Spotlight on graduate medical education [Feb. 2012]

Georgia Board for Physician Workforce Spotlight on Graduate Medical Education
February 2012

Achieving an optimal supply, specialty mix, and distribution of physicians involves many challenges. 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 in needed specialties.
This fact sheet highlights key elements related to GME in Georgia and provides answers to the following questions:
How many Post Graduate Year 1 (PGY-1) residency positions are there at Georgia's teaching
hospitals? What percentage of the PGY-1 positions were matched by graduates of Georgia's medical schools?
How many total 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? What are the most common reasons why new physicians leave the state? Are Georgia's graduates practicing in close proximity to their training site? Are more physicians going into sub-specialties? Why are teaching hospitals and GME programs important? Where should the state focus its energy and resources in the future?

How many PGY-1 residency training (GME) positions are there in Georgia? What percentage of PGY-1 positions are matched by graduates of Georgia's medical schools?

PGY-1 Residency Positions in Georgia by Primary Care & Core Specialties

Number and Percentage of Positions Matched by Graduates of Georgia's Medical Schools

Academic Year 2011-2012

Table 1

Specialty

Total Number of PGY-1 Year

Total Number of PGY-1 Year

# of PGY-1

% of PGY-1 Filled

Positions Matched

Positions

Residency

Residency

by GA Medical

Matched by GA

Positions

Positions Filled***

School

Medical School

Approved***

Graduates****

Graduates

Family Medicine*

72

69

12

16.7%

Internal Medicine

149

144

20

13.4%

Pediatrics

58

54

17

29.3%

Obstetrics & Gynecology

25

25

9

36.0%

General Surgery

48

46

11

22.9%

All Other Specialties**

121

119

54

44.6%

Total

473

457

123

26.0%

* Includes both ACGME and AOA filled family medicine residency positions. ** The category "All Other Specialties" includes transitional year positions, but does not include preliminary year positions (e.g., prelim-surgery, prelim-
medicine which were included under the specialty). *** Sources: Accreditation Council for Graduate Medical Education (www.ACGME.org), the American Osteopathic Association
(http://opportunities.osteopathic.org) and Georgia's Teaching Hospitals and Medical Schools. **** As reported by the medical schools.

For the 2011 2012 Academic Year (beginning July 1, 2011):
Georgia had a total of 473 PGY-1 residency positions available in 12 specialties. Of those 473 positions, 457 (96.6%) were filled leaving 16 (3.4%) PGY-1 positions unfilled. Of the 473 available PGY-1 positions, 123 (26.0%) were filled by graduates from the five Georgia
medical schools.
Of the 457 filled PGY-1 residency positions, 334 (73.1%) were filled by medical school graduates from
outside of Georgia.

If medical school expansion continues as projected, by 2020 there could be 3,210 medical student positions in Georgia and approximately 802 medical school graduates each year entering graduate medical education programs. Source: GBPW Fact Sheet on Georgia Medical Schools, January 2012
How many total physicians are trained each year through Georgia's residency (GME) programs?

Total Number of Approved and Filled Residency (GME) Positions by Teaching Hospital And Total Number of GME Graduates, 2011 - 2012 Table 2

Teaching Institution

Total Number of

Total Number of

Total GME

Approved/Accredited

Filled Residency

Graduates in

Residency Positions**

Positions**

2011***

Emory

1199

1103

308

Medical College of Georgia*

515

424

124

Morehouse School of Medicine

155

146

36

Memorial Health University Medical Center

152

122

32

Medical Center of Central Georgia

115

111

39

Atlanta Medical Center

84

78

23

The Medical Center, Inc.*

41

41

11

Floyd Medical Center*

27

19

8

Phoebe Putney Memorial Hospital

16

18

5

Satilla Regional Medical Center

6

7

1

Total

2,310

2,069

587

* The family medicine programs at these teaching institutions have both ACGME and AOA approved and filled residency positions.

** Sources: Accreditation Council for Graduate Medical Education (www.ACGME.org), the American Osteopathic Association

(http://opportunities.osteopathic.org) and Georgia's Teaching Hospitals and Medical Schools. *** As reported by the teaching hospitals.

As shown in Table 2, 89.6% (2,310 of the 2,069) approved/accredited residency positions in Georgia are filled
and the remaining 10.4% of positions are vacant. The majority of these unfilled positions are in primary care (family medicine, internal medicine, and pediatrics) or other critical specialties such as emergency medicine, neurosurgery, and general surgery. This raises the question of why the slots are not filled. Further study is needed to determine the specific reason(s), to identify potential solutions, and it is this fact that is being considered in the need for new Graduate Medical Education Programs in Georgia.

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 31.0% over the last eleven years (from 1,763 in 2000-2001 to 2,310 in 2011-2012). Medical school enrollment has increased by 56.9% (from 1,515 medical students in 2000-2001 to 2,377 medical students in 2011-2012).

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 for total residents?

