Annual report, fiscal year 2015

Annual Report FY 2015
Cherri Tucker Executive Director
Meeting the health care workforce needs of Georgia communities through the support and development
of medical education programs
2 Peachtree St., NW, 36th Floor, Atlanta, GA 30303-3141 (404) 232-7972, FAX (404) 656-2596 e-mail: gbpw@dch.ga.gov or visit www.gbpw.georgia.gov

Purpose of the Georgia Board for Physician Workforce
The purpose of the Board as specified in O.C.G.A. 49-10-2 is to address the health care workforce needs of Georgia communities through the support and development of medical education programs and to increase the number of physicians and health care practitioners practicing in underserved rural areas. Powers, duties, and responsibilities of the Board as cited in O.C.G.A. 49-10-3 include:
Locate and determine specific underserved areas of the state in which unmet priority needs exist for physicians and health care practitioners by monitoring and evaluating the supply and distribution of physicians and health care practitioners by specialty and geographical location;
Award service cancelable loans and scholarships pursuant to Part 6 of Article 7 of Chapter 3 of Title 20, Chapter 34 of Title 31, or as otherwise provided by law;
Approve and allocate state appropriations for family medicine training programs, including but not limited to, fellowships in geriatrics and other areas of need as may be identified by the Board;
Approve and allocate state appropriations for designated pediatric training programs;
Approve and allocate any other state funds appropriated to the Georgia Board for Physician Workforce to carry out its purposes;
Coordinate and conduct with other state, federal, and private entities, as appropriate, activities to increase the number of graduating physicians who remain in Georgia to practice with an emphasis on medically underserved areas of the state;
Apply for grants, solicit and accept donations, gifts, and contributions from any source for the purposes of studying or engaging one or more contractors to study issues relevant to medical education or implementing initiatives designed to enhance the medical education infrastructure of this state and to meet the physician workforce needs of Georgia communities; and,
Carry out any other functions assigned to the Board by general law.
Additional services provided by the Board include:
Operation of a statewide information clearinghouse to promote placement and retention of physicians in Georgia. The clearinghouse includes information on physicians looking for jobs as well as information on communities, health systems, and/or individual medical practices seeking physicians.
Study of critical issues impacting Georgia's physician workforce and medical education infrastructure.
Organization
The Board was originally established in 1976 as a special purpose board (The Joint Board of Family Practice). In recognition of the broadened responsibilities of the Board, the Statute 1

governing the Joint Board of Family Practice was amended through the passage of Senate Bill 533. Effective July 1, 1998, the Joint Board of Family Practice became the Georgia Board for Physician Workforce (GBPW). While the programs administered did not change, the Board membership was modified and the agency's purpose was broadened.
The Georgia Board for Physician Workforce is comprised of fifteen members: five primary care physicians (at least three shall be from rural areas); five non-primary care physicians (at least three shall practice in rural areas); three representatives of hospitals which are not teaching hospitals (including two rural, non-profit hospital representatives); one business community representative; and one consumer member with no connection to the practice of medicine. The physicians on the Board represent a diversity of medical disciplines. Members are appointed by the Governor and confirmed by the Senate for six-year terms.
The Medical Education Advisory Committee (MEAC) was created in August 1997 to advise the Georgia Board for Physician Workforce on medical education and physician workforce issues. This Committee is the only forum of its kind in the state that brings medical education leaders together on a regular basis. The Committee is comprised of the Deans from the Medical Schools (or their designee) as well as the CEO's (or designated representative) from each of Georgia's teaching hospitals. The Committee meets as needed.
Georgia Board for Physician Workforce staff includes the Executive Director and seven funded positions, two of which are vacant.
The Georgia Board for Physician Workforce is an independent state board attached to the Department of Community Health for administrative purposes only.
Georgia Board for Physician Workforce as a Model For Other States
Over the last several years, legislative and programmatic leaders from three Florida, Mississippi, and New Jersey, have contacted the GBPW. Each of these states consider Georgia's Physician Workforce Board to be a model to learn from and build upon. Representatives from these states were interested in learning about the Agency's purpose, structure, responsibilities, and services.
Reasons the representatives cited for contacting the GBPW: Recognized as a leader in physician workforce analysis.
Experience with GME new program development.
Effective working relationships with public and private medical schools and teaching hospitals throughout the state.
Board's efforts to promote stewardship and ensure accountability for state funds. Contract deliverables and reporting guidelines have been implemented to ensure state funds are spent as intended and that desired results are achieved. The GBPW has a policy of assessing funding reductions/penalties if deliverables are not met.
2

