Investigators: Erin Fraher, PhD, MPP; Evan Galloway, MPS; Erica Richman, PhD, MSW; Andy Knapton, MSc.
Specific Aims: We developed the DocFlows App, a web-based, interactive data visualization tool, to understand the diffusion of physicians from the state where they completed residency training to their practice location state, and the diffusion of all practicing physicians from one state to another. The tool allows users to query, download and share maps showing state-to-state moves by residents and active practicing physicians by specialty. It includes MDs and DOs and allows the user to compare flows of physicians who were residents in 2009 to all actively practicing physicians. Users identify which state to analyze by selecting that state and then choosing one of three calculations to apply (import to the state, export from the state, and net gain/loss for the state) for either residents or actively practicing physicians. The model also gives the user the option to narrow down results from all doctors to only those in a specialty.
Key Findings and Policy Implications:
- States are seeking better data to evaluate the ROI for public funds spent on GME. The DocFlows App fills this gap by providing information on where their workforce is trained and where their trainees are moving.
- Thirteen percent (n=87,829) of actively practicing physicians and 55% (n=64,120) of residents in 2009 had moved to another state in 2015.
- California, Florida, and Texas were the largest net importers of physicians. They also had the highest retention rates for actively practicing physicians, keeping over 90% of their actively practicing physicians in-state between 2009 and 2015.
- Wyoming had the lowest retention rates, keeping just 18% of residents and 76% of practicing physicians.
- The market for physicians is national, with significant migration between states of newly trained and actively practicing physicians. Many of these moves are regional. This means that any change a state implements to expand GME or increase retention will affect other states.
- Fraher E, Richman E, Galloway E, Knapton A. DocFlows: A Web-Based, Interactive App to Explore the Interstate Migration of Residents-in-Training and Practicing Physicians. Policy Brief. August 2017.