Chartbook of Physicians in Ambulatory Settings in New York

Transcription

1 2015 Chartbook of Physicians in Ambulatory Settings in New York School of Public Health University at Albany, State University of New York

2 Chartbook of Physicians in Ambulatory Settings in New York August 2015 School of Public Health, University at Albany State University of New York 1 University Place, Suite 220 Rensselaer, NY Phone: (518) Web: chws@health.ny.gov

3 PREFACE This chartbook provides information on physicians working in ambulatory settings in New York in These data are presented statewide as well as by rural and urban location and by downstate (Long Island, New York City, Rockland County, and Westchester County) and upstate (remaining counties). This chartbook also includes counts of sites and physicians that accept Medicaid patients. This chartbook was prepared by the Center for Health Workforce Studies (CHWS), by Cassondra Bruce, Robert Martiniano, and Jean Moore, with layout design by Leanne Keough. Funding for this chartbook was provided by the New York State Department of Health. Established in 1996, CHWS is a not-for-profit research organization, based at the School of Public Health, University at Albany, State University of New York (SUNY). The mission of CHWS is to provide timely, accurate data and conduct policy relevant research about the health workforce. The research conducted by CHWS supports and promotes health workforce planning and policymaking at local, regional, state, and national levels. Today, CHWS is a national leader in the field of health workforce studies, and the only one uniquely focused on the oral health workforce. The views expressed in this chartbook are those of CHWS and do not necessarily represent positions or policies of the School of Public Health, the University at Albany, SUNY, or the New York State Department of Health. August 2015 ii Center for Health Workforce Studies

4 SUGGESTED CITATION Bruce C, Martiniano R, Moore J. Chartbook of Physicians in Ambulatory Settings in New York. Rensselaer, NY: Center for Health Workforce Studies, School of Public Health, SUNY Albany; August Chartbook of Physicians in Ambulatory Settings in New York iii

5 TABLE OF CONTENTS BACKGROUND...2 METHODS...3 FINDINGS...5 LIMITATIONS...7 iv Center for Health Workforce Studies

6 FIGURES AND TABLES Figure 1. Distribution of Ambulatory Sites in New York, Figure 2. Distribution of Physicians in Ambulatory Settings in New York, Table 1. Distribution of Sites and Physicians by Number of Physicians per Site...11 Table 2. Number of Sites and Physicians by Site Specialty...11 Table 3. Number of Physicians by Specialty...12 Table 4. Number of Physicians by Site Size and Specialty Table 5. Number of Sites and Physicians by Region...12 Table 6. Number of Sites by Site Specialty and County...13 Table 7. Number of Sites by Site Size and Specialty Table 8. Number and Percent of Physicians by Physician Specialty and Region...15 Table 9. Number of Physicians by Physician Specialty and County...15 Table 10. Percent of Ambulatory Sites and Physicians That Accept Medicaid Patients Table 11. Number and Percent of Sites and Physicians That Accept Medicaid Patients Across New York State Table 12. Number of Sites That Accept Medicaid Patients by County Chartbook of Physicians in Ambulatory Settings in New York v

7 BACKGROUND This chartbook provides information on physicians working in ambulatory settings accessible to the general public in New York in 2015, including counts of physicians and ambulatory sites. These data are presented statewide as well as by rural and urban location and by downstate (Long Island, New York City, Rockland County, and Westchester County) and upstate (remaining counties). This chartbook also includes counts of sites and physicians who accept Medicaid patients. This chartbook categorizes sites by services provided, including: Primary care Mental health Specialty care Multispecialty sites with primary care Multispecialty sites without primary care The Methods section describes in more detail how sites were identified for this analysis and provides definitions for the specialties and geographic categories used. 2 Center for Health Workforce Studies

