Georgia graduate medical education exit survey report, 2021 Fall

Georgia Graduate Medical Education Exit Survey Report
Based on responses to the 2021 GME Exit Survey
Georgia Board of Health Care Workforce Published Fall 2021

Contents
Introduction ..................................................................................................................... 4 Methodology.................................................................................................................... 4
Table 1: Respondents and Survey Completion Rate by Program ............................... 5 Executive Summary ........................................................................................................ 6
Demographics.............................................................................................................. 6 Geography ................................................................................................................... 6 Medical School ............................................................................................................ 6 Debt and Salary ........................................................................................................... 6 Retention ..................................................................................................................... 6 Practice Opportunities ................................................................................................. 7 Satisfaction with Training............................................................................................. 7 Demographic Analysis..................................................................................................... 8 Figure 1: Gender Distribution....................................................................................... 8 Figure 2: Percent Female, 2017-2021 ......................................................................... 8 Table 2: Specialties Completing in 2021 by Gender .................................................... 9 Table 3: Racial and Ethnic Distribution ........................................................................ 9 Figure 3: Race/Ethnicity Distribution.......................................................................... 10 Figure 4: Percent Black Race & Percent Hispanic, 2017-2021.................................. 11 Table 4: Citizenship Distribution ................................................................................ 12 Figure 5: Citizenship Status ....................................................................................... 12 Figure 6: Percent Non-US Citizen, 2017-2021 .......................................................... 13 Table 5: Age Distribution ........................................................................................... 14 Figure 7: Age Distribution .......................................................................................... 14 Education ...................................................................................................................... 15 Table 6: Degree Type ................................................................................................ 15 Figure 8: Percent Osteopathic Degree, 2017-2021 ................................................... 15 Table 7: Residence Upon Graduating from High School ........................................... 16 Figure 9: Residence Upon Graduating from High School .......................................... 16 Table 8: Residence Upon Graduating from Medical School ...................................... 17 Figure 10: Location of Medical School ....................................................................... 17 Figure 11: Respondent Attended Which Georgia Medical School ............................. 18
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Financial Information ..................................................................................................... 19 Table 9: Education Debt ............................................................................................ 19 Figure 12: Current Level of Education Debt............................................................... 19 Figure 13: Percent Having no Education Debt, 2017-2021........................................ 20 Table 10: Expected Starting Salary ........................................................................... 21 Figure 14: Expected Gross Income in First Year of Practice ..................................... 21
Practice Information ...................................................................................................... 22 Table 11: Primary Activity after Current Year of Training........................................... 22 Figure 15: Primary Activity After Current Year of Training ......................................... 22 Table 12: Practice Setting.......................................................................................... 23 Table 13: Expect to be at Principal Practice for 4 or More Years by Program ........... 24 Table 14: Practice Location ....................................................................................... 25 Figure 16: Percent Staying in Georgia After Graduation Year, 2017-2021 ................ 25 Table 15: Practice Area ............................................................................................. 26 Figure 17: Percent Planning Rural Practice, 2017-2021............................................ 26
Job Search .................................................................................................................... 27 Table 16: Actively Job Searched ............................................................................... 27 Table 17: Job Offers and Acceptance........................................................................ 27 Table 18: Job Search Approaches............................................................................. 27 Table 19: Difficulty Finding a Job............................................................................... 28 Figure 18: Percent Reporting Difficulty Finding a Job, 2017-2021............................. 28 Table 20: Ratings and Perception of Training, Educational Debt Repayment, Practice Opportunities, and Rural Practice .............................................................................. 29 Table 21: Reason for Leaving Georgia ...................................................................... 30 Other Reasons for Leaving Georgia .......................................................................... 31
Acknowledgements ....................................................................................................... 33
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Introduction
This report is the Georgia Board of Health Care Workforce's 19th annual report of physicians graduating from Georgia's graduate medical education (GME) programs. The purpose of this survey is to inform the medical education community and state health care workforce planners about the experiences of graduates and inform about the supply and demand for new physicians in the state of Georgia. The survey offers insight into residents' demographic characteristics, compensation and debt levels, retention rates, practice plans, assessments of the job market, and training experiences.
Methodology
In 2021, 738 Georgia GME graduates completed the GME Exit Survey. This year, surveys were sent to each of the residency programs for distribution to their graduates as PDF documents and an online survey link. GBHCW staff then compiled all survey data electronically.
The response rates for each question vary and are reported as the "total" for each question. All Georgia GME programs with graduates participated in the survey, and are as follows:
Colquitt Regional Hospital-Moultrie Emory University School of Medicine-Atlanta Floyd Medical Center-Rome Houston Healthcare-Warner Robins Medical College of Georgia-Augusta Memorial Health University Medical Center-Savannah Memorial Satilla Health-Waycross Morehouse School of Medicine-Atlanta Navicent Health-Macon Northside Hospital Gwinnett-Lawrenceville Phoebe Putney Memorial Hospital-Albany Piedmont Athens Regional Medical Center-Athens Piedmont Macon-Macon Piedmont Midtown Medical Center-Columbus Redmond Regional Medical Center-Rome St. Mary's Hospital-Athens WellStar Atlanta Medical Center-Atlanta WellStar Kennestone Hospital-Marietta
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Table 1: Respondents and Survey Completion Rate by Program

