ANNUAL REPORT Fiscal Year 2018 (This page has been 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 2019 ............................... 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 The Board members and staff are pleased to present the Fiscal Year 2018 Annual Report of the Georgia Board for Physician Workforce (GBPW). Among the new year's highlights, most notably would be launching an interactive data visualization tool on the GBPW website to display physician workforce metrics and information for all Georgia counties. The project was in collaboration with the Georgia Technology Authority and the Georgia Composite Medical Board. Additionally, House Bill 769 created a new grant program that would provide malpractice insurance premium assistance for physicians that practice in certain rural counties. The bill implemented recommendations from the House Rural Development Council, which is a two-year legislative working group committed to addressing challenges faced in rural Georgia. 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, and our state is fortunate to have these individuals as public servants. I must also thank the dedicated staff of the Board, who are 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 LaSharn Hughes, MBA Executive Director Janice Campbell Board Secretary Daniel R. Dorsey, CPM External Affairs Coordinator Jocelyn Hart Data Analyst 4 Staff Hughes and Gov. Nathan Deal Tommy Kelly IT Support Specialist Freeman Montaque, MS Budget Manager Andrea Pass, MBA Data Analyst Yvette Speight Contracts Administrator 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 is administratively attached to the Georgia Department of Community Health for certain functions such as budget and human resources. The Board meets quarterly to address the challenges presented above. Although meetings times and location may vary, most 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. Loan repayment programs for dentists were added to the Board in 2016, and programs for physician assistants (PA) and advanced practice registered nurses (APRN) were officially added to the Board's jurisdiction in 2017. 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 area. Antonio Rios, M.D. - Chairperson Gainesville Mark G. Hanly, M.D. St. Simons Thomas L. Hatchett, Jr., M.D. - ViceChairperson Demorest William R. Kemp - Secretary/Treasurer Valdosta W. Scott Bohlke, M.D. Brooklet John E. Delzell Jr., M.D. MSPH Gainesville Jacinto del Mazo, M.D. Atlanta Steven Gautney Cordele B. Indran Indrakrishnan, M.D. Lawrenceville David B. Kay, M.D. Forsyth Phyllis Kozarsky, M.D. Atlanta George M. McCluskey, III, M.D. Columbus Terri McFadden-Garden, M.D. Atlanta Vacant (Consumer member) Vacant (Hospital/health system exec.) Note: This list of Board members is current as of November 2018. 5 Fiscal Overview The Georgia Board for Physician Workforce operates 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 2018, the Board's appropriated budget was $66,847,764, with which the Board enhanced the health and well-being of Georgia's citizens through its programming. This appropriation comprises a 3.68 percent increase from the previous fiscal year's figure of $64,476,659. Overall, the Board saw increases in every program, except for the operating grants for Mercer University and Morehouse schools of medicine. While it appears Morehouse SOM received a reduction, the school requested, and the General Assembly approved, $610,895 be redirected to the Undergraduate Medical Education program instead of utilizing the operating grant line item of the state's budget. Appropriation Figures Breakdown 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 2017 $981,797 $2,437,218 $24,039,911 $23,971,870 $11,185,863 $1,860,000 $64,476,659 FY 2018 $1,191,967 $3,048,113 $24,039,911 $23,360,975 $13,296,798 $1,910,000 $66,847,764 Pct. change 21.41% 25.07% 0% -2.55% 18.87% 2.69% 3.68% 6 Board Administration* Budgeted Expended Balance Percent Expended Personal Services $894,959 $700,384.65 $194,574.35 78.26% Operating Expenses $42,406 $21,880.66 $20,525.34 51.6% Computer Charges $10,271 $4,139.39 $6,131.61 40.3% Rent** $29,900 $30,586.14 ($686.14) 100% Telecommunications $55,835 $17,045 $38,790 30.53% Contracts/Per Diem $158,385 $91,944.48 $66,440.52 58.05% Total $1,191,756 $865,980.32 $325,775.68 72.66% * Program's budget comprises less than 2 percent of the GBPW's total appropriation. ** The GBPW moved offices in March 2018, and the new office has slightly higher rent. However, this slight overrun did not force the overall program budget into a deficit. Board Administration Notable 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 2018. 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 Graduate 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 Met with Georgia-based GME program coordinators to ensure resident physicians completing programs have the resources they need to effectively transition into practice Published a workforce report for 2017 dental practice demographic information and the analysis of the 2014-2015 physician license renewal data to determine number, specialty mix and distribution of physicians in Georgia Held two of our four quarterly Board meetings at Augusta University and Philadelphia College of Medicine to allow Board members the opportunity see firsthand how GBPW funds are utilized in enhancing student learning Held a statewide medical fair to engage hospitals and trade associations with resident physicians and medical students for future practice opportunities in Georgia and executed fair with much success Published quarterly newsletters to keep the public informed of important Board news and updates Started a monthly profile series highlighting the key role rural physicians play as leaders in their respective communities 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 four 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, Emory University School of Medicine and Morehouse 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 $3,048,113. For FY 2018, the contracts provided funding for up to 479 students (Mercer 210; Emory 113; Morehouse 96; and PCOM 60). The capitation rate for FY 2018 was $6,363.49 per student certified