ANNUAL REPORT Fiscal Year 2016 (This page intentionally left blank.) 2 Table of Contents Introduction ........................................ 4 About the Board .................................... 5 Fiscal Overview .................................... 6 Board Administration ............................. 7 Undergraduate Medical Education .............. 8 Mercer SOM Operating Grant .................... 9 Morehouse SOM Operating Grant ............... 10 Graduate Medical Education ...................... 11 Physicians for Rural Areas ......................... 12 Outlook for FY 2017 ............................... 13 The Georgia Board for Physician Workforce strives to identify and meet the physician workforce needs of Georgia communities through the support and development of medical education programs. 3 Introduction Members of the General Assembly, the state's medical community and the general public: The Board members and staff are pleased to present the Fiscal Year 2016 Annual Report of the Georgia Board for Physician Workforce. Among the new year's highlights, the most notable item would be the change in the Board's leadership. After 30 years with the state and eight years as the executive director, Cherri Tucker retired at the end of March. The Board is appreciative of her contributions over the years to address the health care needs of Georgia. Additionally, in the Amended Fiscal Year 2016 budget, the General Assembly included one-time enhancement appropriations of $35,000,000 each to both Mercer and Morehouse schools of medicine. These funds were given to address specific needs and assist with new initiatives at the respective institutions. In this annual report, it is my great pleasure to recognize the hard work of the Board members, as well as the members of the Board's advisory committees. These men and women work tirelessly and without compensation to fulfill our mission. Their contribution of time represents no small sacrifice in itself; quarterly Board meetings alone can cost the typical physician Board member hundreds of dollars in lost revenue. Our state is fortunate to have these individuals as public servants. I must also thank the small but dedicated staff of the Board, who faced obstacles posed by budget cuts and increasing workloads, yet remained committed and determined to give excellent service to their fellow citizens. I am honored and humbled to serve with this group of committed individuals. Would you or someone you know want to know more about the Board and the important work we do to better the health care needs of rural Georgia? Then, please visit us online at http://gbpw.georgia.gov. The website is an invaluable resource for both health care professionals and interested consumers. LaSharn Hughes, MBA Executive Director 4 Hughes and Gov. Nathan Deal The Georgia Board for Physician Workforce works to see Georgia communities, especially in medically underserved areas, have improved access to needed physicians and other health care practitioners, thereby enhancing the health and wellbeing of Georgia's citizens. It fulfills this vision by identifying and meeting the health care workforce needs of Georgia communities through the support and development of medical education programs. The Board meets quarterly to address the challenges presented above. Although meetings times and location may vary, the majority of meetings are held at the Board's office in Atlanta. Agendas, minutes and additional meeting information can be found on the Board's website. Originally started in 1976 as the Joint Board of Family Practice, the Board changed its name to the Georgia Board for Physician Workforce in 1999. In 2011, the powers and duties of the State Medical Education Board were transferred to the GBPW. The Board is administratively attached to the Georgia Department of Community Health for certain functions such as budget and human resources. About the Board Members of the Board The Georgia Board for Physician Workforce is comprised of 15 members appointed by the Governor and confirmed by the State Senate. By law, the composition of the Board is to include five practicing primary care physicians, five practicing nonprimary care physicians, three hospital/health system executives and two consumer members. Of the 15-member board, eight members must be from a rural county. Mark G. Hanly, M.D. - Chairperson St. Simons B. Indran Indrakrishnan, M.D. Lawrenceville Jacinto del Mazo, M.D. - Vice-Chairperson David B. Kay, M.D. Atlanta Macon Antonio Rios, M.D. - Secretary/Treasurer William R. "Will" Kemp Gainesville Valdosta Carol H. Burrell Gainesville George M. McCluskey, III, M.D. Columbus W. Scott Bohlke, M.D. Brooklet Terri McFadden-Garden, M.D. Atlanta Steven Gautney Cordele William C. "Bill" Waters, IV, M.D. Carrollton Thomas L. Hatchett, Jr., M.D. Demorest Vacant (Hospital/health system exec.) Vacant (Consumer) Note: Roster of Board members as of December 2016. 