8 METHODS Data presented in this chartbook were drawn from the SK&A Office-Based Physicians Database. a The original data set included 73,581 records representing practicing physicians and other medical office decisions makers, such as nurse practitioners, physician assistants, office managers, [and] medical directors in ambulatory settings across New York State. 1 The data were cleaned to remove nonphysician providers such as acupuncturists, chiropractors, dentists, podiatrists, and psychologists and nonclinical staff such as administration and clerical personnel. Data regarding nurse practitioners (NPs), physician assistants (PAs), and midwives appeared to be incomplete (see limitations for a fuller explanation). To avoid underestimating the capacity of these providers in the state s ambulatory care workforce, NPs, PAs, and midwives were excluded from analyses, and counts were limited to physicians working in ambulatory sites. Sites serving specific populations (eg, prisoners, students, and veterans) were excluded because they are typically not accessible to the general public. Final counts of sites included the following ambulatory settings: private physician practices, hospital outpatient clinics, federally qualified health centers (FQHCs), FQHC satellites, diagnostic and treatment centers, mental health clinics, and other ambulatory sites. It is important to note that the SK&A data set included physicians who practice at multiple sites, so final counts do not represent the number of unique physicians within a geographic region. Instead, counts represent the aggregate number of physicians at each site location; thus, a physician working in 2 offices would be counted twice once for each site. Ambulatory sites were identified by SK&A s site identifier as described above, counted by site specialty, and were categorized as follows: Primary care: adolescent medicine, family medicine, geriatrics, general practice, preventive medicine, internal medicine/pediatrics, obstetrics/gynecology, and pediatrics Mental health: psychiatry and child psychiatry Specialty care: sites reporting only one specialty that did not fall under primary care or mental health categories a For more information, see 1. Physician List, Physician Mailing List: SK&A. SK&A Website. SK&A Data Products: Office-Based Physicians. Accessed August 5, Chartbook of Physicians in Ambulatory Settings in New York 3

9 Multispecialty b with primary care: reported as a multispecialty site with at least one physician specializing in primary care, as defined below. Multispecialty b without primary care: reported as a multispecialty site SK&A classified physicians by specialty, and for this analysis, they were grouped as follows: Primary care: adolescent medicine, family medicine, geriatrics, general practice, preventive medicine, internal medicine/pediatrics, obstetrics/gynecology, and pediatrics Mental health: psychiatry and child psychiatry Specialty care: all other specialties that did not fall under primary care or mental health Site location was determined by the street address reported in the database, from which corresponding zip codes were used to identify counts by county. Counties were categorized as either downstate or upstate and urban or rural. The urban/rural distinction is based on Eberts and Merschrod s Typology. c The downstate region includes the following 9 counties: Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk, and Westchester. The remaining counties are considered upstate. Urban counties include: Albany, Bronx, Broome, Dutchess, Erie, Kings, Monroe, Nassau, Niagara, New York, Oneida, Onondaga, Orange, Queens, Richmond, Rockland, Saratoga, Suffolk, and Westchester. Rural counties include: Allegany, Cattaraugus, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Cortland, Delaware, Essex, Franklin, Fulton, Genesee, Greene, Hamilton, Herkimer, Jefferson, Lewis, Livingston, Madison, Montgomery, Ontario, Orleans, Oswego, Otsego, Putman, Rensselaer, Schenectady, Schoharie, Schuyler, Seneca, St. Lawrence, Steuben, Sullivan, Tioga, Tompkins, Ulster, Warren, Washington, Wayne, Wyoming, and Yates. b Site specialty identified as multispecialty by SK&A. Considered to be with primary care if at least one physician reported a primary care specialty. c Eberts PR, Merschrod K. Socioeconomic Trends in New York State, rd ed. Albany, NY: New York State Legislative Commission on Rural Resources; Center for Health Workforce Studies

10 FINDINGS Total Ambulatory Sites and Physicians There are 20,854 ambulatory sites distributed across New York States, with 51,900 physicians at these sites (Figure 1, Figure 2, and Table 1). Nearly 58% of ambulatory sites have only one physician, and slightly more than 1% of sites have 16 or more physicians (Table 1 and Table 7). Specialty care sites (as defined in the Methods section) are the most common type of ambulatory site, representing nearly 43% of sites across New York State (Table 2). Likewise, the majority of physicians who practice at ambulatory sites are specialists, accounting for about 60% (Table 3). About 91% of ambulatory sites are located in urban counties, and 73% of sites are located downstate. Similarly, nearly 92% of physicians work in urban counties, and almost 71% practice in the downstate region (Table 5). The number of ambulatory sites per county ranges from 4 (Hamilton) to 4,496 (New York), and the number of physicians practicing at ambulatory sites per county range from 4 to 10,852 (Table 6 and Table 9). Three counties Kings, Nassau, and New York contain nearly 43% of the state s ambulatory sites and 40% of physicians practicing at these sites (Table 6 and Table 9). Primary Care Physicians and Sites There are 6,975 (34%) primary care only ambulatory sites and 2,180 (11%) multispecialty sites that have a primary care physician within New York State (Table 2). 11,788 (23%) physicians across the state work at primary care only ambulatory care sites (Table 2 and Table 4). 17,654 (34%) of physicians working at ambulatory sites specialize in primary care (Table 3). About 41% of physicians working at primary care sites work at single-physician sites (Table 4). Nearly 71% percent of primary care only sites have only one physician (Table 7). Chartbook of Physicians in Ambulatory Settings in New York 5