Program Name
Emory University School of Medicine-Atlanta Medical College of Georgia Morehouse School of Medicine-Atlanta Navicent Health-Macon* Northside Hospital Gwinnett-Lawrenceville* WellStar Atlanta Medical Center-Atlanta* WellStar Kennestone Hospital-Marietta* Memorial Health University Medical Center-Savannah Piedmont Midtown Medical Center-Columbus Redmond Regional Medical Center-Rome Piedmont Macon-Macon St. Mary's Hospital-Athens Floyd Medical Center-Rome Piedmont Athens Regional Medical Center-Athens Colquitt Regional Hospital-Moultrie Phoebe Putney Memorial Hospital-Albany Houston Healthcare-Warner Robins Memorial Satilla Health-Waycross

Frequency
369 136 46 33 26 24 20 16 12 11 10
9 7 7 4 3 3 2

Percent of Total Respondents
50.0% 18.4% 6.2% 4.5% 3.5% 3.3% 2.7% 2.2% 1.6% 1.5% 1.4% 1.2% 0.9% 0.9% 0.5% 0.4% 0.4% 0.3%

Total Graduates
424 192 51 32 19 21 19 38 12 11 10 10
7 15 4 8 6 2

Survey Completion Rate
87.0% 70.8% 90.2% 100.0% 100.0% 100.0% 100.0% 42.1% 100.0% 100.0% 100.0% 90.0% 100.0% 46.7% 100.0% 37.5% 50.0% 100.0%

Total

738

100.0%

881

83.8%

*Note: these programs had more than 100% response rate, possibly due to some respondents submitting multiple surveys.