5 Fiscal Overview The Georgia Board for Physician Workforce operates solely with a budget appropriated by the General Assembly. All state funding for medical education, with the exception of money appropriated through the Board of Regents, is administered by the GBPW. In FY 2016, the Board's appropriated budget was $132,275,747, with which the Board enhanced the health and well-being of Georgia's citizens through its programming. This appropriation comprises a 157.26 percent increase over the previous fiscal year's figure of $51,417,044. Overall, the Board saw increases in every program. The operating grants for Mercer University and Morehouse schools of medicine appear far greater than the FY 2015 figures, which is due to an increase of $35,000,000 to each school for one-time enhancements. Even without this appropriation, the Board received an increase of $10,858,703 over the previous fiscal year toward fulfilling its mission. Expenditures Program Administration Undergraduate Medical Education Mercer S.O.M. Operating Grant Morehouse S.O.M. Operating Grant Graduate Medical Education Physicians for Rural Areas Total FY 2016 $682,944 $2,119,068 $59,039,911 $58,971,870 $9,849,786 $1,435,574 $132,099,153 FY 2015 $581,650 $2,087,250 $22,769,911 $15,933,642 $8,852,837 $1,067,354 $51,292,644 Pct. change 17.41% 1.52% 159.29% 270.11% 11.26% 34.50% 157.54% FY 2016 Appropriation $1,560,000, 1% $9,890,440, 7% $694,458, 0% $2,119,068, 2% $58,971,870, 45% $59,039,911, 45% Administration Mercer S.O.M. Operating Grant Graduate Medical Education Undergraduate Medical Education Morehouse S.O.M. Operating Grant Physicians for Rural Areas 6 Board Administration* Budgeted Expended Balance Personal Services $473,070 $465,287.18 $7,782.82 Operating Expenses $221,388 $217,656.37 $3,731.63 Total $694,458 $682,943.55 $11,514.45 *Program's budget comprises 0.53 percent of the GBPW's total appropriation Percent Expended 98.35% 98.31% 98.34% Board Administration Accomplishments The Board and its staff work diligently to carry out the GBPW's mission. Below are a few highlights of the Board's work in FY 2016. Surveyed medical school graduates from Emory, MCG, Mercer, Morehouse and PCOM-GA Campus to determine factors that influence specialty choice and residency selection/location, and then produced Georgia Medical School Survey Report Surveyed graduates of all Georgia graduate medical education 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 physician residency program sites to help encourage residents to pursue in-state practice opportunities upon completion of GME training Completed the analysis of 2014 physician license renewal data to determine number, specialty mix, and distribution of physicians in Georgia Continued work on the analysis of the 2013-2015 physician assistant license renewal data to determine number, specialty mix and distribution of physician assistants in Georgia Developed and implemented the Dentists for Rural Areas Assistance Program, which provides service-cancellable loans of up to $25,000 per year in return for dental practice in an underserved, rural county in Georgia Staff LaSharn Hughes, MBA, Executive Director Daniel R. Dorsey, External A ffairs Coordinator Olive Jones-Golden, Contracts A dministrator Tommy Kelly, IT Support Specialist Audra Cochran, Medical Intern Freeman Montaque, Budget Manager Andrea Pass, Operations A nalyst Yvette Speight, Board Secretary 7 Undergraduate Medical Education 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. 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, which for this fiscal year was $2,119,068. For FY 2016, the contracts provided funding for up to 333 students (Mercer 210; Emory 113; and PCOM - 10). The capitation rate for FY 2016 was around $6,364 per student, which is the same rate from the past few fiscal years. The contracts stipulate that at least 50 percent 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 participating schools combined was 63.07 percent. The GBPW considers six specialties as "primary care and core specialties," which are: family medicine, internal medicine, pediatrics, obstetrics/gynecology, emergency medicine and general surgery. History of Undergraduate Medical Education Funding Fiscal Year Amount Appropriated Pct. Change over previous FY 2016 $2,119,068 1.52% 2015 $2,087,250 1.55% 2014 $2,055,432 -22.36% 2013 $2,647,228 -3.09% 2012 $2,731,636 0.00% 2011 $2,731,636 N/A Number of Medical Students Funded PCOM, 0 FY 2014 Emory, 113 Mercer, 210 FY 2015 PCOM, 5 FY 2016 PCOM, 10 0 50 Emory, 113 Emory, 113 100 150 Mercer, 210 Mercer, 210 200 250 8 Mercer SOM Operating Grant Number of medical students enrolled at Mercer University School of Medicine 440 432 430 420 420 416 410 400 400 390 387 380 370 360 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 Snapshot of graduates now Fiscal Year 2012 2013 2014 2015 2016 Percentage of graduates entering core 55.00% 66.00% 61.30% 66.66% 66.00% specialties Percentage of graduates practicing in 65.00% 66.08% 66.80% 61.72% 58.90% Georgia The purpose of the Mercer University School of Medicine Operating Grant is to educate physicians and health professionals to meet the primary care and health care needs of rural and medically underserved areas of Georgia. With 432 total students (all of whom are Georgia residents), Mercer SOM is spread over three campuses in Georgia: Macon, which houses the school's traditional campus; Savannah, which started as a clinical campus but is now a four-year campus; and Columbus, which is a clinical campus (includes third- and fourth-year students). There are several new initiatives at the school, including a rural health initiative ($250,000) and an expansion of the Primary Care Accelerated Track program ($1,020,000). The $35,000,000 one-time enhancement appropriation in the FY 2016 budget will help Mercer SOM explore new and innovative approaches to meeting the rural health challenges of our state. 