Georgia ranks 41st among the 50 states in total
residents per 100,000 population (down from 39th in 2009 and 37th in 2007). Georgia's rate of 20.0 residents per 100,000 is well below the national average of 35.8 residents per 100,000. (Source: AAMC Center
for Workforce Studies; 2011 State Physician Workforce Data Book; November 2011.)
To meet the national average of 35.8 residents per
100,000 population, Georgia would have to add a total of approximately 1,565 residency positions.
Only one of the surrounding states (Florida at 18.8)
has a total resident to population ratio lower than Georgia's.
To reach the average of 24.1 residents per 100,000
population in the contiguous states (includes GA), Georgia would have to add a total of approximately 408 residency positions.

Comparison of Georgia's GME Capacity

Physicians in ACGME-Accredited

Residencies & Fellowships

Per 100,000 Population

Table 3

Rate per

Rank

100,000

U.S.

35.8

Contiguous States

24.1

TN

34.2

17th

NC

31.2

18th

AL

25.3

29th

SC

25.2

30th

GA

20.0

41st

FL

18.8

42nd

Source: AAMC Center for Workforce Studies; 2011 State Physician Workforce Data Book; November 2011.

Where do graduates of Georgia's residency programs come from and do they stay in state to practice?
According to the GBPW's 2011 GME Exit Survey, an overwhelming majority (78.2%) of Georgia's graduating
residents who responded reported attending high school in another state or country. Georgia retained 46.4% of the GME graduates that came from another state.
Georgia GME programs retained 53.5% of their GME graduates in 2011. This figure includes all respondents
going into practice with confirmed practice plans upon graduation.
Of the respondents that had practice plans in Georgia, 79.5% of the graduates indicated they planned to be at
their principle practice for four or more years.
What are the most common reasons why new physicians leave the state?
The top reasons for leaving Georgia included: proximity to family; better jobs in desired locations outside of Georgia; better job for spouse or partner offered outside of Georgia; and never intended to practice in Georgia. According to the GBPW's 2011 GME Exit Survey results, graduates leaving Georgia to practice in another state had a higher average expected salary ($212,748) when compared to graduates that were staying in Georgia to practice ($193,240). (Salary figures only include those going into practice)
Are Georgia's graduates practicing in close proximity to their training site?
Of the respondents to the GBPW Graduate Medical Education Exit Survey with confirmed practice plans, 40.8% have practice plans within 60 miles of their residency training program. Residency training lasts a minimum of three years.

60.0% 40.0% 20.0%

GME Graduates Reporting Confirmed Practice Plans by Proximity to Training Location, 2011

46.5%

27.1%

13.7%

12.7%

0.0%

Same

Same Region as Other Area in Outside Georgia

City/County Residency (within Georgia (other state or

60 miles)

country)

Source: 2011 GBPW Graduate Medical Education Exit Survey

The graph shows that for 2011, 27.1% of respondents stayed in the same city/county of their residency training. Additionally, 13.7% of respondents reported plans to practice in the same region as their residency training and 12.7% have plans to practice in another region in Georgia. Overall, 53.5% of respondents reported they were remaining in Georgia to practice.

Practice specialty and medical education debt
The rate of GBPW survey respondents practicing primary care (family medicine, internal medicine, pediatrics, obstetrics/gynecology) was 44.6% with 55.4% practicing in a sub-specialty. Additionally, 70.1% of the graduates responding to the 2011 GME Exit Survey reported having medical education debt totaling over $100,000. For 2011, 31.6% of survey respondents reported having debt totaling over $200,000.
Why are teaching hospitals and GME programs important?
Teaching hospitals and resident physicians are an integral part of Georgia's healthcare delivery system. Over 2,000 resident physicians actively care for patients throughout their residency training. In addition, teaching hospitals have a positive economic impact in their communities 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 (most of Georgia's teaching hospitals are designated Level 1 or Level 2
trauma centers).
Where should the state focus its energy and resources in the future?
The collective contributions of all five medical schools must be considered in evaluating the impact of
expansion efforts on Georgia's physician workforce.
Expansion initiatives already underway at the five medical schools in Georgia are significant. If these
efforts were discontinued, there would be a serious long-term negative effect on the state's medical education infrastructure and Georgia's physician workforce.
It is important for the state to maintain the commitment to undergraduate medical education; however,
expanding medical school enrollment alone will not meet Georgia's need for physicians.
Georgia must invest in expanding graduate medical education capacity (residency training positions)
based on the expanding medical school enrollment physician workforce needs of the state by expanding existing GME programs as well as adding new GME programs in the State.
Georgia must also invest in incentives to attract physicians to practice in the state such as:
1) Salary supplements for Georgia medical school graduates entering Georgia primary care residency programs;
2) Additional loan repayment funding for physicians practicing in rural and underserved areas of the state;
3) Additional scholarship funding for medical students who agree to practice in rural and underserved areas in Georgia;
4) Additional tax credits; and 5) Tort reform.
Georgia Board for Physician Workforce 2 Peachtree St., N.W., 36th Floor, Atlanta, Georgia 30303, (404) 656-3913 www.gbpw.georgia.gov Cherri Tucker, Executive Director. Colette Caldwell, Carla Graves, and G.E. Alan Dever, M.D., Ph.D., contributors.