Physician supply and demand indicators in Georgia: a survey of Georgia's GME graduates completing training in June 2003 [Aug. 2004]

PHYSICIAN SUPPLY AND DEMAND INDICATORS IN GEORGIA
A SURVEY OF GEORGIA'S GME GRADUATES COMPLETING TRAINING IN JUNE 2003
THE GEORGIA BOARD FOR PHYSICIAN WORKFORCE AUGUST 2004
MEETING THE PHYSICIAN WORKFORCE NEEDS OF GEORGIA COMMUNITIES THROUGH THE SUPPORT AND DEVELOPMENT OF MEDICAL EDUCATION PROGRAMS
1718 PEACHTREE STREET, NW, SUITE 683, ATLANTA, GA 30309-2496 PHONE (404) 206-5420 / FAX (404) 206-5428

TABLE OF CONTENTS

Executive Summary and Key Findings

2

Background and Response Rate by Specialty

5

Demographic Characteristics

7

Residence Upon Graduation from High School

8

Type of Medical Education

8

Location of Medical School

9

Educational Debt

10

Primary Activity Following Completion of Training

11

Location of Primary Activity

11

Active Job Search

12

Offered/Accepted Job

12

Difficulty Finding Practice Opportunity

13

Changed Plans Due to Limited Practice Opportunities

13

Primary Practice Setting

14

Practice Area

14

Type of Compensation Package

15

Level of Satisfaction with Compensation

15

Average Starting Salary by Specialty

16

Perception of Job Market

17

EXECUTIVE SUMMARY AND KEY FINDINGS 2003 GME EXIT SURVEY
In fiscal year 2002, the Georgia Board for Physician Workforce (GBPW) conducted a survey of physicians completing their final year of residency training in Georgia. The survey was similar to surveys administered in New York and California. The responses provided through this survey gave policy makers, planners, and educators insight into market forces and other factors, which impact physicians completing training in Georgia. To build on this work, the GBPW repeated this survey in 2003. As in 2002, the responses to survey questions have provided an important glimpse into the landscape confronting new physicians in Georgia.
The purpose of this survey is to inform the medical education community and state physician workforce planners about the experiences of graduates and the demand for new physicians in Georgia. The survey offers insight into residents' demographic characteristics; starting salaries; in-state retention rates; proportion of graduates planning to practice in underserved areas; graduates' assessment of the job market; as well as other information. Collectively, this information provides policy makers and educators with knowledge to better tailor medical education and ancillary supports for physicians in training to ensure that Georgia has the physician workforce it needs in the future. Important findings from the 2003 survey are discussed below, along with comparisons to the fiscal year 2002 GME Exit Survey and other similar surveys conducted in other states.
The physician marketplace needs new physicians. o 76 percent of respondents had actively searched for a job, and 85% of these job seekers had already received and accepted an offer; o Those graduates who had actively searched for employment typically received three job offers; o Jobs for physicians appear to be plentiful, as 63% of respondents indicated there were some, if not many, jobs available within 50 miles of their residency program. Similarly, 84% indicated there were some, if not many, jobs available nationally. o Fewer respondents indicated that they would engage in teaching/research or patient care in 2003, when compared to responses in 2002.
Georgia is not training enough physicians for its own use. o Only 23% of respondents graduated from high school in Georgia o Only 25% percent graduated from a Georgia medical school. o Only 39% of those physicians with confirmed plans to practice in Georgia attended medical school in Georgia.
Serious pressures continue to challenge new physicians and Georgia's physician workforce.
o Approximately 42% of responding GME graduates had educational debt totaling $80,000 or more.
o Only six of respondents planned to practice in a rural area, down sharply from responses in 2002.
2

Other Key Findings
1. The strength of Georgia's job market for physicians appears strong and compares well to other states.
Only 29% of respondents who had actively searched for a job reported having difficulty finding a satisfactory position. The percentage that reported difficulty in Georgia (29%) was higher than the percentage in California (24%), but lower than the percentage in New York (31%).
Of those respondents with confirmed practice plans, 13% indicated having to change plans because of limited practice opportunities. The most common reason was lack of jobs in desired locations/settings. The percentage of Georgia respondents reporting having to change plans was lower than both California (14%) and New York (17%).
2. Demand for specialists (non-primary care physicians) was stronger than for primary
care physicians (Family Practice, General Internal Medicine, General Pediatrics, and Obstetrics and Gynecology).
Specialists received more job offers than generalists (mean of 3.6 versus 2.7). These figures are comparable with those reported by California graduates (mean of 3.92 for specialists and 2.82 for generalists).
Specialists who had searched for a job experienced less difficulty finding a satisfactory position in comparison to generalists (24% versus 38%). These results are comparable to California, though slighter higher in both categories. California rates were 20% for specialists and 31% for generalists.
3. Georgia continues to rely heavily on other states and countries to train needed physicians.
The majority of physicians completing residency training in Georgia are from other states. Of the 398 respondents, 237 (60%) lived in another state upon graduation from high school.
Seventeen percent of respondents indicated they graduated from a high school in another country.
Fifty three percent of survey respondents attended medical school in another state, with 22% attending medical school in another country.
Fifty-four percent of the graduates with confirmed practice plans are remaining in Georgia. This rate falls between California at 79% and New York at 51% retention.
3

