Select your criteria for display from the options below and then click apply.


1. Select a View:

2. Select a Geography:


3. Select a Model:




4. Select a Scenario:



What happens when conditions change? The scenario menu can provide additional tools to help explore and model various change scenarios.






Using the form on the left, select which options you want to see on the map.

Choose to view data from all TSAs or search for a particular one by zip code.






Baseline


The baseline scenario is the model’s default scenario. This scenario assumes that there are no changes to factors influencing healthcare workforce supply and healthcare services use between 2013 and 2030. It is important to note that the baseline scenario begins in 2013 and assumes that the Patient Protection and Affordable Care Act is not implemented.

Retirement Scenarios



These scenarios allow users to understand how retirement rates affect physician supply. There are two options for this scenario: a low retirement rate and a high retirement rate. The baseline retirement rate is the average of the high retirement rate and the low retirement rate.

  • The low retirement scenario models retirement delay of 2 years compared to the baseline.
  • The high retirement scenario models retirement 2 years earlier than the baseline.

Full-time Equivalents (FTE) Scenarios



The model includes scenario options that allow users to understand how increases and decreases in physician work effort—measured in terms of patient care FTEs—affect physician supply and physician shortages and surpluses. One scenario option allows users to reduce patient care FTEs supplied by all clinically active physicians by 5% beginning in 2013. In this scenario, FTEs are reduced equally across all specialties and between both genders. Similarly, users are able to increase the patient care FTEs provided by clinically active physicians by 5%.

Affordable Care Act Implementation


Our model includes a scenario that estimates the effect of the Patient Protection and Affordable Care Act’s (ACA) Medicaid expansion and health insurance exchanges on use of healthcare services and on shortages and surpluses. Users can select from three scenario options related to the ACA. The first option is that health insurance exchanges are implemented in all states, but no states opt to expand Medicaid coverage through the ACA. The second option is that health insurance exchanges are implemented in all states, but Medicaid coverage is only expanded in the 26 states that accepted the ACA's Medicaid expansion as of January 1, 2014. It should be noted that states that have accepted the ACA’s Medicaid expansion after January 1, 2014, are not included as "expansion" states under this scenario option. We will update the model as the number of ACA Medicaid-expansion states grows. Finally, in the third option, all states have health insurance exchanges, and all states expand Medicaid in 2014. For a more detailed explanation of this scenario see the Additional Resources section.

Increase Use of Nurse Practitioners and Physician Assistants



This scenario estimates how nurse practitioners (NPs) and physician assistants (PAs) will contribute to meeting future healthcare services use. To implement this scenario, we updated the model’s plasticity matrix to include two additional "specialty" rows—one for NPs and one for PAs—and we projected NP and PA supply under two growth rates. We then compared the combined physician and NP and PA supply projection with healthcare services use under the baseline scenario. This allowed us to obtain estimates of surpluses and shortages of visits that incorporate the important and growing role that NPs and PAs play in health care delivery. Note that only the shortage surplus data change in this scenario, the physician supply and use of health care services data remain the same. For a more detailed explanation of this scenario see the Additional Resources section.

Graduate Medical Education (GME)




The question of whether, and in which specialties and geographies, to expand Graduate Medical Education (GME) is a topic of intense policy interest. Our model includes three scenarios that increases the number of positions according to different criteria.
  • Increase of 3,000 PGY1 slots: This scenario adds 3,000 GME positions for medical school graduates each year for five years, and distributes them according to states and specialties in the most need. This amounts to 15,000 new residency positions being allocated from 2016-2021. The addition of 3000 PGY1 GME positions has been discussed as a potential policy option, but no methodology on distribution of those slots is yet available. This scenario presents one possible method, and shows the impact through 2030.
  • Raise minimum supply to 50% demand: This scenario adds additional GME to move all states and specialties to have enough supply to meet at least 50% of demand. Though the scenario aims to give each state and specialty enough GME positions to reach 0.5 supply/visit ratio in 2026, states and specialties may show lower and higher ratios due to physician diffusion after residency. For more information on diffusion, see "How does this model diffuse physicians to different geographies?"
  • Raise minimum shortage/supply ratio to 0.85: This scenario adds additional GME to move all states and specialties to have enough supply to meet at least 85% of demand. Though the scenario aims to give each state and specialty enough GME positions to reach 0.85 supply/visit ratio in 2026, states and specialties may show lower and higher ratios due to physician diffusion after residency. For more information on diffusion, see "How does this model diffuse physicians to different geographies?"
For a more detailed explanation of this scenario see the Additional Resources section.
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