5

Executive Summary
Demographics 53.7% of respondents identify as male; 46.3% identify as female. This indicates a decrease in the percentage of respondents identifying as female from 2020, when 49.4% identified as female. Female-identified respondents were slightly more likely than male-identified respondents to be completing a primary care/core specialty in 2021 (51.2% versus 48.0%). Female-identified respondents made up 50.0% or more of the respondents in the following primary care/core specialties: family medicine (65.1%); OB/GYN (83.3%); and pediatrics (72.4%). 65.4% of respondents are native-born US citizens, which is slightly lower than 69.4% reported in 2020. The percentage of respondents identifying as Black this year is 15.4%, which is a very slight increase from 14.5% in 2020. The percentage of respondents identifying as Hispanic this year is 8.1%, which is an increase from 6.2% in 2020.
Geography 24.8% of respondents graduated from a high school in Georgia, which is comparable to the percentage reported last year. 44.9% of respondents plan to be in Georgia for their primary activity after completion of their program.
Medical School The percentage of respondents holding an osteopathic degree is 10.9%, which is slightly lower than the 11.2% of respondents last year. 24.8% of respondents attended medical school in Georgia. This is slightly higher than the 22.7% reported in 2020.
Debt and Salary 48.8% of respondents report having $200,000 or greater in educational debt. 31.2% of respondents report having no educational debt. This is similar to the 30.2% reported last year. 22.3% of respondents anticipate a starting salary of $200,000 a year or less, compared with 25.3% last year.
Retention The primary care/core specialty with the highest percentage of respondents planning to stay in Georgia after graduation is family medicine (59.5%). The primary care/core specialty with the lowest percentage of respondents planning to stay in Georgia is general surgery (25.9%).
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65.0% of respondents who went to high school in Georgia plan to stay in Georgia next year. This is lower than the 68.5% last year.
62.4% of respondents who went to medical school in Georgia plan to stay in Georgia next year. This is slightly lower than the 62.9% last year.
68.9% of people who answered the question considered one or more job offers in Georgia. This is up from 63.9% last year.
The most-selected reasons for leaving Georgia after GME are: proximity to family (23.4% selected); additional training or fellowship (23.2% selected); and better jobs in desired location outside Georgia (15.3% selected). These are the same three top choices as last year.
Practice Opportunities The average of respondents' overall assessments of practice opportunities in their specialty within 50 miles of the site where they trained is 3.2 on a scale where 1 is very few jobs and 5 is many jobs. This is the same average assessment on this question as last year. The average of respondents' overall assessments of practice opportunities in their specialty nationally is 3.8 on a scale where 1 is very few jobs and 5 is many jobs. This is slightly lower than last year's mean average of 4.0.
Satisfaction with Training The average response to the statement "Overall, I am satisfied with the training I received" is 4.4 on a scale where 1 is very dissatisfied and 5 is very satisfied. This is the same as last year's average. The average agreement with the statement "I would choose to train at the same site again," is 4.2 on a scale where 1 is strongly disagree and 5 is strongly agree. This is slightly lower than last year's average of 4.3.
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Demographic Analysis
Figure 1: Gender Distribution
Gender Distribution

Female 46.3%

Male 53.7%

Figure 2: Percent Female, 2017-2021

50.0% 49.0% 48.0% 47.0% 46.0% 45.0% 44.0% 43.0% 42.0% 41.0%

44.3% 2017

Percent Female, 2017-2021
49.4%

46.9%

47.2%

2018

2019

2020

46.3% 2021

8

Table 2: Specialties Completing in 2021 by Gender

Specialty Completing in 2021 Emergency Medicine Family Medicine General Surgery Internal Medicine OB/GYN Pediatrics Psychiatry All Other Specialties
Total

Female

Frequency Percent

8

23.5%

55

64.7%

11

40.7%

79

48.2%

14

82.4%

21

72.4%

7

31.8%

Male

Frequency Percent

26

76.5%

30

35.3%

15

55.6%

83

50.6%

3

17.6%

8

27.6%

15

68.2%

130

38.7%

202

60.1%

325

45.5%

382

53.5%

Total
34 85 27 164 17 29 22 336
714

Note: some specialties do not total 100.0% because of missing data on the gender question.
Table 3: Racial and Ethnic Distribution

Race/Ethnicity
White Asian or Pacific Islander Black/African American Multi-Race Native American/Alaskan Native
Total

Frequency
355 213 111 41
1
721

Percent
49.2% 29.5% 15.4% 5.7% 0.1%
100.0%

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Figure 3: Race/Ethnicity Distribution
Race/Ethnicity
MultiRace 5.7% Black/African American 15.4%
Asian or Pacific Islander 29.5%

Native American/Alaskan
Native 0.1%
White 49.2%

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Figure 4: Percent Black Race & Percent Hispanic, 2017-2021

Percent Black Race & Percent Hispanic Ethnicity, 2017-2021
18.0%

16.0%

14.0% 12.0%

12.5%

14.3%

11.6%

14.5%

15.4%

10.0% 8.0% 6.0% 4.0%

3.6%

4.8%

6.2%

6.2%

8.1%

2.0%

0.0%

2017

2018

Percent Black

2019 Percent Hispanic

2020

2021

11

Table 4: Citizenship Distribution

Citizenship Status
Native Born U.S. Naturalized U.S. J-1, J-2 Exchange Visitor Permanent Resident H-1, H-2, H-3 Temporary Worker
Total

