Fact sheet on Georgia's trauma physicians

Georgia Board for Physician Workforce Fact Sheet on Georgia's Trauma Physicians
August 2008

This Fact Sheet highlights the current supply and distribution of physicians who play a critical role in Georgia's trauma network. These specialties include: General Surgery, Emergency Medicine, Orthopedic Surgery, and Neurological Surgery. It is relevant to note that other physicians, in addition to those mentioned in this Fact Sheet, play an important part in stabilizing and treating trauma patients.
Most Frequent Causes of Traumatic Injuries
"Care at a trauma center lowers by 25 percent the risk of death for injured patients compared to treatment received at non-trauma centers." (Source: A National Evaluation of the Effect of Trauma Care on Mortality; New England
Journal of Medicine; Jan. 26, 2006).
Nationwide, Motor Vehicle Accidents account for the greatest number of patients treated in trauma centers. (Source: Division of Advocacy and Health Policy, 2006) In Georgia, hospital discharges, as a result of Motor Vehicle Accidents, have risen from a rate of 89.5 in 2002 to a rate of 92.7 in 2006. (Source: Georgia Dept. of Human
Resources; Division of Public Health; Online Analytical Statistical Information System. 2008)
Trauma resulting from falls had the highest discharge rate of all external cases in Georgia in 2006 (182.3 per 100,000 population). (Source: Georgia Dept. of Human Resources; Division of Public Health; Online Analytical Statistical
Information System. 2008)

The Core Specialty of General Surgery

The core specialty of General Surgery is particularly important when considering access to trauma services. A General Surgeon manages a broad spectrum of surgical conditions affecting almost any area of the body. The surgeon establishes the diagnosis and provides the preoperative, operative, and postoperative care to surgical patients and is usually responsible for the comprehensive management of the trauma victim and the critically ill surgical patient. (Source: Association of American Medical Colleges)

GENERAL SURGERY Physician Distribution - 2006 Deficit, Adequate, and Surplus PCSAs*

1 2 Dade

Catoosa Whitfield

Fannin
4 3

Towns
6 Union 5

Rabun
7

DASuderfeipqcliuutaste Cha1WttHo8aoaFlgrklP1aoCaeHolyrs9aeldkorarnordllPG1aBou1M6arl2CdDdur7toiooron0nr24wugwagey11ltaaCsPCo2Fi1bh1caF2Gbekyu445eriellotnmCt0oktse3lneeSareyp39Dta2oe7lDndFk313iaaonHw8lGL3rgbseuswRyn12mo2tiornhnyp2c5n4kBkeidnutNatttelWsHe1wa3WBhtJ1lo2ialt6aanerJs6lrtaoopHcwenBM1akrabso0neorOrkgnCscsa2PShloan3uta7nrFe8tmke5npreMa9eahGnmeaOkrnd3elgisinesl4eonHtnehHao23anTrrpac83Eteloilabc3fke2We0rrWt9irlokaeGrsrelaMnsc3cJDoLe2ucifnkffefcierCos3loonl1numRbiciaGUhmpp.AoSeeBnu.drrRrkR11ae00ate00te,,=00=007001.72pp.poo5hpppyuuhsllaaiycttsiiiooaicnnniasns

42 50 Meriwether Pike Lamar Monroe 47 49 Troup

Baldwin Jones

Washington

44 45 46 48 54 Harris

Upson

Talbot

Crawford

Bibb

Wilkinson

Twiggs

Johnson

Jenkins Emanuel

Screven
51

43
Muscogee Marion
Chattahoochee

Taylor

Peach 67

Houston

Macon

Bleckley
63

60 57 55 53 Laurens

Treutlen

Candler Bulloch Effingham

Schley

66

Pulaski Dodge

68 Stewart Webster Sumter 69

Dooly
65

64
Wilcox

62

Crisp

Quitman 70

Terrell Lee

Randolph

Ben Hill

Turner

87

59Montgomery Wheeler 58

56 Evans Tattnall

Toombs

52 Bryan Chatham

Telfair
61

Jeff Davis
89

Appling
91

Liberty Long
92

79 86 90 Clay Calhoun Dougherty Worth

76 77 85 88 94 93 Early

Baker

Irwin Tift
Berrien

71 78 80 Miller

Mitchell

Colquitt

Cook

Coffee Bacon

Wayne

Atkinson

PPieIErRcCeE

Ware

Brantley

McIntosh Glynn

72 84 83 Seminole

Lanier Clinch

Charlton

Camden

95 96 Decatur Grady Thomas Brooks

73

74

75 81 82 Lowndes Echols

* A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/-1 standard deviation of the physician rate per 100,000 in 2006.

