Labor Markets and Healthcare Workforce
Paper Session
Saturday, Jan. 6, 2024 10:15 AM - 12:15 PM (CST)
- Chair: David Mitchell, Ball State University
Medical Residency Subsidies and Provider Supply
Abstract
Funding for graduate medical education (GME) is one way by which the federal government can influence physician labor supply across specializations and geographies. Changes to Medicare GME payments are an oft-proposed solution to the growing issues of primary care and rural physician shortages. Still, there is little empirical evidence that GME subsidies affect teaching hospitals’ use of medical residents or area-run physician supply. In this paper, we quantify the impact of an increase in GME payments on residency program size and area-level primary care physician (PCP) supply by examining the impact of Section 5503 of the Affordable Care Act, which increased the number of residents that teaching hospitals in in rural and high need areas could receive subsidies for training. Instrumenting for selection into the program using its published eligibility and allocation criteria, we find that the funding increase resulted in an increase of hospitals' resident-to-bed ratios of 6.5 residents per 100 beds on average. We also find that the funding increase resulted in an increase in primary care physician supply of 0.59 PCPs per ten thousand persons in treated counties, implying a retention rate of approximately 60 percent.The Evolving Healthcare Workforce: Keys to Access to Care
Abstract
ebates over access to healthcare often focus on access to health insurance or government programs that mirror health insurance. However, access to healthcare necessarily requires access to healthcare providers. This paper explores the evolution of the healthcare workforce, with a focus on professions that deliver a full range of healthcare (as opposed to specialists like podiatrists or respiratory therapists). Over the last decade, the nurse practitioner (NP) and physician assistant (PA) professions have grown faster than the medical profession. However, these growth patterns have not been uniform across the United States with some areas of the country having greater access to NPs than PAs and vice versa. This differential access matters for the delivery of care because different laws govern the practices of NPs and PAs. Examining comprehensive data on the locations of NPs, PAs, MD-prepared physicians, and DO-prepared physicians, this paper details changes in the healthcare workforce over the last decade. It demonstrates that some areas of the country rely more heavily on NPs than PAs (and vice versa). It also demonstrates that, in some parts of the country, NPs and PAs outnumber physicians and therefore represent the primary profession providing care to patients. Understanding these emerging patterns in the evolution of the healthcare workforce will be key to formulating healthcare law and policy over the next decade as policymakers seek to deploy healthcare professionals where they are needed most.Returns to Physician Sub-Specialization and Multi-Specialty Practices
Abstract
Historically, physician practices have been organized around specific medical specialties. In recent years, there has been a documented shift towards consolidation into large, multi-specialty practices in response to a variety of healthcare quality and reimbursement regulations, as well as a desire to increase negotiation leverage with commercial insurers. This has occurred simultaneously with trends towards higher investment in individual physician human capital through increased sub-specialization within traditional medical specialties. This study examines the effect of these two changes on physicians' average reimbursement per patient using a difference-in-differences framework that exploits physician movements from sole-specialty to multi-specialty practices using detailed individual-level physician data that allows us to identify physician's affiliated practices and directly quantify the degree of physician sub-specialization and individual allocation between low and high skill procedures. These results will help disentangle the returns to advanced human capital formation in physicians from the returns to greater team-based care attributed to multi-specialty practices and help policy makers address projected shortages of primary care and generalist specialty providers.Discussant(s)
Daniel Dench
,
Georgia Institute of Technology
Jose Fernandez
,
University of Louisville
Tingting Zhang
,
University of Illinois-Urbana-Champaign
JEL Classifications
- J3 - Wages, Compensation, and Labor Costs
- J1 - Demographic Economics