Financial Information
The GBPW budget is comprised of 100% state funds. All state funding for medical education, with the exception of money appropriated through the Board of Regents, is administered by the GBPW.
Actual FY 2015 expenditures for the GBPW totaled $51,292,644. The breakdown by category is shown in the following graph.
Georgia Board for Physician Workforce FY 2015 Expenditures

$8,852,837 (17.26%)

$581,650 $2,087,250

(1.13%)

(4.07%)

$15,933,642 (31.07%)

$1,067,354 (2.08%)

$22,769,911 (44.39%)

Administration Mercer Op Grant Morehouse Op Grant

UME Physicians for Rural Areas GME

Accomplishments
Surveyed medical school graduates from Emory, MCG, Mercer, Morehouse, and PCOM-GA Campus to determine factors that influence specialty choice and residency selection/location. Produced Georgia Medical School Survey Report.
Surveyed graduates of all Georgia Graduate Medical Education (GME) programs and produced a GME Exit Survey Report to inform the medical education community and state physician workforce planners about the experiences of graduates and demand for new physicians in Georgia.
Held practice opportunity fairs at residency sites to help encourage residents to stay in-state to practice upon completion of training.
Continued work with GTA on a web-based physician recruitment program. Started the analysis of 2014 physician license renewal data to determine number, specialty mix,
and distribution of physicians in Georgia. Started the analysis of the 2013 physician assistant license renewal data to determine number,
specialty mix and distribution of physician assistants in Georgia.

3

Undergraduate Medical Education (UME)
State funding for undergraduate medical education helps ensure an adequate supply of primary care and other needed physician specialists through public/private partnerships with three of Georgia's private medical schools (Mercer, Emory and PCOM-GA Campus). The GBPW considers six specialties as "primary care and core specialties." They are: family medicine, internal medicine, pediatrics, obstetrics/gynecology, emergency medicine, and general surgery.
Medical School Operating Grants
Mercer University School of Medicine The State of Georgia, through the Georgia Board for Physician Workforce, contracts with the Mercer University School of Medicine (MUSM) as a means of increasing the supply of primary care physicians for Georgia. The mission of the School is to educate physicians and health professionals to meet the primary care and healthcare needs of rural or medically underserved areas of Georgia. During the five year period FY 2011 - FY 2015, 61.3% of Mercer graduates entered a primary care or core specialty residency program.
First accredited in 1982, Mercer has demonstrated their success in training and retaining primary care physician in Georgia. The School only accepts Georgia residents and conducts extensive interviews to ensure students are likely to pursue a career in primary care and practice in Georgia. Additionally, Mercer University has expanded in response to Georgia's physician shortage. Mercer's Savannah campus now serves as a 4-year school and the Columbus Campus serves as a clinical campus for 3rd and 4th year students.
Fifty-eight percent (58.69%) of Mercer alumni in practice as of June 30, 2014 are in Georgia. Practice locations for Mercer graduates are shown in the map on page 11.
Morehouse School of Medicine The State of Georgia, through the Georgia Board for Physician Workforce, contracts with Morehouse School of Medicine (MSM) as a means of increasing the supply of primary care and under-represented minority physicians. The MSM concentrates its efforts on training primary care physicians in order to address the disproportionate shortage of health care resources in poor and minority communities (principally inner cities and rural areas). During the five year period FY 2011 - FY 2015, 65.8% of Morehouse graduates entered a primary care or core specialty residency program.
The MSM was accredited by the LCME in 1983 to award the M.D. degree beginning with the class of 1985. Today, MSM is one of seven institutions in the Atlanta University Center - the world's largest consortium of historically black institutions of higher education. MSM is one of only four predominantly black medical institutions in the country.
Morehouse is currently executing a class size expansion. The new slots created by the expansion will be reserved for Georgia residents in an effort to increase the pool of physicians more likely to remain in Georgia.
Forty-five percent (45.6%) of Morehouse alumni in practice as of June 30, 2014 are in Georgia. Practice locations for Morehouse graduates are shown in the map on page 12.
4