Overall, since 1996, the number of practicing General Surgeons in Georgia has increased by 1.2%. However, between 2004 and 2006, it has decreased by 4.6%.
The growth in General Surgeons has not kept pace with the rapid growth in population. The rate of General Surgeons per 100,000 Population decreased from 9.59 in 1996 to 7.67 in 2006. The national rate in 2006 was 12.5 General Surgeons per 100,000 Population (a decrease from 2004).
General Surgery shows a deficit in 27 of the 96 Primary Care Service Areas of Georgia (2006). This is 28% of the PCSA's in Georgia in 2006.
In 2006, 45.7% of the General Surgeons were aged 50+, and 20.3% were 60 and older.
According to the American College of Surgeons, each year there are more surgical residency positions offered nationally than there are students waiting to apply.
In 2006/2007 7.6% of the General Surgery GME slots in Georgia were left unfilled.

Emergency Medicine
An Emergency Medicine physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians, and in the emergency department. (Source: Association of American Medical Colleges)
EMERGENCY MEDICINE Physician Distribution - 2006* by Secondary Care Service Areas

Dade Catoosa

Fannin

Towns Rabun

Murray

Union

Whitfield

White

Walker
Chattooga Gordon
Region 1

Gilmer

Habersham

Pickens

Lumpkin
Region

2

Stephens

7.7 Dawson

Banks Franklin

Hart

Below State Rate Above State Rate

6.8

Cherokee Forsyth Hall

Floyd

Bartow

Jackson Madison Elbert

GA Rate = 9.6 physicians per 100,000 population
U.S. Rate = 10.0 physicians

Polk

Cobb

Region 3 Paulding
Haralson

Gwinnett Barrow Clarke Oglethorpe

Dekalb

Walton Oconee

Wilkes

per 100,000 population Lincoln

9.4 Reg1io2n.05 Carroll

Douglas

Rockdale

Fulton Clayton

Newton

Morgan Greene Taliaferro

Columbia

McDuffie

Region 7 Coweta
Heard

Henry Fayette
Butts Spalding

Jasper

Warren Putnam
Hancock Glascock

Richmond

Region 4 19.9 Meriwether Pike Lamar Monroe 10.1 Region 6 Troup

Baldwin Jones

Jefferson Washington

Burke

Harris

Upson

Talbot

8.6 Bibb
Crawford

Wilkinson

Twiggs

Johnson Emanuel

Jenkins

Screven

Taylor

Peach

Muscogee
Region 8 Marion

Bleckley Laurens Houston

Treutlen

Bulloch Candler

Effingham

Region 9 Region 12 Chattahoochee

Macon

7.3 Schley

4.6 10.8 Stewart Webster

Sumter

Pulaski Dodge Dooly
Wilcox

Montgomery

Evans

Wheeler

Tatnall Toombs

Bryan Chatham

Crisp

Telfair

Liberty

Quitman

Terrell Lee

Randolph

Clay Calhoun Dougherty

Region 10

Early

Baker

9.2 Mitchell

Miller

Turner

Ben Hill

Jeff Davis Appling

Long

Worth Colquitt

Irwin

Coffee Bacon

Wayne

Tift Region 11

Pierce

Berrien 11.3

Cook

Atkinson

Ware

Brantley

McIntosh Glynn

Seminole Decatur

Grady Thomas Brooks

Lanier Lowndes

Clinch

Charlton

Camden

Echols

*State Service Delivery Regions; Effective July 1, 1998, the State Legislature voted to provide regional boundaries for the purpose of consistency in planning and service delivery from State Agencies.
6/08
According to the AAMC, the Center for Health Workforce Studies said in 2006: "There are concerns that the supply of board-certified emergency physicians may not be adequate to meet demand."
Between 1996 and 2006, the number of physicians practicing Emergency Medicine increased by 55.0%.
The rate of Emergency Medicine physicians per 100,000 population increased from 7.8 to 9.6 between in 1996 and 2006.
Georgia's rate of 9.6 Emergency Medicine physicians per 100,000 population was below the national rate of 10.0 in 2006.
Seven of the 12 Secondary Care Service Areas were below the state ratio of 9.6 Emergency Medicine physicians per 100,000 in 2006.

