The Association of American Medical Colleges estimates that by 2020, there will be a shortage of more than 90,000 physicians, split evenly between primary care physicians and specialists. Data from the U.S. Census Bureau indicate that there are already many geographic regions within Michigan that are facing physician shortages as well as some low income and migrant farm workers around that state that are unable to access care. At the same time that baby-boomer aged physicians and health care professionals begin to retire, Michigan’s aging baby-boomers will demand more health care. And beginning in January 2014, 32 million more Americans will have health care through the federal Affordable Care Act; these newly insured populations will increase overall demand for health care services, especially those for general practitioners.
The current health care professional shortage is not as dramatic in Michigan compared to the national average. As measured by the number of physicians, registered nurses, and physician assistants per 100,000 population, Michigan is nearly average or near the national median. However, the number of nurse practitioners throughout the state is lower than average and the state has the 43rd most nurse practitioners per 100,000 in 2011.
The number of health professionals is perhaps not as important as where they practice and which populations they serve. By using the U.S. Department of Health and Human Services designation for primary care professional shortages areas, 18.2% of Michigan’s population has insufficient access to primary care. In order for a geographic region to be defined as a HPSA, there must be less than one full-time equivalent primary care provider for every 3,500 population. Compared to the rest of the country, Michigan has a smaller under-served population (10.2 percent, 28th highest).
Table 1. Primary Care Health Professional Shortage Areas (HPSAs), 2012A search on the Health Resources and Services Administration database of the United States Department of Health and Human Services reveals that 270 geographic primary medical care HPSAs exist in 16 of Michigan’s 83 counties.[i] Only 44 of the HPSA designations are outside of Wayne County; the majority of HPSAs are within census tracts in the city of Detroit. There are 215 population group HPSAs in 48 of Michigan’s counties. Low income groups are most impacted by primary care shortages followed by migrant farm workers.
Is the health care professional shortage as bad in Michigan as it is in the rest of the country? No. Is it something that policymakers should be concerned about? Yes. Because health care professionals require many years of training, particularly nurse practitioners, physicians assistants, and physicians, policymakers should be keeping tabs on the workforce, and geographic and population shortages, and be taking precautions now to ensure that all residents in the state have access to necessary health care. CRC’s new paper Health Care Costs in Michigan: Drivers and Policy Options discusses in more detail the implications of and solutions to health care professional shortages in Michigan.