4. The face of medicine is likely changing, as new physicians reflect diverse backgrounds. Over 1/3 of respondents were female. The reported race and ethnicity of physicians completing training appears to be increasingly diverse, with 35% of respondents indicating they were of AfricanAmerican, Asian, or other races.
5. Respondents entering practice in Georgia reported satisfaction with their salary/compensation packages. Starting salaries range from $112,000 to well over $200,000, depending on the specialty; Fifty percent of the respondents entering clinical practice who had accepted a position indicated they were "Very Satisfied" with their compensation package (122 of 245 respondents). Only 15 of the 245 applicable respondents (or six%) reported they were "Not Too Satisfied" with their compensation package. Specialists also enjoyed higher overall starting salaries. The average starting salaries for specialists ranged from $111,692 for Psychiatry to $245,909 for Radiology. Salaries for new primary care physicians (Family Practice, General Internal Medicine, General Pediatrics, and Obstetrics and Gynecology) ranged from $113,357 to $162,471;
4

BACKGROUND

This report presents the results of the Georgia Board for Physician Workforce's second annual GME Exit Survey of physicians completing a Georgia residency or fellowship training program in June 2003. The survey instrument was developed by the Center for Health Workforce Studies based at the State University of New York in Albany. No changes have been made to the questionnaire. Similar surveys have been administered in other states in recent years. Comparisons with the 2002 results are shown throughout the report where appropriate, as well as comparisons with New York and California.

A total of 504 surveys were electronically distributed and 398 were returned, yielding an overall response rate of 79%. The overall response rate is up from 2002, when 42% of physicians completing training completed the survey. The response rate by specialty is denoted in Exhibit 1.

Exhibit 1 GME Exit Survey (2003) Response Rate by Specialty

Specialty Allergy and Immunology

Number of GME Graduates
(Total N=504)
1

Number of Surveys Returned
(Total N=398)
1

Percentage Response Rate
by Specialty 100%

Anesthesiology

22

21

95%

Cardiology/Cardiothoracic

22

16

73%

Surgery

Child and Adolescent

2

1

50%

Psychiatry

Dermatology

8

7

88%

Emergency Medicine

22

17

77%

Endocrinology and

4

4

100%

Metabolism

Family Practice

74

58

78%

Gastroenterology

4

4

100%

Hematology/Oncology

5

4

80%

Infectious Disease

4

4

100%

Internal Medicine

96

75

78%

Nephrology

11

10

91%

5

Specialty
Neurology/Neurological Surgery OB/GYN Ophthalmology Orthopedic Surgery Otolaryngology Pain Management (Anesthesiology) Pathology Pediatrics Physical Med and Rehab Plastic Surgery Psychiatry Pulmonary Disease/CCM Radiology Rheumatology Surgery Urology Specialty Not Listed Other Specialty OVERALL TOTAL

Number of GME Graduates
(Total N=504)
18

Number of Surveys Returned
(Total N=398)
12

27

21

8

6

9

7

5

1

1

1

18

13

37

27

2

2

4

4

22

20

5

4

25

20

5

3

34

19

7

4

-

12

2

-

504

398

Percentage Response Rate
by Specialty 67% 78% 75% 78% 20% 100% 72% 73% 100% 100% 91% 80% 80% 60% 56% 57% 79%

6

DEMOGRAPHIC CHARACTERISTICS Exhibit 2
Gender of Respondents (N=397)
36%

Male

64% Female

Of the respondents: 255 (64%) were Male
142 (36%) were Female

Results showed a lower percentage of female respondents entering the job market in 2003. The percentage was 36%, down from 47% in 2002. The mean age for 2003 graduates was 33 with a range of 26-65.

Of the respondents: 247 (62%) were White
71 (18%) were Asian/Pacific Islander
50 (13%) were Black/African American
16 (4%) were Other
9 (2%) were Hispanic/Latino
2 (<1%) were Native American

Exhibit 3 Race/Ethnicity of Respondents
(N=395)
62%

18%

1% 2% 4%

13%

White Black/African American Hispanic/Latino

Asian/Pacific Islander Other Native American

7

RESIDENCE UPON GRADUATION FROM HIGH SCHOOL AND TYPE OF MEDICAL EDUCATION
Exhibit 4 Residence of Respondents Upon Graduation From High School
(N=397)

60

60%

53%

50

40

30

26% 23%

20

21% 17%

Of the respondents: 92 (23%) lived in Georgia
237 (60%) lived in Another State
68 (17%) lived in Another Country

10

0

Georgia

Other State
2002 2003

Other Country

Over two-thirds (77%) of physicians completing training in Georgia attended high school in

another state or country (up from 74% in 2002). The percentage of respondents that attended an

allopathic medical school remained consistent from 2002-2003.