11 Eighty-nine percent of primary care physicians at ambulatory care sites practice in urban counties, and 68% practice in the downstate region (Table 8). Medicaid Participation Statewide, 60% of ambulatory sites and 68% of physicians working at ambulatory sites accept Medicaid (Table 10). d Ambulatory sites in rural areas (78%) are more likely to accept Medicaid than sites in urban areas (58%). Similarly, physicians practicing at ambulatory sites in rural areas are more likely to accept Medicaid than those in urban areas (Table 11). The percent of ambulatory sites that accept Medicaid patients ranges from 41% (New York) to 100% (Hamilton). In 4 counties (Nassau, New York, Suffolk, and Westchester), less than half of ambulatory sites accept Medicaid patients (Table 12). d With physicians and all other providers identified in multiple practice locations, the percentage of those accepting Medicaid patients is overestimated. 6 Center for Health Workforce Studies

12 LIMITATIONS The data used in this chartbook are primarily collected for market research purposes; consequently, the office-based physicians database is not ideal for workforce analysis. The following considerations and limitations should be noted: The data set reported physicians working in all ambulatory settings, including private physician practices, hospital outpatient clinics, FQHCs and FQHC satellites, diagnostic and treatment centers, and mental health clinics. Therefore, it was neither possible to provide a count of physicians working in any particular type of ambulatory setting nor to identify specific medical practices. Some sites provided mailing or billing addresses, rather than practice addresses. As a result, some sites may not be identified with their actual county of practice. The data set included a limited number of workforce variables; specifically, measures of provider work effort (full-time equivalents) were not included. When applicable, physicians working in more than 1 practice location are counted twice once for each location. As a result, this analysis may overestimate ambulatory care physician capacity. Data were not available for all NPs, PAs, and midwives in ambulatory practice. Data for nonphysician medical office decision makers were available in the dataset, but appeared to include some but not all NPs, PAs, and midwives at ambulatory sites. 1 As a result, NPs, PAs, and midwives were excluded from this analysis because counts would likely underestimate their presence in the ambulatory care workforce. Answers regarding Medicaid acceptance were missing for 723 (3.5%) ambulatory sites, which included 982 (1.9%) physicians; thus, counts may underrepresent health care services available to Medicaid-eligible populations. Conversely, because physicians who accept Medicaid may be identified in more than 1 practice location, counts of physicians may overestimate the number of providers available to these patients. Consequently, the percentage of ambulatory sites and physicians working at these sites serving the Medicaid-eligible population may be inaccurate. Chartbook of Physicians in Ambulatory Settings in New York 7

13 8 Center for Health Workforce Studies

14 Figures & Tables

15 FIGURES & TABLES Figure 1. Distribution of Ambulatory Sites in New York, 2015 Figure 2. Distribution of Physicians in Ambulatory Settings in New York, Center for Health Workforce Studies

16 Table 1. Distribution of Sites and Physicians by Number of Physicians per Site Number of Sites Physicians Physicians per Site Number Percent Number Percent 1 12, % 12, % 2 3, % 7, % 3 4 2, % 9, % 5 6 1, % 6, % % 5, % % 5, % % 3, % % 2, % % % Total 20, % 51, % Table 2. Number of Sites and Physicians by Site Specialty Sites Physicians Site Specialty a Number Percent Number Percent Primary Care 6, % 11, % Specialty Care 8, % 20, % Mental Health 1, % 2, % Multispecialty w/ Primary Care 2, % 12, % Multispecialty w/o Primary Care % 4, % Total 20, % 51, % a Primary care is dened as: adolescent medicine, family practice, geriatric medicine, general practice, general preventative medicine, internal medicine/pediatrics, internal medicine, obstetrics/gynecology, and pediatrics. Mental health is dened as: forensic psychiatry, psychiatry, and mental health practices. Specialty care is dened as sites reporting only one specialty that did not fall under primary care or mental health categories. Multispecialty reported as a multispecialty site; those with primary care reported as a multispecialty site with at least one primary care physician. Chartbook of Physicians in Ambulatory Settings in New York 11

