Fact sheet on Georgia's trauma physicians

Georgia Board for Physician Workforce Fact Sheet on Georgia's Trauma Physicians
April 2011

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.

The State of Georgia's Trauma Network

According to the Georgia Statewide Trauma Action Team, nearly 45 million Americans do not have access to a Level l or ll trauma center within one hour of being injured. That is equal to populations of Arizona, New Mexico, Texas, Louisiana, Mississippi, and Alabama combined. The Governor's Office of Highway Safety reported one in seven fatal car crashes in Georgia took place at least 50 miles away from the closest trauma center.
(www.gohs.state.ga.us)

While most injuries can be treated at a local emergency department, if you are severely injured, getting care at a Level 1 trauma center can lower your risk of death by 25%. (Source: Access to Trauma
Centers in the United States; U.S. Department of Health and Human Services Centers for Disease Control and Prevention; Sept 2009; www.cdc.gov/traumacare)

Currently, there are 18 designated trauma centers. Georgia should have approximately 25 to 30 trauma centers in strategic locations to adequately address the emergency and preparedness needs. Meeting the national average would result in 700 fewer deaths a year. (Source: Georgia Trauma Care Network
Commission, www.georgiatraumacommission.org)

As displayed in the map to the left, vast stretches of south Georgia are 50 miles or more from the nearest trauma center. (Source: Georgia Statewide Trauma Action Team
http://www.ciclt.net/sn/adm/editpage.aspx?ClientCode=dhrtn&FileNa me=Trauma_Map.txt)


Most Frequent Causes of Traumatic Injuries

The map was the most recent available at the time of this publication. Three additional trauma centers have been designated (a Level II center in Clarke County, a Level IV center in Pulaski County, and a Level IV center in Wheeler County).

Georgia's death rate from traumas (usually the result of car crashes, work accidents, and falls) is significantly higher than the national average: 63 of every 100,000 people compared to the national average of 56 per 100,000. This rate is 20% higher than the national average. (Source: Georgia Trauma Care Network Commission,
www.georgiatraumacommission.org.)
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. However, in 2008 the rate dropped to 80.9. (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 and 2008 (182.3 and 187.7 respectively). (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 - 2008 Deficit, Adequate, and Surplus PCSAs*

4 6 Dade

Catoosa Whitfield

Fannin

Towns Rabun Union

1 2 3 5 7 Deficit Walker 8 Adequate Chattooga
18 1167 1145 1312 11 10 9 2829 Surplus Floyd

Murray Gordon
Bartow

Gilmer

White Habersham

Pickens

Lumpkin

Dawson

Cherokee Forsyth Hall

Stephens Banks Franklin Hart

Jackson

Elbert

Madison

GA Rate = 7.7 physicians per 100,000 population

27 Polk 21Cobb
Paulding
25 Haralson

Gwinnett Dekalb

Barrow Clarke Oglethorpe

Walton Oconee

Wilkes

Lincoln

U.S. Rate = 12.5 physicians per 100,000

19 20 22 23 24 26 34 30 31 Carroll

Douglas Fulton Clayton

Rockdale Newton Morgan

Greene

Taliaferro

Columbia

McDuffie

41 40339738 36 35 33 32 Heard

Fayette Coweta

Henry

Jasper

Spalding Butts

Putnam

Warren Hancock Glascock

Richmond Burke

42 50 Meriwether Pike Lamar Monroe 47 49 Troup

Baldwin Jones

Jefferson 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

Macon Houston

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

70 Quitman

Terrell Lee

Randolph

Ben Hill

Turner

87

59Montgomery 58 Wheeler

56 Evans Tattnall

Toombs

Telfair
61

Jeff Davis
89

Appling
91

Long
92

52 Bryan Chatham
Liberty

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 2008.

Emergency Medicine

Overall, from 1998 to 2008, the number of practicing General Surgeons in Georgia has increased from 708 to 730 (3.1%).
The growth in General Surgeons has not kept pace with the rapid growth in population. The rate of General Surgeons per 100,000 population was 9.3 in 1998 compared to 7.7 in 2008. The national rate in 2008 was 12.5 General Surgeons per 100,000 population. (National Rate Source: AMA Physician Characteristics and
Distribution in the U.S., 2010 edition.)
General Surgery shows a deficit in 25 of the 96 Primary Care Service Areas of Georgia (2008). This is 26.0% of the PCSAs in Georgia in 2008. (Twenty-two PCSAs have no General Surgeon.)
According to the American College of Surgeons, each year there are more surgical residency positions offered nationally than students waiting to apply.