9 Morehouse SOM Operating Grant The purpose of the Morehouse School of Medicine operating grant is to educate physicians and other health professionals to address primary healthcare needs with an emphasis on people of color and the underserved urban and rural populations in Georgia and the nation. With 297 total students (235 of whom are Georgia residents), Morehouse SOM's campus is located in Atlanta. New initiatives at the school include upgrades to the equipment and simulation labs, which was made possible through the $35,000,000 one-time enhancement appropriation in the FY 2016 budget. This additional investment from the state will allow the school to continue increasing the enrollment of the medical school and residency programs, as well as ensure increased access to innovative and critical health services for the citizens of our state. Snapshot of graduates now Fiscal Year 2012 2013 2014 2015 2016 Percentage of graduates entering core 66.00% 69.00% 65.80% 75.00% 70.90% specialties Percentage of graduates practicing in 46.30% 45.41% 46.74% 46.73% 47.00% Georgia Number of medical students enrolled at Morehouse School of Medicine FY 2016 FY 2015 FY 2014 FY 2013 FY 2012 0 294 274 249 236 230 50 100 150 200 250 300 350 10 Graduate Medical Education Residency Capitation, by the numbers Number of Residents Program Under Contract Residency Capitation 1,229 Family Medicine 232 Pediatrics 50 Preventative Medicine 10 General Surgery 4 Obstetrics/Gynecology 2 Internal Medicine 15 New Program Development N/A Total Capitation Rate $3,398.16 $18,754.85 $15,591.28 $8,073.30 $15,502.50 $15,333.00 $15,000.00 $185,000.00 Total Funds $4,176,341 $4,351,126 $779,564 $80,733 $62,010 $30,666 $225,000 $185,000 $9,890,440 FY 2016 GME Appropriation Residency Capitation Family Medicine Pediatrics Preventative Medicine General Surgery Obstetrics/Gynecology Internal Medicine New Program Development $30,666, 0% $62,010, 1% $80,733, 1% $779,564, 8% $4,351,126, 44% $225,000, 2% $185,000, 2% $4,176,341, 42% The Graduate Medical Education Program helps ensure an adequate supply of primary care and other needed physician specialists through partnerships with the state's designated teaching hospitals and GME (residency training) programs. The Board provides state funding to help offset the cost of training physicians in some of Georgia's teaching hospitals. The map to the right provides a snapshot of where all Board-funded GME programs throughout the state are located. In FY 2016, the Board provided $9,890,440 to 15 hospitals benefitting over 1,542 residents. 11 Physicians for Rural Areas 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. 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. Since 1990, this program has proven to retain talent here in Georgia. About 80 percent of the program's participants remained in Georgia to practice after completing their obligation. Additionally, around 60 percent of the participants continue to practice in a qualifying county. In FY 2016, the Board implemented the Dentists for Rural Areas Assistance Program, which is the dental version of the PRAA and is similar in program structure and requirements to the PRAA. Physicians for Rural Areas, FY 2016 Budget $180,000 $200,000 $680,000 $200,000 $300,000 Country Doctor Scholarship Georgia Physician Loan Repayment Program Physicians for Rural Areas Assistance Dentists for Rural Areas Assistance Program FM Accelerated Track Program Program Country Doctor Scholarship Georgia Physician Loan Repayment Physicians for Rural Areas Assistance Dentists for Rural Areas Assistance Family Medicine Accelerated Track Total 12 Expended Balance Percent Expended $200,000.00 $0.00 100.00% $249,999.50 $50,000.50 83.33% $655,574.99 $24,425.01 96.41% $200,000.00 $0.00 100.00% $180,000.00 $0.00 100.00% $1,435,574.49 $124,425.51 92.02% Outlook for FY 2017 The Board has been hard at work toward initiatives and goals for FY 2017. Some of which include: Further develop the Dentists for Rural Areas Assistance Program, which provides service-cancellable loans of up to $25,000 per year in return for dental practice in an underserved, rural Georgia county (maximum of four years) Implement both the Physician Assistant and the Advanced Practice Registered Nurse loan repayment programs, which will provide service-cancellable loans of up to $10,000 per year for any outstanding medical education loan debt in return for practicing in an underserved, rural Georgia county (maximum of four years) Draft additional reports on the supply, distribution and specialty mix of health care practitioners in the state Provide the contact information of recruiters of Georgia hospitals on the Board's website to better connect resident physicians with in-state practice opportunities Roll out new data visualization tools on the Board's website via the state's partnership with Georgia Interactive The Board's website contains a wealth of information on physician workforce needs in Georgia. Copies of any report published by the Board, including previous annual reports, are accessible on the Board's website. Questions? Comments? Concerns? Feel free to reach out! 2 Peachtree Street, NW 36th Floor Atlanta, Georgia 30303 (404) 232-7972 http://gbpw.georgia.gov/ GBPW@dch.ga.gov 13