17 Table 3. Number of Physicians by Specialty Physician Specialty Physicians Number Percent Primary Care 17, % Mental Health 3, % Specialty Care 31, % Total 51, % Table 4. Number of Physicians by Site Size and Specialty Number of Physicians per Site Site Specialty Primary Care Specialty Care Mental Health Multispecialty Sites Multispecialty Sites without Primary with Primary Care Care Total Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent 1 4, % 5, % 1, % % % 12, % 2 2, % 2, % % 1, % % 7, % 3-4 2, % 3, % % 2, % % 9, % 5-6 1, % 2, % % 1, % % 6, % % 2, % % 1, % % 5, % % 2, % % 1, % % 5, % % % % 1, % % 3, % % % 0 0.0% 1, % % 2, % % % 0 0.0% % % % Total 11, % 20, % 2, % 12, % 4, % 51, % Table 5. Number of Sites and Physicians by Region Region Sites Physicians Number Percent Number Percent Urban 18, % 47, % Rural 1, % 4, % Downstate 15, % 36, % Upstate 5, % 15, % Total 20, % 51, % 12 Center for Health Workforce Studies

18 Table 6. Number of Sites by Site Specialty and County County Site Specialty Number of % of State- Multispecialty Multispecialty Primary Specialty Mental Sites per Wide Site Sites with Sites without Care Care Health County Total Primary Care Primary Care Albany % Allegany % Bronx % Broome % Cattaraugus % Cayuga % Chautauqua % Chemung % Chenango % Clinton % Columbia % Cortland % Delaware % Dutchess % Erie % Essex % Franklin % Fulton % Genesee % Greene % Hamilton % Herkimer % Jeerson % Kings , % Lewis % Livingston % Madison % Monroe % Montgomery % Nassau 674 1, , % New York 1,032 2, , % Niagara % Oneida % Onondaga % Ontario % Orange % Orleans % Oswego % Otsego % Putnam % Chartbook of Physicians in Ambulatory Settings in New York 13

19 Table 6. Number of Sites by Site Specialty and County (Cont.) County Site Specialty Number of % of State- Multispecialty Multispecialty Primary Specialty Mental Sites per Wide Site Sites with Sites without Care Care Health County Total Primary Care Primary Care Queens , % Rensselaer % Richmond % Rockland % Saratoga % Schenectady % Schoharie % Schuyler % Seneca % St. Lawrence % Steuben % Suolk , % Sullivan % Tioga % Tompkins % Ulster % Warren % Washington % Wayne % Westchester , % Wyoming % Yates % Total 6,975 8,959 1,819 2, , % Table 7. Number of Sites by Site Size and Specialty Site Specialty Number of Physicians per Site Primary Care Specialty Care Mental Health Multispecialty sites with Primary Care Multispecialty sites without Primary Care Total Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent 1 4, % 5, % 1, % % % 12, % 2 1, % 1, % % % % 3, % % 1, % % % % 2, % % % % % % 1, % % % % % % % % % 5 0.3% % % % % % 2 0.1% % % % % % 0 0.0% % % % % 3 0.0% 0 0.0% 1 0.1% 8 0.4% % Total 6, % 8, % 1, % % 2, % 20, % 14 Center for Health Workforce Studies

