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.