Sunday, May 25, 2014

The Provider Shortage Problem: The Definitive Bottom 5 States

So far this month our theme has been provider shortage problems, an issue that plagues every State to one extent or another according to the latest data from the Health Resources and Services Administration (HRSA).  Today we will divulge the Definitive Bottom 5 States, the ones with the overall worst provider shortage problems, based on our analysis of May 2014 data from the HRSA.

To this point we have presented our lists of the 5 States with the worst shortages in three separate areas: primary care, dentists and mental health care.  In our analysis of the HRSA data, the key consideration is the size of the provider shortage in a State relative to its overall population.  The absolute number of providers needed to eliminate a shortage in a particular State does not paint the whole picture.  If two States have the same provider shortage in absolute terms, one might conclude that their provider shortage problem is the same.  Yet if one State has triple the overall population of the second State, it becomes apparent that the smaller State has a more severe problem.  So in our analysis, it is the relative provider shortage that counts the most.

Our assessment of the Definite Bottom 5 States follows the same methodology we used when developing our prior lists.  We looked at the aggregate shortage of primary care physicians, dentists and psychiatrists in each State in relation to the aggregate national shortage of these providers.  We then compared those results against each State's share of the national population.  Our Definitive Bottom 5 States had an overall provider shortage (primary care physicians, dentists and psychiatrists) that was disproportionately out of whack given each State's total population.

So without further adieu, the worst-of-the-worst provider shortage problems, our Definitive Bottom 5 States:

Fifth worst place belongs to Alabama.  Based on May 2014 HRSA data, the State is short 545 providers, which is 3% of the national total of just under 18,000.  Alabama only accounts for 1.5% of the national population, so its shortage is about double what one would expect given its population size.  Alabama is particularly short of dentists, which make up over 55% of its provider shortfall.

Coming in fourth from the bottom is Missouri.  The State, which accounts for about 1.9% of the nation's population, is short 738 providers, or about 4.1% of the national total. Primary care physicians is where Missouri's provider shortage is most severe.

Sitting at third worst in our Definitive Bottom 5 is Arizona, with a shortage of 1,050 providers, or about 5.8% of the national total.  Home to approximately 2.1% of the population, the State's shortage is about 2.7X times more than one would expect given its population.  Arizona is weak across the board, making our "5 Worst" lists for primary care physicians, dentists and psychiatrists.

In the number 2 spot on our Definite Bottom 5 list is New Mexico.  The State is home to 1.9% (347 providers) of the national provider shortage, but its share of the national population is less than 0.7%.  Consequently, its provider shortage is more out of balance with its population than all other States, except one.  Like Arizona, New Mexico has provider shortage problems across the board and also made each of our prior "5 Worst" lists.

And who takes the bottom spot on our list of the Definite Bottom 5 States for Provider Shortage Problems?  That dishonor goes to Mississippi.  The State has an aggregate provider shortage of 495 professionals, or about 2.75% of the national total.  As compared to its population, which is approximately 0.94% of the national total, Mississippi's provider shortage is 2.93X worse than one would expect for its population.  That result barely edged out New Mexico's provider shortage, which was 2.92X worse than expected given the size of its population.

So there you have it.  The Definitive Bottom 5 States for Provider Shortage Problems.  Let's hope the political leaders in each of these States drums up the courage to implement corrective policies that would encourage more primary care physicians, dentists and psychiatrists to set up shop in their respective states.  Sadly, that is probably asking too much.


Monday, May 19, 2014

5 States with the Worst Mental Health Care Shortage

In recent posts we've looked at States with the worst primary care and dentist shortages.  Today we will reveal the 5 States with the Worst Mental Health Care Shortage based on our analysis of data from the Human Resources and Services Administration (HRSA).  As of May 2014, the HRSA estimates that 96 million Americans, spread across close to 4,000 geographic areas, population groups or facilities in the country, lack enough psychiatrists to adequately meet their mental health care needs.  A mental health care shortage area, according the the HRSA, is one where there is less than 1 psychiatrist for every 30,000 people who live the in the designated area.  On a national basis, the HRSA estimates that there is a shortage of just over 2,700 psychiatrists throughout the country, with a psychiatrist shortage being found in every state except Rhode Island and Vermont.

