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.