Frequency
477 142 58 42 10
729

Percent
65.4% 19.5% 8.0% 5.8% 1.4%
100.0%

Figure 5: Citizenship Status

Citizenship Status
Permanent Resident
5.8%

H-1, H-2, H-3 Temporary Worker 1.4%

J-1, J-2 Exchange
Visitor 8.0%

Naturalized U.S. 19.5%

Native Born U.S. 65.4%

12

Figure 6: Percent Non-US Citizen, 2017-2021

18.0% 16.0% 14.0% 12.0% 10.0%
8.0% 6.0% 4.0% 2.0% 0.0%

Percent Non-US Citizen, 2017-2021

16.6%

15.1%

13.3%

14.4%

2017

2018

2019

2020

15.2% 2021

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Table 5: Age Distribution

Age Grouping
25-29 30-34 35-39 40 and Above
Total

Frequency
105 448 112 54
719

Percent
14.6% 62.3% 15.6% 7.5%
100.0%

Figure 7: Age Distribution
Age Distribution

500 450 400 350 300 250 200 150
105
100 50 0
25-29

448 30-34

112 35-39

54 40 and Above

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Education
Table 6: Degree Type

Degree Type Allopathic (MD) Osteopathic (DO)
Total

Frequency 645 79 724

Percent 89.1% 10.9% 100.0%

Figure 8: Percent Osteopathic Degree, 2017-2021

12.0% 10.0%

Percent Osteopathic Degree, 2017-2021
11.2% 9.6%

10.9%

8.0%

7.8%

6.0%

7.2%

4.0%

2.0%

0.0%

2017

2018

2019

2020

2021

15

Table 7: Residence Upon Graduating from High School

Residence Upon Graduating from High School
Other US State Georgia Other Country
Total

Frequency 417 180 128 725

Percent 57.5% 24.8% 17.7% 100.0%

Figure 9: Residence Upon Graduating from High School

Residence Upon Graduating from High School

Other Country 17.7%

Georgia 24.8%

Other US State 57.5%

16

Table 8: Residence Upon Graduating from Medical School

Location of Medical School
Other US State Georgia Other Country
Total

Frequency
352 143 229 724

Figure 10: Location of Medical School

Percent
48.6% 19.8% 31.6% 100.0%

Location of Medical School

Other Country 31.6%
Georgia 19.8%

Other US State 48.6%
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Figure 11: Respondent Attended Which Georgia Medical School Respondent Attended Which GA Medical School
Morehouse School of Medicine 18

Mercer University School of Medicine

23

PCOM-Georgia Campus

29

Emory University School of Medicine

29

MCG (@AU or @UGA)

45

Does not apply

Note: "Does not apply" indicates the respondent did not attend a Georgia Medical School.

531 18

Financial Information
Table 9: Education Debt

Current Level of Education Debt
$0 Less than $100,000 $100,000-$199,999 $200,000-$299,999 $300,000-$399,999 $400,000-$499,999 $500,000 or Greater
Total

Frequency
222 48 71 131 101 69 38
680

Percent
32.6% 7.1% 10.4% 19.3% 14.9% 10.1% 5.6%
100.0%

Figure 12: Current Level of Education Debt

Current Level of Education Debt

250

222

200

150

131

100

71

48 50

101 69 38

0

19

Figure 13: Percent Having no Education Debt, 2017-2021

Percent Having no Education Debt, 2017-2021

35.0% 30.0%

30.3%

30.2%

32.6%

25.0%

20.0%

15.0%

13.5%

10.0% 5.0%

7.5%

0.0%

2017

2018

2019

2020

2021

20

Table 10: Expected Starting Salary
Expected Gross Income in First Year of Practice
Less than $100,000 $100,000-$199,999 $200,000-$299,999 $300,000-$399,999 $400,000-$499,999 $500,000 or Greater
Total

Frequency
46 71 220 123 44 21
525

Percent
8.8% 13.5% 41.9% 23.4% 8.4% 4.0%
100.0%

Figure 14: Expected Gross Income in First Year of Practice
Expected Gross Income in First Year of Practice
250
220
200

150
100
71 46
50
0

123
44 21

21

Practice Information
Table 11: Primary Activity after Current Year of Training

Primary Activity after Current Year of Training
Patient Care/Clinical Practice Additional Training or Fellowship Other* Teaching/Research
Total