In ascertaining which states have the worst mental health care shortage, the key variable in our analysis is a State's psychiatrist shortage in relation to its total population.  To be a candidate for our "5 States with the Worst Mental Health Care Shortage" list, a State will have a psychiatrist shortage that is disproportionately large given the State's total population.  Each of the 5 States on our list is one where its share of the total national psychiatrist shortage is substantially greater than its share of the total national population.

So which states make our list of the 5 States with the Worst Mental Health Care Shortage?

At fifth worst is Montana.  While having 0.32% of the national population, Montana has 0.78% of the national psychiatrist shortage, giving the state a psychiatrist shortage that is 2.4X more than one would expect given its population.  It's a disproportionately bad number, but not nearly bad enough to seriously compete for the bottom spot on our list.

Barely edging out Montana for the 4th worst place on our list is New Mexico.  New Mexico accounts for 1.66% of the national shortage of psychiatrists and 0.66% of the national population.  With a shortage 2.5X more than one would expect for a state its size, New Mexico did just bad enough to squeak past Montana for the 4th spot from the bottom on our list of 5 States with the Worst Mental Health Care Shortage.

South Dakota sits comfortably on our list as the State with the 3rd worst mental health care shortage based on our analysis of HRSA numbers.  The State is home to only 0.81% of the national shortage of psychiatrists.  Unfortunately, that is about 3.1X more than one would expect given that South Dakota has just 0.26% of the overall national population

Moving on, we found that the second worst place on our list belongs to Arizona.  Arizona has a psychiatrist shortage that is over 3.5X more than one would expect for a state its size.  The State has just over 2.1% of the national population, yet it has more than 7.5% of the HRSA's estimated psychiatrist shortage.  Even with this disproportionately bad mental health care shortage, Arizona still lagged our bottom finisher by a solid margin.

Finishing dead last on our list of States with the Worst Mental Health Care Shortage is Wisconsin.  This result was a bit of a surprise as Wisconsin fared well in our analysis of primary care and dentist shortages.  Unfortunately, those favorable conditions in the primary care and dental care arenas did not carry over at all to the State's mental health care environment.  With 7.83% of the HRSA estimated psychiatrist shortage and 1.82% of the national population, Wisconsin's shortage is almost 4.3X worse than one would expect for a state with its population.

 

Thursday, May 15, 2014

5 States with the Worst Dentist Shortage

Before revealing the 5 States with the Worst Dentist Shortage, a few words about the national problem.  The Health Resources and Services Administration (HRSA) designates nearly 4,900 geographic areas, population groups or facilities across the country has having a dental care shortage.  More than 47 million people, or about 15% of the U.S. population, live in one of these dental care shortage areas.  The trait shared by these areas is that each has fewer than 1 dentist for every 5,000 people who live in the area. 

Based on May, 2014 data, the HRSA estimates that more than 7,200 additional dentists are needed to provide adequate care to residents of these shortage areas.  As with the shortage of primary care physicians, the dentist shortage is expected to worsen in coming years as the growth in demand for dental care services will outpace growth in the number of practicing dentists.

In our last commentary, 5 States with the Worst Primary Care Shortage, we noted that raw shortage numbers alone do not provide a good picture of the problem at the State level.  States with bigger populations typically have bigger dentist shortage numbers than many small States.  Yet relative to their population size, a small State can easily have a more severe dentist shortage problem than their larger brethren.  The variable that keys our analysis is a State's dentist shortage in relation to the size of its population.  To be a candidate for our "5 States with the Worst Dentist Shortage" list, a State has to have a shortage that is disproportionately large for the State's total population.  All 5 of the States on our list are ones where their share of the total national dentist shortage is significantly greater than their share of the total national population.

So who are the 5 States with the Worst Dentist Shortage?

At number 5 in our countdown is Tennessee.  Per the HRSA's May, 2014 data, Tennessee is short 353 dentists, or about 4.9% of the 7,200 dentist shortage nationally.  Since the State accounts for about 2% of the national population, their dentist shortage is 2.4X greater than what one would expect given the State's relative population size. Only 4 States had disproportionately worse dentist shortage conditions than did Tennessee.

In 4th place on our list is Alabama.  Its shortage of 304 dentists is about 4.2% of the national total.  In comparison, its population is 1.5% of the national population, so the State's shortage is over 2.7X more than one would expect to see for a State the size of Alabama.