Medical Student Capitation Program
The Medical Student Capitation Program provides funding to Mercer University School of Medicine, Philadelphia College of Osteopathic Medicine-GA campus, and Emory University School of Medicine for a designated number of Georgia residents enrolled in each medical school. The level of funding is determined by the General Assembly. For FY 2015, the contracts provided funding for up to 328 students (Mercer 210; Emory 113; and PCOM - 5). The capitation rate for FY 2015 was $6,364 per student. The contracts stipulate that at least 50% of the graduates enter a primary care or core specialty. Over the last five years, the rate of graduates entering primary care and core specialties for the three schools combined was 61.9%.
Graduate Medical Education (GME)
The Graduate Medical Education Program of the GBPW helps ensure an adequate supply of primary care and other needed physician specialists through partnerships with Georgia's designated teaching hospitals and graduate medical education (residency training) programs.
Family Medicine Residency Capitation
The Georgia Board for Physician Workforce administers state appropriated funds for accredited Family Medicine Residency Programs. Funds are distributed based on a capitation formula and go to offset the cost of training family physicians for Georgia. Since its creation, the GBPW has played a key role in increasing the number of Family Medicine Residency Programs from four to twelve. In FY 2015, funding was provided for a total of 227 family medicine residents. The annual capitation rate was $18,255 per resident.
It has been documented that graduates of residency training programs often establish practice within a hundred mile radius of their training program. To better target Georgia's areas of need, programs have been strategically placed throughout the state. These programs are:
# Morehouse School of Medicine (Atlanta) # Emory University School of Medicine (Atlanta) # Phoebe Putney Memorial Hospital (Albany) # Medical College of Georgia at GRU (Augusta) # Midtown Medical Center (Columbus) # Gwinnett Medical Center (Lawrenceville) # Navicent Health (Macon) # Atlanta Medical Center (Morrow/Atlanta) # Floyd Medical Center (Rome) # Memorial Health University Medical Center (Savannah) # Mayo Clinic Health System (Waycross) # Houston Medical Center (Warner Robins)
5

Pediatric Residency Capitation
Funding for designated pediatric training programs was initiated in Fiscal Year 1996 by Georgia's General Assembly. Although the Medical College of Georgia and Emory University School of Medicine have had long-standing programs in pediatrics, the need for this specialty continues to be great.
To address the specific need for pediatricians in south Georgia, funds were provided to establish Pediatric Residency Programs at Memorial Medical Center in Savannah and the Medical Center of Central Georgia in Macon. In recent years, funds have also been given to the Pediatric Residency Program at Morehouse School of Medicine.
Like the Family Medicine Capitation funding, the Pediatric Capitation funds are intended to help offset the high cost of training a physician. Funds for the Program are distributed based on a per resident capitation formula. In FY 2015, funding was provided for a total of 50 pediatric residents. The annual capitation rate was $15,591 per resident.
Pediatric Residency Programs funded through the GBPW: # Morehouse School of Medicine (Atlanta) # Navicent Health (Macon) # Memorial Health University Medical Center (Savannah)
Preventive Medicine Residency Capitation
Funding for designated Preventive Medicine Residency Programs was initiated in FY 2000 by Georgia's General Assembly. Preventive Medicine Residency Capitation funds are intended to help offset the high cost of training public health physicians. Funds for the Program are distributed based on a per resident capitation formula. In FY 2015, funding was provided for a total of 10 preventive medicine residents. The annual capitation rate was $7,573 per resident.
Preventive Medicine Programs funded through the GBPW: # Morehouse School of Medicine (Atlanta) # Emory University School of Medicine (Atlanta)
General Surgery Residency Capitation
Funding for the expansion of the General Surgery Residency Program at Navicent Health in Macon was initiated in FY 2009 in recognition of the need for more General Surgeons. In FY 2015, the GBPW provided capitation funding for four General Surgery residents. The per resident capitation rate for these residents was $15,002.
6

