Where Have All the Doctors Gone? A Short Summary of the Census of Washington Physicians
Independent practices are on the decline. 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 multispecialty groups. The multispecialty groups tend to be quite large. Only about 20% sponsor Physician Assistants. The data suggests that there is an opportunity for physicians 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 a 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 seven 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.
Skamania and Wahkiakum Counties, along the Columbia River in southwest Washington each have 3 physicians, or about 1,500 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 2,200 people. Perhaps not surprisingly, that physician practices emergency medicine.
The experience of Washington physicians in the past 20 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. 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 underserved communities in need of more providers.