Frequency
448 205 46 21
720

Percent
62.2% 28.5% 6.4% 2.9%
100.0%

Figure 15: Primary Activity After Current Year of Training

Primary Activity After Current Year of

Training

Other* 6.4%

Teaching/Research 2.9%

Additional Training or Fellowship
28.5%

Patient Care/Clinical
Practice 62.2%

*Note: "Other" includes chief resident (15), undecided (8), and temporarily out of medicine (3).
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Table 12: Practice Setting
Practice Setting
Hospital-Inpatient Group Practice-As Employee Hospital-Ambulatory Care Other Group Practice-As Owner/Partner Hospital-Emergency Room Partnership (2 Person) Freestanding Health Center/Clinic Military Solo Practice HMO Nursing Home
Total

Frequency
243 167 68 51 42 38 10
9 8 8 3 1
648

Percent
37.5% 25.8% 10.5% 7.9% 6.5% 5.9% 1.5% 1.4% 1.2% 1.2% 0.5% 0.2%
100.0%

23

Table 13: Expect to be at Principal Practice for 4 or More Years by Program

Program Name
Colquitt Regional Hospital-Moultrie Emory University School of Medicine-Atlanta Floyd Medical Center-Rome Houston Healthcare-Warner Robins Medical College of Georgia Memorial Health University Medical Center-Savannah Memorial Satilla Health-Waycross Morehouse School of Medicine-Atlanta Navicent Health-Macon Northside Hospital Gwinnett-Lawrenceville Phoebe Putney Memorial Hospital-Albany Piedmont Athens Regional Medical Center-Athens Piedmont Macon-Macon Piedmont Midtown Medical Center-Columbus Redmond Regional Medical Center-Rome St. Mary's Hospital-Athens WellStar Atlanta Medical Center-Atlanta WellStar Kennestone Hospital-Marietta

Expect to be at Principal Practice for 4 or More Years

No

Yes

Frequency Percent Frequency Percent

Total

0

0.0%

4

100.0%

4

89

28.5%

223

71.5%

312

1

14.3%

6

85.7%

7

1

33.3%

2

66.7%

3

33

29.5%

79

70.5%

112

2

14.3%

12

85.7%

14

0

0.0%

2

100.0%

2

16

40.0%

24

60.0%

40

12

42.9%

16

57.1%

28

7

31.8%

15

68.2%

22

2

66.7%

1

33.3%

3

3

60.0%

2

40.0%

5

5

55.6%

4

44.4%

9

1

8.3%

11

91.7%

12

4

36.4%

7

63.6%

11

2

22.2%

7

77.8%

9

4

18.2%

18

81.8%

22

9

45.0%

11

55.0%

20

Total

191

30.1%

444

69.9%

635

24

Table 14: Practice Location

Location of Primary Activity After Graduation Year
Other State Georgia Outside of US
Total

Frequency
388 323
8
719

Percent
54.0% 44.9% 1.1%
100.0%

Figure 16: Percent Staying in Georgia After Graduation Year, 2017-2021

Percent Staying in Georgia After Graduation, 2017-2021
60.0%

50.0% 40.0%

49.9%

44.2%

44.9%

30.0% 20.0%

23.9%

26.4%

10.0%

0.0%

2017

2018

2019

2020

2021

25

Table 15: Practice Area

Practice Area
Inner City Other Area Within Major City Suburban Small City (City Population Less Than 50,000) Rural (County Population Less Than 50,000)
Total

Frequency Percent

215

30.6%

196

27.9%

161

22.9%

81

11.5%

50

7.1%

703

100.0%

Figure 17: Percent Planning Rural Practice, 2017-2021

Percent Planning Rural Practice*, 2017-2021

8.0%

7.0% 6.0%

6.4%

6.2%

6.2%

7.1%

5.0% 4.0%

4.5%

3.0%

2.0%

1.0%

0.0%

2017

2018

2019

2020

2021

*Note: Before 2019, the definition of "rural" entailed an area with a county population of 35,000 or less; starting in 2019, the definition of "rural" entails an area with a county population of 50,000 or less.

26

Job Search
Table 16: Actively Job Searched

Actively Job Searched
No Yes
Total

Frequency
148 484
632

Table 17: Job Offers and Acceptance

Percent
23.4% 76.6%
100.0%

Been Offered a Job
Yes and accepted Not been offered Yes and declined
Total
Table 18: Job Search Approaches

Frequency
471 88 40
599

Percent
78.6% 14.7% 6.7%
100.0%

Job Search Approaches
Independent job search Third party representation Announcements/ career fairs Other Want ads

Frequency
362 168 132 125 64

Percent
49.1% 22.8% 17.9% 16.9% 8.7%

Note: Respondents could select multiple job search approaches.