Obstetrics/Gynecology Residency Capitation
Funding for the expansion of the Obstetrics/Gynecology Residency Program at Memorial Health University Medical Center in Savannah was initiated in FY 2009 in recognition of the need for more OB/GYN physicians. In FY2015, the GBPW provided capitation funding for two residents. The capitation rate was $14,833 per resident.
Residency Capitation
Residency Capitation funds are provided to public and designated teaching hospitals in recognition of their commitment to training physicians for Georgia and to help offset the cost of sponsored medical education programs. Rather than being limited to primary care, Residency Capitation funding is provided for all specialties. The rate per resident is based on the annual appropriation divided by the actual number of residents in training.
In FY 2015, funding was provided for approximately 1,220 residents. The capitation rate was approximately $2,896 per resident.
Residency Capitation funds are provided to the following institutions: # Grady Memorial Hospital (Atlanta) # Atlanta Medical Center (Atlanta) # Phoebe Putney Memorial Hospital (Albany) # MCG Health, Inc. (Augusta) # Midtown Medical Center (Columbus) # Gwinnett Medical Center (Lawrenceville) # Navicent Health (Macon) # Floyd Medical Center (Rome) # Memorial Health University Medical Center (Savannah) # Mayo Clinic Health System (Waycross) # Houston Medical Center (Warner Robins)
Physicians for Rural Areas Assistance Loan Repayment Program
The purpose of the Physicians for Rural Areas Assistance Program is to increase access to high quality medical care for medically underserved rural communities in Georgia.
The Physicians for Rural Areas Assistance Program pays medical education student loan debt for physicians who agree to practice medicine full time in a rural community in Georgia. The program provides up to $25,000 a year in student loan repayment in return for a 12-month commitment to practice in a rural community. Recipients may receive a maximum of four loans and a maximum total student loan repayment of $100,000. Contractual default provision double damages.
7

The Physicians for Rural Areas Assistance Contract requires a commitment to practice medicine a minimum of 40 clinical hours per week in a Georgia County with a population of 35,000 or fewer people according to the 2010 Census Count of the United States Bureau of the Census. The practice time requirement can be split between two or more counties, provided that none of the practice location counties exceeds the 35,000 population limit.

Historical Reflection of PRAA

FY2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015

NEW APPLICANTS
23 15 15 16 07 15 19 21

RENEWALS APPLICANTS
17 25 14 17 11 13 19 12

NEW AWARDS/ RENEWAL AWARDS
15/9 7/15 7/10 5/8 6/11 10/7 6/12 12/12

# FUNDED/AMOUNT
24/$480,000 22/$440,000 17/$340,000 13/$260,000 17/369,920 17/$340,000 18/$360,000 24/$590,000

A review of the Loan Repayment Program from 1990 to 2013 shows:
A total of 171 participants, with 143 (83.6%) of the participants remained in Georgia to practice after completing their obligation; 86 (60.1%) remained in a qualifying county (population 35,000 or less); and The 143 physicians remaining in Georgia have produced approximately 1,859 jobs and will yield between $107and $215 million in economic activity.

8

Georgia's Medical Schools, Community Based Teaching Hospitals, and Clinical Campuses

MCG Clinical Campus

Floyd Medical Center

Emory University School of Medicine

Grady Hospital
Morehouse School of Medicine
Atlanta Medical Center- Family Medicine Center
Navicent Health
Mercer University School of Medicine-
Macon Campus
Midtown Medical Center, Columbus Regional Medical
Center

Philadelphia College of Osteopathic Medicine
GRU-UGA Medical Partnership Campus
Georgia Regents Health System
Medical College of Georgia at Georgia Regents University
Memorial Health University Medical
Center
Mercer University School of MedicineSavannah Campus
MCG Clinical Campus

Mercer University Columbus Clinical Campus

Phoebe Putney Memorial Hospital

Satilla Regional Medical Center
MCG Clinical Campus

Legend:

Medical Schools

Community Based Teaching Hospitals

Clinical Campuses

9

10

(1) GME New Program Development funding was expended for residency training in FY2014 GBPW budget in the amount of $308,000.
(2) Figures do not include personal services or other operating expenditures.

Mercer University School of Medicine Alumni in Practice as of June 30, 2014*
*Review of graduates from 1986 2011 11

Morehouse School of Medicine Alumni in Practice as of June 30, 2014*
* Review of graduates from 1980 - 2011 12