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 - 2008* by Secondary Care Service Areas

Dade Catoosa

Fannin

Towns Rabun

Murray

Union

Whitfield

White

Walker
Chattooga Gordon
Region 1 Floyd5.6 Bartow

Gilmer

Habersham

Lumpkin
Region

2

Stephens

Pickens Dawson

8.3 Banks Franklin Hart

Cherokee Forsyth Hall

Jackson Madison Elbert

Below State Rate Above State Rate
GA Rate = 9.7 per 100,000 population

Region 3 Polk

Cobb

Paulding Haralson

Gwinnett Barrow Clarke Oglethorpe

Dekalb

Walton Oconee

Wilkes

Carroll

Douglas

9.6

Fulton Clayton

Region 5

Rockdale

Mor1ga0n .2Greene

Newton

Taliaferro

US Rate = population
Lincoln
Columbia McDuffie

10.5

per

100,000

Region 7 Coweta
Heard

Henry Fayette
Butts Spalding

Jasper

Warren Putnam
Hancock Glascock

Richmond

Reg9io.6n 4 Region 6 19.6 Troup Meriwether Pike Lamar Monroe

Baldwin Jones

Jefferson Washington

Burke

Harris

Upson

Talbot

9.5 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

7.3 Schley

9.4 11.1 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

9.1 Mitchell

Miller

Turner

Ben Hill

Jeff Davis Appling

Long

Worth Colquitt

Irwin

Coffee Bacon

Wayne

Tift Region 11

Pierce

Berrien 10.3

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.

The AAMC Center for Health Workforce Studies reported a substantial shortage of non-primary care specialists. They project the U.S. will face a shortage of 33,100 physicians in specialties such as Emergency Medicine, Cardiology and Oncology. These projections are 50% worse than originally anticipated prior to health care reform.
Between 1998 and 2008, the number of physicians practicing Emergency Medicine increased from 643 to 921 (43.2%).
The rate of Emergency Medicine physicians per 100,000 population increased from 8.4 to 9.7 between 1998 and 2008.
Georgia's rate of 9.7 Emergency Medicine physicians per 100,000 population was below the national rate of 10.5 in 2008. (National Rate Source: AMA Physician Characteristics and Distribution
in the U.S., 2010 edition.)
Eight of the 12 Secondary Care Service Areas were below the state ratio of 9.7 Emergency Medicine physicians per 100,000 population in 2008.

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 - 2008* by Secondary Care Service Areas

Dade Catoosa

Murray

Fannin

Towns Rabun

Union

Whitfield

White

Walker
Chattooga Gordon
Region 1 Floyd4.6 Bartow

Gilmer

Habersham

Pickens

Lumpkin
Region

2

Stephens

6.6 Dawson

Banks Franklin

Hart

Cherokee Forsyth Hall

Jackson Madison Elbert

Below State Rate Above State Rate
GA Rate = 7.2 physicians per 100,000 population

Polk

Cobb

Region 3 Paulding
Haralson

Gwinnett Barrow Clarke Oglethorpe

Dekalb

Walton Oconee

Wilkes

US Rate = 8.2 physicians per 100,000 population
Lincoln

7.5 Reg3io.7n 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

Reg4io.4n 4 Region 6 13.3 Troup Meriwether Pike Lamar Monroe

Baldwin Jones

Jefferson Washington

Burke

Harris

Upson

Talbot

8.9 Bibb
Crawford

Wilkinson

Twiggs

Johnson Emanuel

Jenkins

Screven

Taylor

Peach

Muscogee

Bulloch

Region 8 Marion

Bleckley Laurens Houston

Treutlen

Candler

Effingham

Region 9 Region 12 Chattahoochee

Macon

11.2 Schley

3.9 7.7 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
10.4Mitchell

Miller

Turner

Ben Hill

Jeff Davis Appling

Long

Worth Colquitt

Irwin

Coffee Bacon

Wayne

Tift Region 11

Pierce

Berrien 5.1

Cook

Atkinson

Ware

Brantley

McIntosh Glynn

Seminole Decatur

Grady Thomas Brooks

Lanier Lowndes

Clinch

Charlton

Camden

Echols

Between 1998 and 2008, the number of practicing Orthopedic Surgeons increased from 550 to 688 (a 25.1% increase).
The rate of Orthopedic Surgeons per 100,000 population remained level at 7.2 in 1998 and 2008.
In comparison to Georgia's rate of 7.2, the national rate was 8.2 Orthopedic Surgeons per 100,000 population in 2008.
(National Rate Source: AMA Physician Characteristics and Distribution in the U.S., 2010 edition.)
Six of the 12 Secondary Care Service Areas were below the state's rate of 7.2 Orthopedic Surgeons per 100,000 in 2008.

*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.

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 - 2008* by Secondary Care Service Areas

Dade Catoosa

Murray

Fannin

Towns Rabun

Union

Whitfield Walker

Gilmer

White Habersham

Chattooga Gordon
Region 1
Floyd0.7 Bartow

Pickens

Lumpkin
Region

2

Stephens

0.8 Dawson

Banks Franklin

Hart

Cherokee Forsyth Hall

Jackson Madison Elbert

Below State Rate Above State Rate
GA Rate = 1.4 physicians per 100,000 population US Rate = 1.8 physicians per 100,000

Polk

Cobb

Region 3 Paulding
Haralson

Gwinnett Barrow Clarke Oglethorpe

population

Dekalb

Walton Oconee

Wilkes Lincoln

1.4 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 3.9 Troup Meriwether Pike Lamar Monroe

Baldwin Jones

Jefferson Washington

Burke

Harris

Upson

Talbot

2.1 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

1.1 Schley

Pulaski Dodge

Montgomery

Evans

0.0 2.2 Stewart Webster

Sumter

Dooly

Wilcox

Wheeler

Tatnall Toombs

Bryan Chatham

Crisp

Telfair

Liberty

Quitman

Terrell Lee

Randolph

Clay Calhoun Dougherty

Region 10

Early

Baker

2.2 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

*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.