Orthopedic Surgery
An Orthopedic Surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical, and physical means. (Source: Association
of American Medical Colleges)

ORTHOPEDIC SURGERY Physician Distribution - 2006* by Secondary Care Service Areas

Dade Catoosa

Fannin

Towns Rabun

Murray

Union

Whitfield

White

Walker

Chattooga Gordon
Region 1

5.2

Floyd

Bartow

Gilmer

Habersham

Pickens

Lumpkin
Region

2

Stephens

6.2 Dawson

Banks Franklin

Hart

Cherokee Forsyth Hall

Jackson Madison Elbert

Below State Rate Above State Rate
GA Rate = 7.5 physicians per 100,000 population
U.S. Rate = 8.1 physicians

Polk Paulding
Haralson

Region 3 Cobb

Gwinnett Barrow Clarke Oglethorpe

Dekalb

Walton Oconee

Wilkes

7.7

Region 5

per 100,000 population Lincoln

Carroll

Douglas

Rockdale

Fulton Clayton

Newton

3.5 Morgan Greene Taliaferro

Columbia

McDuffie

Region 7 Coweta
Heard

Henry Fayette
Butts Spalding

Jasper

Warren Putnam
Hancock Glascock

Richmond

Reg4io.8n 4 Region 6 15.2 Troup Meriwether Pike Lamar Monroe

Baldwin Jones

Jefferson Washington

Burke

Harris

Upson

Talbot

8.2 Bibb
Crawford

Wilkinson

Twiggs

Johnson Emanuel

Jenkins

Screven

Taylor

Peach

Muscogee
Region 8 Marion

Houston Bleckley Laurens

Treutlen

Bulloch Candler

Effingham

Region 9 Region 12 Chattahoochee

Macon

9.3 Schley

3.3 8.7 Stewart Webster

Sumter

Pulaski Dodge Dooly
Wilcox

Montgomery

Evans

Wheeler

Tatnall Toombs

Bryan Chatham

Crisp

Telfair

Liberty

Quitman

Terrell Lee

Randolph

Clay Calhoun Dougherty
Region 10

Early

Baker
12.5Mitchell

Miller

Turner

Ben Hill

Jeff Davis Appling

Long

Worth Colquitt

Irwin

Coffee Bacon

Wayne

Tift Region 11

Pierce

Berrien 5.5

Cook

Atkinson

Ware

Brantley

McIntosh Glynn

Seminole Decatur

Grady Thomas Brooks

Lanier Lowndes

Clinch

Charlton

Camden

Echols

Between 1996 and 2006, the number of practicing Orthopedic Surgeons increased by 24.0%.
The rate of Orthopedic Surgeons per 100,000 Population decreased slightly from 7.6 in 1996 to 7.5 in 2006.
In comparison to Georgia's rate of 7.0, the national rate was 8.1 Orthopedic Surgeons per 100,000 Population in 2006.
Six of the 12 Secondary Care Service Areas were below the state rate of 7.5 Orthopedic Surgeons per 100,000 in 2006.

*State Service Delivery Regions; Effective July 1, 1998, the State Legislature voted to provide regional boundaries for the purpose of consistency in planning and service delivery from State Agencies.
6/08
Neurological Surgery
A Neurological Surgeon provides the operative and non-operative management of disorders of the central, peripheral, and autonomic nervous systems including the brain, spinal cord, peripheral nerves, and muscles, as well as the blood vessels that relate to these structures. (Source: Association of American Medical Colleges)

NEUROLOGICAL SURGERY Physician Distribution - 2006* by Secondary Care Service Areas

Dade Catoosa

Murray

Fannin

Towns Rabun

Union

Whitfield

White

Walker

Chattooga Gordon
Region 1

0.8

Floyd

Bartow

Gilmer

Habersham

Pickens

Lumpkin
Region

2

Stephens

0.7 Dawson

Banks Franklin

Hart

Cherokee Forsyth Hall

Jackson Madison Elbert

Below State Rate Above State Rate
GA Rate = 1.5 physicians per 100,000 population
U.S. Rate = 1.8 physicians