as a Georgia resident, which is a similar 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 participating schools combined was 67.76 percent. The GBPW considers seven specialties as "primary care and core specialties," which are: family medicine, internal medicine, pediatrics, obstetrics/gynecology, emergency medicine, general surgery and psychiatry. History of Undergraduate Medical Education Funding Fiscal Year Amount Appropriated 2018 $3,048,113 2017 $2,437,218 2016 $2,119,068 2015 $2,087,250 2014 $2,055,432 Total Students Funded 479 383 333 328 323 8 Mercer SOM Operating Grant Snapshot of Graduates Now Year 2014 2015 2016 2017 2018 Percentage of graduates entering core 61.30% 66.66% 66.00% 67.00% 72.50% specialties Percentage of graduates now practicing in Georgia 66.80% 65.50% 64.00% 63.40% 52.23% 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 460 total students (ALL of whom are Georgia residents), Mercer University School of Medicine 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). This operating grant helps to fund several initiatives at the school, including clinical rotations for students at rural practice locations and an expansion of its Primary Care Accelerated Track program which condenses medical school to three years and transitions graduates into a residency program at Memorial Health University Medical Center in Savannah. 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 365 total students (267 of whom are Georgia residents), Morehouse School of Medicine's campus is located in Atlanta. A big milestone was announced at the end of FY 2018 for Morehouse School of Medicine the school anticipated to welcome its first class of 100 students! This additional investment from the state through the operating grant will allow the school to continue increasing the enrollment of the medical school and its residency programs even more, as well as ensure increased access to innovative and critical health services for the citizens of our state. Also, the operating grant provides funding for upgrades to the equipment and simulation labs, which provide hands-on learning opportunities for medical students to start developing their clinical skills. Snapshot of Graduates Now Year 2014 2015 2016 2017 2018 Percentage of graduates entering core 65.80% 75.00% 70.90% 78.90 % 77.60% specialties Percentage of graduates practicing in 46.74% 46.73% 47.00% 46.00% 43.44% Georgia 10 Graduate Medical Education Residency Capitation, by the Numbers Program Residency Capitation Family Medicine Pediatrics Preventative Medicine General Surgery Obstetrics/Gynecology Internal Medicine Psychiatry FM Accelerated Track Psych Program Develop. Statewide Medical Fair Total Number of Residents Under Contract 1,435 252 50 10 4 38 125 4 N/A N/A N/A 1,918 Capitation Rate $3,172.77 $18,754.85 $15,591.28 $8,073.30 $15,502.50 $15,333.00 $15,000.00 $14,500.00 N/A N/A N/A N/A Total Funds $4,552,926 $4,726,227 $779,564 $80,733 $62,010 $582,654 $1,875,000 $58,000 $219,684 $360,000 $40,000 $13,296,798 The Graduate Medical Education (GME) 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 the state's teaching hospitals. The map to the right provides a snapshot of where all Board-funded GME programs are located in Georgia. In FY 2018, the Board provided $13,296,798 to 19 programs benefitting 1,918 residents. 11 Physicians for Rural Areas The GBPW administers service-cancelable loan repayment programs for physicians, dentists, physician assistants and advanced practice registered nurses that assist in paying debt incurred for tuition, fees, and other expenses associated with the completion of the aforementioned degrees. Practitioners must agree to practice at least 40 clinical hours per week in an underserved, rural county in Georgia with a population of 35,000 or less. The Physicians for Rural Areas Assistance and Georgia Physician Loan Repayment Programs provide up to $25,000 a year in student loan repayment in return for a 12month 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. The Dentists for Rural Area Assistance program offers the same contract to dentists in return for their rural dental practice. 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 65.79 percent of the participants continue to practice in a qualifying county. In FY 2017, the Board implemented the Physician Assistant and Advanced Practice Registered Nurse loan repayment programs, which are the PA and APRN versions of the PRAA and are similar in program structure and requirements to the PRAA offering $10,000 per year, for a maximum of $40,000 over four years. Some recipients are practicing in the same county as other recipients. Also, some counties may not be "rural" but are Board-approved. Program Number of recipients Country Doctor Scholarship 24 Georgia Physician Loan Repayment 8 Physicians for Rural Areas Assistance 36 Dentists for Rural Areas Assistance 12 PA/APRN Loan Repayment 17/22 Total 95 12 Counties 22 8 28 14 16/17 67 Outlook for FY 2019 The Board has been hard at work toward initiatives and goals for FY 2019. Some of which include: Continue working with the General Assembly, health care organizations and medical trade associations to address Georgia's growing physician needs Continue transition process for moving Board files and archives to a cloud-based software as part of the Board's charge to reduce paper usage and shift more into the digital age Establish a solid foundation for the Medical Malpractice Insurance Premium Grant Program, which is in its first year of implementation Coordinate with the University System of Georgia and the State Office of Rural Health to develop a one-stop shop residency website to connect residents and physicians with employment opportunities Develop and grow further the Georgia Medical Fair, a statewide job fair for resident physicians to connect with Georgia-based hospitals, health centers and large practices Engage more with residency programs and medical schools to strengthen relationships with physicians earlier in the medical education pipeline 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! 13 2 Peachtree Street, NW, 6th Floor Atlanta, Georgia 30303 (404) 232-7972 http://gbpw.georgia.gov/ GBPW@dch.ga.gov @GaPhysicianWork