191,382 39.1% Medicare 48,622 16.0% 1,032,782 18.4% Public assist medical care 82,508 27.2% 1,129,486 20.2% Military medical ins pymts 623 0.2% 29,114 0.5%
Income maint benefit pymts 30,322 10.0% 632,192 11.3% Unemp ins benefit pymts 5,332 1.8% 93,217 1.7% Vtrns benefit pymts 7,513 2.5% 196,847 3.5%
State of Hawai'i
Transfer Payments (NAICS) for Kaua'i County and State of Hawai'i, 2005
Kaua'i County
Health Total Full-Time Income
Sector & Part-Time (Payroll plus Benefits)
Component Employment
West Kauai Medical Center 156 $10,716,639
Physician Clinics 38 $1,886,861
Other Medical and Health Services 31 $2,174,668
Total Direct Economic Activities of Kauai Veterans Memorial Hospital and West Kauai Clinics 225 $14,778,168
Direct Economic Activities
of the Kauai Veterans Memorial Hospital and West Kauai Clinics, FY 2007
CommunityEconomic
System
Households
Industry
Basic
ServicesGoods &
$
Inputs
Products
Inputs
$ $
$
$
Services
$ $
Labor
Health Care Number of Employment Secondary Total
Entity Employees Multiplier Impact Impact
West Kauai Medical Center 156 1.38 59 215
Physician Clinics 38 1.42 16 54
Other Medical and Health Services 31 1.42 13 44
Totals 225 88 313
Employment Impact of Health Services
of Kauai Veterans Memorial Hospital and West Kauai Clinics, HI 2007
Health Care Income Secondary TotalComponent Income Multiplier Impact Impact
West Kauai Medical Center 10,716,639 1.24 $2,571,993 $13,288,632
Physician Clinics 1,886,861 1.18 $339,635 $2,226,496
Other Medical and Health Services 2,174,668 1.31 $674,147 $2,848,815
Totals $14,778,168 $3,585,775 $18,363,943
Income Impact of Health Servicesof Kauai Veterans Memorial Hospital and West Kauai Clinics, HI 2007
Other CAH Hospital Other CAH Hospital StudiesStudies
KaKa u Hospital in Pahala, Hawaiu Hospital in Pahala, Hawai i i County County
Hale HoHale Ho ola Hamakua in ola Hamakua in Honokaa, Hawaii CountyHonokaa, Hawaii County
Samuel Mahelona Memorial Samuel Mahelona Memorial Hospital in Kapaa, KauaHospital in Kapaa, Kaua i Countyi County
SummarySummaryI.I. Physician ModelsPhysician Models
1)1) Presented Model to Estimate Presented Model to Estimate Physician NeedsPhysician Needs
2)2) Presented Model to Estimate Presented Model to Estimate Impact of PhysiciansImpact of Physicians
3)3) Presented Model to Estimate Presented Model to Estimate Specialty Physician NeedsSpecialty Physician Needs
II.II. Economic impact of Kaua’i Economic impact of Kaua’i Veterans Memorial Hospital and Veterans Memorial Hospital and West Kaua’i ClinicsWest Kaua’i Clinics
Contact Information:
Gerald A. DoeksenRegents Professor and Director
National Center for Rural Health [email protected]
405-744-6083
National Center for Rural Health Works
www.ruralhealthworks.orgwww.ruralhealthworks.org
H
W Rural Health WorksR National Center for
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