27

Table 19: Difficulty Finding a Job

Had Difficulty Finding a Job
No Yes
Total

Frequency
403 142
545

Percent
73.9% 26.1%
100.0%

Figure 18: Percent Reporting Difficulty Finding a Job, 2017-2021

30.0% 25.0%

Percent Reporting Difficulty Finding a Job, 2017-2021

24.5%

26.1%

20.0%

15.0% 10.0%

9.5%

14.3%

15.5%

5.0%

0.0%

2017

2018

2019

2020

2021

28

Table 20: Ratings and Perception of Training, Educational Debt Repayment, Practice Opportunities, and Rural Practice

Question or Statement
In your job search, how strongly did you consider practicing in a rural area (county population less than 50,000)? If all of your medical school debt were forgiven, how likely would you consider a five-year obligation to practice in a rural setting (GA county population less than 50,000)?
What is your level of satisfaction with your salary/compensation?
What is your overall assessment of practice opportunities in your specialty within 50 miles of the site where you trained?
What is your overall assessment of practice opportunities in your specialty nationally?

Rating Scale
1 = DID NOT CONSIDER 5 = STRONGLY CONSIDERED
1 = VERY UNLIKELY 5 = VERY LIKELY
1 = VERY DISSATISFIED 5 = VERY SATISFIED
1 = VERY FEW JOBS 5 = MANY JOBS

Number of Responses
627
632
632 638 645

Average
2.4 2.9 3.7 3.2 3.8

Overall, I am satisfied with the training I received.

675

4.4

1 = STRONGLY DISAGREE

5 = STRONGLY AGREE

I would choose to train at the same site again.

676

4.2

29

Table 21: Reason for Leaving Georgia

Reason for Leaving Georgia Proximity to Family Fellowship or Additional Medical Training Better Jobs in Desired Location Outside Georgia Better Job for Spouse/Partner Outside Georgia Other Reason Better Salary Offered Outside Georgia Better Jobs in Desired Practice Setting Outside Georgia Never Intended to Practice in Georgia Overall Lack of Jobs/Practice Opportunities in Georgia Better Jobs Outside Georgia That Meet Visa Requirements Other Service Obligation Cost of Starting a Practice Cost of Malpractice Insurance in Georgia

Frequency 173 171 113 90 81 79 76 63 56 25 19 4 3

Note: Respondents could select multiple reasons for leaving Georgia.

30

Other Reasons for Leaving Georgia In addition to the above reasons for leaving Georgia after the current year of training, some respondents entered another reason in an open-ended format. The responses are organized into the following themes: Living Conditions or Preferences: Respondents mentioned living conditions in the South, experiences of racism, traffic, diversity, wanting a more desired location or geography, safety concerns, and the political atmosphere. Financial Considerations: Respondents mentioned better insurance and tax situations in other states. Licensing or Practice Considerations: A few respondents mentioned not wanting to or not being able to stay at their current institution or needing extra licensing to practice in their specialty.
31

Map 1: Location of Primary Activity After Current Year of Training 32

Acknowledgements
This report was produced under the direction of LaSharn Hughes, MBA, Executive Director; Leanna Greenwood, MA, Senior Data Analyst; G.E. Alan Dever, MD PhD, Consultant; and Jocelyn Hart, Data Analyst. The Board would like to thank Georgia's Graduate Medical Education programs for their assistance with this survey. Thank you to the Georgia Board of Health Care Workforce Board Members for their leadership and support. Board Members
Terri McFadden-Garden, M.D. - Chair James Barber, M.D. - Vice Chair William R. "Will" Kemp - Secretary/Treasurer Garrett Bennett, M.D. W. Scott Bohlke, M.D. Carolyn Clevenger, DNP Jacinto del Mazo, M.D. John E. Delzell Jr., M.D. MSPH Steven Gautney, MSHA Michael J. Groover, D.M.D. Lily Jung Henson, M.D. Indran Indrakrishnan, M.D. George M. McCluskey, III, M.D. Amy Reeves, PA-C Antonio Rios, M.D.
33