Coming in 3rd from the bottom of our list is Arizona.  Its dentist shortfall is 6% of the national shortage, while its population is 2.1% of the national total.  Having 6% of the national dentist shortfall, while having only 2.1% of the national population, is abysmal, even if it is better than our bottom two.

Not that it is of much comfort, but Arizonans only need to look their neighbors to the East to find an even worse dentist shortage than their own.  The next to last place on our worst dentist shortage list belongs to New Mexico. The state's dentist shortage is about 1.93% of the national total based on current HRSA data.  That is over 2.9X what one would expect given that the state has just 0.66% of the national population.

And coming in dead last on our list of the 5 States with the Worst Dentist shortage is Mississippi.  The State is 206 dentists short of what it needs.  That raw number comes to 2.86% of the national shortfall total, while its population is just 0.94% of the national population.  At just over 3X more than one would expect considering its small share of the total U.S. population, Mississippi has the most disproportionate dentist shortage in the country.

Congratulations to our 5 bottom-dwellers for their pitiful dental care state of affairs.

Sunday, May 11, 2014

5 States with the Worst Primary Care Shortage

Before taking a look at the 5 States with the Worst Primary Care Shortage, let's examine the national scene.  The Health Resources and Services Administration (HRSA) designates more than 6,000 geographic areas, population groups or facilities across the country has having a primary care shortage.  More than 60 million people, or about 19% of the U.S. population, live in a designated primary care shortage area.

Shortage areas exist in every State of the Union and what these areas share in common is that each has fewer than 1 primary care physician for every 3,500 people who live in the area. Using this metric, the HRSA's May, 2014 data estimates that close to another 8,100 primary care physicians are needed to provide adequate care to residents of these shortage areas.  Some healthcare experts think the actual shortage is more like 16,000, arguing that the formula of 1 primary care physician for every 3,500 people used by the HRSA is understated.

While some experts assess the situation differently, all agree that a sizable portion of the nation lacks adequate access to primary care physicians.  Moreover, everyone agrees that the shortage of primary care physicians will grow worse over the next 5 to 10 years at least.  The fundamental problem is basic supply and demand.  On the one hand, demand is growing due to several factors:  (1) the population as a whole continues to grow; (2) the population over 50, which naturally require more primary care services, is growing at an even faster rate than the overall population; and (3) under Obamacare millions more have, or will have, health insurance coverage than under our "historical" system, thereby making primary care more financially accessible than ever.  On the other hand, U.S Medical Schools are definitely turning out new primary care physicians every year, so the supply of primary physicians is growing.  However, the pace of supply growth has not been, nor is it expected to be, fast enough to keep pace with demand growth.  So with demand growing at a faster clip than supply, the experts agree that today's primary care shortfall, whether it is 8,000 or 16,000, is only going to get worse in coming years.

So which 5 States have the worst primary care shortage?  If we looked at the raw numbers alone, the 5  largest population states would make our list.  But in our analysis, raw numbers alone do not provide an accurate picture.  What matters in our analysis is a State's primary care shortage in relation to the size of its population.  To be a candidate for our "5 States with the Worst Primary Care Shortage" list, a State has to have a shortage that is disproportionately large for the State's total population.

So who are the 5 States with the Worst Primary Care Shortage?

At number 5 is North Dakota.  According to HRSA's May, 2014 data, the North Dakota shortage was a mere 34 primary care physicians, or just 0.42% of the national primary care shortage.  But with only about 0.22% of the national population, North Dakota's primary care shortage is almost double what one would expect it to be given its population.  We found only 4 States that had disproportionately worse conditions.

Coming in 4th on our list is Missouri.  Its shortage of 363 primary care physicians is about 4.5% of the national total.  In comparison, its population is under 2% of the national population, so the State's shortage is over 2.3X more than one would expect to see for a State the size of Missouri.

In 3rd place is Arizona.  Its primary care shortfall is 5.1% of the national shortage, while its population is 2.1% of the national total.  Not good.

The second worst primary care shortage on our list belongs to Mississippi. The state has a shortage of 230 primary care physicians, or about 2.85% of the national total based on HRSA data.  That is more than triple what one would expect given that the state has just 0.94% of the national population.

And occupying last place on our list of the 5 States with the Worst Primary Care shortage is New Mexico.  The state's 163 primary care physician shortage is 2.02% of the national shortfall total, while its population is 0.66% of the national population.  While Mississippi came in a close second, no other state has a primary care shortage more out of proportion with its state population than does New Mexico.