Polk

Cobb

Region 3 Paulding
Haralson

Gwinnett Barrow Clarke Oglethorpe

per 100,000 population

Dekalb

Walton Oconee

Wilkes Lincoln

1.7 Reg1io.2n 5 Carroll

Douglas

Rockdale

Fulton Clayton

Newton

Morgan Greene Taliaferro

Columbia

McDuffie

Region 7 Coweta
Heard

Henry Fayette
Butts Spalding

Jasper

Warren Putnam
Hancock Glascock

Richmond

Reg0io.0n 4 Region 6 5.1 Troup Meriwether Pike Lamar Monroe

Baldwin Jones

Jefferson Washington

Burke

Harris

Upson

Talbot

1.7 Bibb
Crawford

Wilkinson

Twiggs

Johnson Emanuel

Jenkins

Screven

Taylor

Peach

Muscogee
Region 8 Marion

Bleckley Laurens Houston

Treutlen

Bulloch Candler

Effingham

Region 9 Region 12 Chattahoochee

Macon

0.8 Schley

Pulaski Dodge

Montgomery

Evans

0.0 2.1 Stewart Webster

Sumter

Dooly Wilcox

Wheeler

Tatnall Toombs

Bryan Chatham

Crisp

Telfair

Liberty

Quitman

Terrell Lee

Randolph

Clay Calhoun Dougherty

Region 10

Early

Baker

2.0 Mitchell

Miller

Turner

Ben Hill

Jeff Davis Appling

Long

Worth Colquitt

Irwin

Coffee Bacon

Wayne

Tift Region 11

Pierce

Berrien 0.3

Cook

Atkinson

Ware

Brantley

McIntosh Glynn

Seminole Decatur

Grady Thomas Brooks

Lanier Lowndes

Clinch

Charlton

Camden

Echols

Between 1996 and 2006, the number of practicing Neurological Surgeons increased by 23.4%.
The rate of Neurological Surgeons per 100,000 Population remained the same during the period 1996 to 2006 (1.5). In comparison, the national rate was 1.8 Neurological Surgeons per 100,000 Population in 2006 (rate had no change between 2004 and 2006.
Seven of the 12 Secondary Care Service Areas were below the state rate of 1.5 Neurological Surgeons per 100,000 Population in 2006.
In 2006, 41.1% of the Neurological Surgeons were age 50+ and 12.4% were 60 and older.

*State Service Delivery Regions; Effective July 1, 1998, the State Legislature voted to provide regional boundaries for the purpose of consistency in planning and service delivery from State Agencies.
6/08

Comparison of Trauma Specialties by Year: 1996 2006

Total Physicians by Specialty and Rate*, 1996-2006

Specialty
Emergency Medicine General Surgery
Neurological Surgery Orthopedic Surgery

1996
7.8 9.6 1.5 7.6

1998
8.4 9.3 1.5 7.2

2000
8.9 9.4 1.3 6.8

2002
8.8 8.5 1.4 6.9

2004
9.6 8.4 1.5 7.0

2006
9.6 7.7 1.5 7.5

* Rate per 100,000 Population: Population for 1996-2006 came from the Governor's Office of Planning and Budget.

As shown in the above table, the overall rate of General Surgeons, and Orthopedic Surgeons per 100,000 Population was lower in 2006 than in 1996.
Emergency Medicine is the only listed trauma specialty that has seen an overall rate increase in the last decade.
MSA / Non-MSA Distribution of Trauma Specialists: 2006

Percentage of Total Physicians by Specialty Practicing in Metropolitan (MSA) and Non-Metropolitan (Non-MSA) Statistical
Areas 2006*

Specialty
Emergency Medicine General Surgery
Neurological Surgery Orthopedic Surgery

% Practicing in MSA 83.7 83.3 97.8 86.3

% Practicing in Non-MSA 16.9 16.7 2.2 13.7

* Source: 2006 physician license renewal data.

As shown in the table above, the majority of trauma physicians were practicing in MSA's in 2006.
In terms of Georgia's 2006 population, 81.1% of Georgians resided in MSA's and 18.9% lived in Non-MSA's.
Most large trauma centers/hospitals are located in MSA's, which explains the concentration of these physicians in urban areas. However, much of the state of Georgia is considered rural and hospitals in Non-MSA's are finding it increasingly difficult to ensure trauma physicians are available to serve Georgians in these respective geographic areas.

For more information, please contact the Georgia Board for Physician Workforce at (404) 206-5420 or 1718 Peachtree St, NW, Suite 683, Atlanta, Georgia 30309.