By Thomas A. Lerner
The Washington Medical Commission conducted a census of Washington licensed physicians over a 2 year period, and published its results this spring. While no survey yields a 100% response rate, the Commission timed their inquiry with license renewals and then followed up approximately 3-4 weeks afterwards with those who had not responded. About 40% of those who received the follow up inquiry submitted responses. The comments below summarize some of the highlights from the census.
Almost 15,400 licensed physicians are actively practicing in Washington. 88% of Washington physicians are Board certified. The largest cohort among currently active practitioners is in the “echo generation” which followed the baby boomers. 44% of that generation of physicians are women, while 54% of the physicians born after 1983 are women. This is a sharp acceleration of a trend that has been increasing over prior generations.
If you have the sense that independent practices are on the decline, the survey supports that impression. Only 8% of physicians report being solo practitioners. 45% of active physicians are employed by a hospital, a clinic or the state or federal government. 26% practice in single specialty groups and 23% practice in multi-specialty groups. The multi-specialty groups tend to be quite large. Only about 20% sponsor Physician Assistants. The data suggests that there is an opportunity for physicians—particularly those working the hardest—to make more use of physicians assistants.
40% of active physicians practice in more than one location. 62% work more than 100 hours per month, and 16% work more than 200 hours per month. For context, a 40 hour work week averages 180 hours per month. 55% report spending about 30 hours or less per week on administrative tasks, and only 3% report spending more time than that.
About three quarters of Washington physicians practice general medicine, with internal medicine representing over one-third of that number, followed by family medicine and pediatrics. Surgeons represent the next largest category.
Most physicians accept Medicare and Medicaid patients, but about a quarter didn’t know the answer to that question. (One assumes that they are not the ones burdened with the heaviest administrative load). The State Insurance Commissioner has identified about 40 direct health care practices, almost all of which are west of the Cascades. A “direct health care” practice, sometimes referred to as “concierge practices”, charge a monthly fee and in return provides unlimited access to doctors for primary-care services. Direct health care practices are required to be registered with the Insurance Commissioner.
About half of Washington’s physicians are in King County, although only about 30% of the State’s population live here. This is consistent with the concentration of physicians in counties with Washington’s largest population centers. The Commission sorted its data into four regions across the state, and it is easy to see the impact of the urban concentration of physicians in cities.
In the dozen counties in Eastern Washington, there are about 500 people per physician. If you exclude Spokane County, there is one physician for every 700 people in the rest of Eastern Washington. In Central Washington, the disparity is less. In these 8 counties, there are 610 people per physician. If you exclude the population centers of Yakima and Benton counties, the number rises to 660 people per doctor. Western and Southwestern Washington (excluding the Puget Sound counties north of Thurston County) are well served with 380 people per physician. But if you drop Thurston and Clark County from the calculation, each doctor has 605 potential patients. The 7 counties that make up the Puget Sound region and north average 396 people per doctor. King County (not surprisingly) has the densest concentration of physicians with 303 people per physician. If you exclude King County from the analysis, from the Snohomish County line to the Canadian border is home to 580 people per physician. If you are feeling oppressed by competition, housing costs or traffic, the answer is clear—get out of town! The rest of the state needs you.
Skamania and Wahkiakum Counties, along the Columbia River in southwest Washington each have 3 physicians, or about 1500 people for each doctor. But let’s tip our caps to the one physician—yes, one—in all of Garfield County (in southeastern Washington), taking care of 2200 people. Perhaps not surprisingly, that physician practices emergency medicine.
The experience of Washington physicians in the past twenty years suggests that all of this data are points on a trend line. Consolidation of health care has been the big story for physicians, as larger institutions roll up formerly free standing ones, like The Everett Clinic, Northwest Hospital and The Polyclinic. That has implications for employment and the prospect for maintaining independence in your practices. But the data is also revealing of opportunities for those ready to shift directions away from the trends of concentration and urbanization. One doesn’t need to go far to find under served communities in need of more providers.
Thomas Lerner is an attorney with Stokes Lawrence, P.S. in Seattle, and regularly represents physicians on business and employment matters. He can be reached at Tom.Lerner@stokeslaw.com or 206-626-6000.