20 Table 8. Number and Percent of Physicians by Physician Specialty and Region Physician Specialty Region Primary Care Mental Health Specialty Care Total Number Percent Number Percent Number Percent Number Percent Urban 15, % 2, % 28, % 47, % Rural 1, % % 2, % 4, % Downstate 12, % 2, % 22, % 36, % Upstate 5, % % 8, % 15, % Total 17, % 3, % 31, % 51, % Table 9. Number of Physicians by Physician Specialty and County County Physician Specialty Physicians per % of State-Wide Primary Mental Specialty County Physician Total Care Health Care Albany , % Allegany % Bronx 1, ,575 2, % Broome % Cattaraugus % Cayuga % Chautauqua % Chemung % Chenango % Clinton % Columbia % Cortland % Delaware % Dutchess % Erie ,497 2, % Essex % Franklin % Fulton % Genesee % Greene % Hamilton % Herkimer % Jeerson % Kings 2, ,459 4, % Chartbook of Physicians in Ambulatory Settings in New York 15

21 Table 9. Number of Physicians by Physician Specialty and County (Cont.) County Physician Specialty Physicians per % of State-Wide Primary Mental Specialty County Physician Total Care Health Care Lewis % Livingston % Madison % Monroe ,397 2, % Montgomery % Nassau 1, ,481 5, % New York 2, ,271 10, % Niagara % Oneida % Onondaga ,095 1, % Ontario % Orange % Orleans % Oswego % Otsego % Putnam % Queens 1, ,902 3, % Rensselaer % Richmond , % Rockland % Saratoga % Schenectady % Schoharie % Schuyler % Seneca % St. Lawrence % Steuben % Suolk 1, ,631 4, % Sullivan % Tioga % Tompkins % Ulster % Warren % Washington % Wayne % Westchester 1, ,909 3, % Wyoming % Yates % Total 17,654 3,203 31,043 51, % 16 Center for Health Workforce Studies

22 Table 10. Percent of Ambulatory Sites and Physicians That Accept Medicaid Patients Medicaid Participation Specialty Total Yes No Missing Respondents % Yes a Ambulatory Care Sites 12,083 8, , % Specialty Care 4,972 3, , % Primary Care 4,013 2, , % Multispecialty with Primary Care 1, , % Mental Health , % Multispecialty without Primary Care % Ambulatory Physicians 34,729 16, , % Specialty Care 20,968 9, , % Primary Care 11,739 5, , % Mental Health 2,022 1, , % a Percent of respondents (excluding those for which an answer was missing) that accept medicaid. Table 11. Number and Percent of Sites and Physicians That Accept Medicaid Patients Medicaid Participation Region Sites Physicians Number Percent a,b Number Percent a,b Urban 10, % 31, % Rural 1, % 3, % Downstate 8, % 23, % Upstate 3, % 11, % New York State Total 12, % 34, % a Percent of sites with at least 1 physician accepting Medicaid patients, excluding sites with missing information. b With physicians identied in multiple practice locations, the percentage of those accepting Medicaid is overestimated. Chartbook of Physicians in Ambulatory Settings in New York 17

23 Table 12. Number of Sites That Accept Medicaid Patients by County County Medicaid Participation County Totals Yes No Missing Sites % Yes a Albany % Allegany % Bronx % Broome % Cattaraugus % Cayuga % Chautauqua % Chemung % Chenango % Clinton % Columbia % Cortland % Delaware % Dutchess % Erie % Essex % Franklin % Fulton % Genesee % Greene % Hamilton % Herkimer % Jeerson % Kings 1, , % Lewis % Livingston % Madison % Monroe % Montgomery % Nassau 941 1, , % New York 1,773 2, , % Niagara % Oneida % Onondaga % Ontario % Orange % Orleans % Oswego % Otsego % a Percent of sites with at least 1 physician accepting Medicaid patients, excluding sites with missing information. 18 Center for Health Workforce Studies

24 Table 12. Number of Sites That Accept Medicaid Patients by County (Cont.) County Medicaid Participation County Totals Yes No Missing Sites % Yes a Putnam % Queens 1, , % Rensselaer % Richmond % Rockland % Saratoga % Schenectady % Schoharie % Schuyler % Seneca % St. Lawrence % Steuben % Suolk , % Sullivan % Tioga % Tompkins % Ulster % Warren % Washington % Wayne % Westchester , % Wyoming % Yates % Total 12,083 8, , % a Percent of sites with at least 1 physician accepting Medicaid patients, excluding sites with missing information. Chartbook of Physicians in Ambulatory Settings in New York 19

25 School of Public Health University at Albany, SUNY 1 University Place, Suite 220 Rensselaer, NY