Spotlight on graduate medical education [Jan. 2009]

Georgia Board for Physician Workforce Spotlight on Graduate Medical Education
January 2009

Georgia is facing a physician shortage and there are many challenges when it comes to achieving an optimal supply, specialty mix, and distribution of physicians. The state has invested considerable resources to expand undergraduate medical education (medical school enrollment). However, expanding medical school enrollment alone will not meet Georgia's need for physicians. The state must also engage in a coordinated effort to add residency training (graduate medical education or GME) positions.

Increasing the number of residency programs to accommodate the increase in medical school graduates is far more difficult. The largest source of funding for graduate medical education is the federal government, which provides funding to pay for Medicare and Medicaid's share of medical education costs. Caps have been placed on the number of residency slots the federal government will fund. Therefore, there is no incentive for existing hospitals to expand. Additionally, there are other external factors such as accreditation requirements, which impact the establishment or expansion of residency programs.

This fact sheet highlights key elements related to GME in Georgia and provides answers to the following questions:
Why are teaching hospitals and GME programs important? How many physicians are trained each year through Georgia's GME programs? How does this compare to the Southeast and national averages? How many positions would Georgia
have to add to meet these various targets?
Where do graduates of Georgia's residency programs come from and do they stay in state to practice? Are existing teaching hospitals expanding or have plans to expand residency positions?

Why are teaching hospitals and GME programs important?
Teaching hospitals and resident physicians are an integral part of Georgia's healthcare delivery system. Nearly 2,000 resident physicians actively care for patients throughout their residency training. In addition, teaching hospitals contribute by:
training physicians for Georgia; providing specialized healthcare services; caring for a disproportionate share of Georgia's uninsured, Medicaid, and Medicare populations; and, serving as trauma centers (all of Georgia's teaching hospitals are designated Level 1 or Level 2
trauma centers).

How many physicians are trained each year through Georgia's residency (GME) programs?

Teaching Institution

Total Number of

Approved/Accredited

Residency Positions*

(2008-2009)

Emory

1137

Medical College of Georgia

435

Morehouse School of Medicine

140

Memorial Health University Medical

118

Center

Medical Center of Central Georgia

109

Atlanta Medical Center

81

The Medical Center, Inc.

41

Floyd Medical Center

21

Phoebe Putney Memorial Hospital

16

Satilla Regional Medical Center

6

Total

2,104

* Source: Accreditation Council for Graduate Medical Education (www.ACGME.org)

** As reported by the teaching hospitals

Total Number of Filled Residency Positions*
(2008-2009)
1051 403 133 117
97 78 40 22 16 6 1,963

Total Graduates in
2008**
301 134 30 27
30 21 7 7 5 2 564

How does this compare to the Southeast and national averages? How many positions would

Georgia have to add to meet the southeast and national targets?

Georgia ranks 37th among the 50 states in residents
per 100,000 population. Georgia's rate of 20.7 residents per 100,000 is well below the national average of 35.6 residents per 100,000. (Source: AAMC Center
for Workforce Studies; 2007 State Physician Workforce Data Book; November 2007.)

Comparison of Georgia's GME Capacity Physicians in ACGME-Accredited Residencies & Fellowships Per 100,000 Population

To meet the national average of 35.6 residents per
100,000 population, Georgia would have to add approximately 1,400 residency positions.

Rate per 100,000

Rank

Only one of the surrounding states (Florida at 16.9)

U.S.

35.6

has a resident to population ratio lower than Georgia's.

Southeast

23.6

To reach the southeast average of 23.6 residents per

TN

100,000 population, Georgia would have to add

NC

approximately 270 residency positions.

AL

33.7

16th

31.7

18th

26.7

26th

The General Assembly has appropriated one million
dollars for a study related to establishing new residency programs in the Athens/Gainesville region (at three hospitals). If the Athens/Gainesville initiative goes forward, and all residency programs outlined in the consultant's report are implemented, approximately 94 residency positions will be added.

SC

23.5

35th

GA

20.7

37th

FL

16.9

43rd

Source: AAMC Center for Workforce Studies; 2007 State Physician Workforce Data Book; November 2007.

Are efforts underway to expand residency capacity or do the teaching hospitals have future plans to increase residency capacity?

On a recent GBPW survey, seven out of nine existing teaching hospitals indicated GME expansion efforts are
already underway or planned.

There has been some increase in accredited residency training positions in Georgia, but the increase is
relatively small in light of medical school expansion. The number of accredited residency positions has increased by 19.3% over the last eight years (from 1,763 in 2000-2001 to 2,104 in 2008-2009). Medical school enrollment has increased by 37.4% (from 1,515 medical students in 2000-2001 to 2,082 medical students in 2008-2009).

Existing teaching hospitals with a single residency program may be the most viable starting point when
considering expansion of residency positions. These hospitals already have a structure in place and have experience with operating residency programs. If the patient base would support additional residency programs, economies of scale could be realized. However, the CMS policies do not allow funding for teaching hospitals that expand/add new residency programs. Medicare will only fund GME positions at new teaching hospitals and there are many requirements which must be met.

Where do graduates of Georgia's residency programs come from and do they stay in state to practice?
According to the GBPW's 2008 GME Exit Survey, an overwhelming majority (82%) of residents completing
residency training in Georgia attended high school in another state or country. Additionally, only 26% of the respondents graduated from a Georgia medical school. These findings demonstrate Georgia continues to rely heavily on other states and countries to train needed physicians.
The overall retention rate for graduates of GBPW funded GME programs for the last five years was 61.4%,
which is well above the last published national average of 47.2% (Sources: Graduate Practice Location Reports analyzed
by GBPW staff; AAMC Center for Workforce Studies; 2007 State Physician Workforce Data Book; November 2007.)
Graduates of Georgia's residency programs continue to have favorable perceptions of the state job market.
Of the 2008 respondents to the GME Exit Survey, 75% indicated there were some, if not many, jobs available within 50 miles of their training site. In addition, 83% had actively searched for a job (and received an average of four offers), 89% had been offered and accepted a job, and only 22% reported difficulty finding a job.
For more information, please contact the Georgia Board for Physician Workforce at gbpw@dch.ga.gov (404) 206-5420, 1718 Peachtree St, NW, Suite 683, Atlanta, Georgia 30309, or visit www.gbpw.georgia.gov