Between 1998 and 2008, the number of practicing Neurological Surgeons increased from 117 to 131 (12.0%).
The rate of Neurological Surgeons per 100,000 population decreased from 1.5 to 1.4 Neurological Surgeons between 1998 and 2008. The national rate was 1.8 Neurological Surgeons per 100,000 population in 2008. (National Rate Source: AMA
Physician Characteristics and Distribution in the U.S., 2010 edition.)
Seven of the 12 Secondary Care Service Areas were below the state rate of 1.4 Neurological Surgeons per 100,000 population in 2008.
In 2008, 51.1% of the Neurological Surgeons were age 50+ and 14.5% were 60 and older.

Comparison of Trauma Specialties by Year: 1998 2008
As shown in the table below, the overall rate of General Surgeons and Neurological Surgeons per 100,000 population was lower in 2008 than in 1998.
Emergency Medicine is the only listed trauma specialty that has seen an overall rate increase in the last decade.
Orthopedic Surgery has fluctuated slightly during the ten year period, but the rate of 7.2 Orthopedic Surgeons per 100,000 population was the same in 1998 and 2008.

Total Physicians by Specialty and Georgia Rate*, 1998-2008

Specialty
Emergency Medicine General Surgery
Neurological Surgery Orthopedic Surgery

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

2008
9.7 7.7 1.4 7.2

* Rate per 100,000 Population: Population for 1998-2008 came from the Governor's Office of Planning and Budget.

Residency Training Positions in Trauma Specialties: 2010-2011
As shown in the table below, there is at least one teaching hospital in Georgia that trains physicians in each of the trauma specialties.
Both Emory University School of Medicine and the Medical College of Georgia at Georgia's Health Sciences University have residency training programs in all four trauma-related specialties.

ACGME Approved Residency Training Positions in Georgia For Trauma Specialties 2010-2011

General Surgery Emergency Medicine Orthopedic Surgery Neurological Surgery

Atlanta Emory Medical Ctr Medical Univ. Sch Central Center Medicine Georgia

16

70

20

-

66

-

15

25

-

-

21

-

MCG
28 30 15 11

Memorial Morehouse Health School of Medicine

20

22

Total Approved
176

-

-

96

-

-

55

-

-

32

"-" Indicates there is no corresponding residency program at that hospital for the respective specialty.

MSA / Non-MSA Distribution of Trauma Specialists: 2008

Percentage of Total Physicians by Specialty in Georgia Practicing in Metropolitan (MSA) and Non-Metropolitan (Non-MSA)
Statistical Areas 2008*

Specialty
Emergency Medicine General Surgery
Neurological Surgery Orthopedic Surgery

% Practicing in MSA 84.0 83.3 96.2 86.2

% Practicing in Non-MSA 16.0 17.0 3.8 13.8

* Source: 2008 physician license renewal data.

As shown in the table above, the majority of trauma physicians were practicing in MSA's in 2008.

In terms of Georgia's 2008 population, 81.2% of Georgians resided in MSA's and 18.8% lived in Non-MSA's.

Thirteen of 18 trauma centers/hospitals are located in MSA's. No Level I trauma centers are located in a Non-MSA. The table below provides the name, location, and trauma level designation for Georgia's 18 trauma hospitals.

A significant population base is required to ensure the economic feasibility of establishing practice in a trauma specialty. For this reason, trauma physicians are mostly in the MSA's and not as widely distributed throughout the state.

Georgia Trauma Centers By Location and Level

Hospital & Location Grady Atlanta Medical Center of Central GA Macon MCG Health Augusta Memorial Health Savannah Archbold Memorial Thomasville Athens Regional* Athens Atlanta Med. Center Atlanta CHOA at Egleston Atlanta CHOA at Scottish Rite Atlanta Columbus Regional Columbus Floyd Med. Center Rome Gwinnett Med. Center - Lawrenceville Hamilton Med. Center Dalton North Fulton Regional - Roswell Walton Regional Monroe Morgan Memorial Madison Taylor Regional* - Hawkinsville Lower Oconee Comm. Hosp* - Glenwood

Level I
X X X X

Level II

Level III Level IV

X X X X X X X X X X
X X X X

* Three of the centers included in this table are not reflected on the map on the first page of the fact sheet. The Georgia Trauma Care Network Commission anticipates an updated map will be available in July 2011.
Source: Georgia Trauma Care Network Commission.

Georgia Board for Physician Workforce 1718 Peachtree St., N.W., Suite 683, Atlanta, Georgia 30309, (404) 206-5420 www.gbpw.georgia.gov Cherri Tucker, Executive Director. Colette Caldwell, Carla Graves, Kelly McNamara, and G.E. Alan Dever, M.D., Ph.D., contributors.