Exhibit 5 Type of Medical Education
(N=396)

Of the 396 respondents:

382 (96%) went to an

Allopathic Medical School

96%

and received an M.D. degree

14 (4%) attended an Osteopathic Medical School and received a D.O. degree

4%

Allopathic (M.D.)

Osteopathic (D.O.)

8

LOCATION OF MEDICAL SCHOOL
Exhibit 6 Location of Medical School
100%

80% 60% 40% 20%

28% 25%

49% 53%

23% 22%

0% Georgia

Other State

Other Country

N = 264

2002

N = 396
2003

Only a quarter (25% or 100) of the 396 respondents answering this question in 2003graduated from a Georgia medical school, with the majority being graduates from MCG (43%).

Exhibit 7 Respondents by Georgia Medical School EDUCATIONAL DEBT OF SURVEY RESPONDENTS

100%

80%

60% 40% 20% 0%

42% 43%

31% 21%

28% 20%

MCG N = 71

Emory 2002

Mercer 2003 N = 100

8% 6% Morehouse

9

Exhibit 8 Educational Debt of Survey Respondents Number/Percentage of Respondents by Level

Amount of Debt None

Number of Respondents
135

Percentage of Respondents
35.81%

Less than $20,000

7

1.86%

$20,000-$39,999

21

5.57%

$40,000-$59,999

25

6.63%

$60,000-$79,999

30

7.96%

$80,000-$99,999

32

8.49%

$100,000-$124,999

47

12.47%

$125,000-$149,999

14

3.71%

$150,000-$199,999

35

9.28%

Over $200,000

31

8.22%

TOTAL Respondents (n =)

377

100%

As illustrated in Exhibit 8, approximately 42% of Georgia's GME graduates have educational debt totaling $80,000 or more. One-third of the graduates have educational debt of $100,000 or more.

10

PRIMARY ACTIVITY AND LOCATION UPON COMPLETION OF TRAINING
Exhibit 9 Primary Activity of Respondents Following Completion of Training
(All Respondents)

Chief Resident

1% 1%

Teaching/Research

3% 6%

Undecided

4%

3%

Other

5% 3%

Sub-Specialty Training

Patient Care

21% 18%

66% 68%

0% 10% 20% 30% 40% 50% 60% 70% 80%

N = 263

2002

2003 N = 392

Exhibit 10 Location of Primary Activity for Graduates with Confirmed Practice Plans

60% 50% 40% 30% 20% 10% 0%

56% 54%

42% 45%

Georgia N = 172

Other State 2002

2% 2%

0% 5%

Other Country Not Reported

2003 N = 250

11

JOB SEARCH AND ACCEPTANCE

Exhibit 11 Graduates Who Had Actively Searched for a Job
(N=357)

76%

Of the respondents: 272 (76%) indicated "Yes" they had actively searched for a job

85 (24%) indicated "No" they had not actively searched for a job

24%

Yes

No

Exhibit 12 Graduates Receiving/Accepting Job Offer Among Those Who Had Actively Searched
(N=272)

Of the respondents who had actively searched for a job:
232 (85%) indicated "Yes" they had received and accepted a job offer
22 (8%) indicated "Yes" they had received but rejected a job offer and are still searching
18 (7%) indicated they had actively searched but not received any offers

85%
8% 7%
Yes, Accepted Offer Declined Offer and Still Searching No Offers Received

12

EASE OF FINDING PRACTICE OPPORTUNITY
Exhibit 13 Difficulty Finding Practice Opportunity Among
Graduates Who Had Actively Searched
(N=272)

Of the graduates who had actively

searched for a job:

6%

65%

78 (29%) indicated "Yes" they had experienced difficulty finding a job

179 (65%) indicated "No" they did

not have any difficulty

29%

15 (6%) provided no answer

Yes

No

No Answer

Exhibit 14 Graduates with Confirmed Practice Plans Having to Change Plans because of Limited Opportunities
(N=245)

Of the graduates with confirmed practice plans:
33 (13%) indicated they had to change plans because of limited practice opportunities
The remaining 212 (87%) respondents with confirmed plans reported no changes being made because of limited practice opportunities

87%

13%

Yes, Had to Change Plans No, Did Not Have to Change Plans

13

PRIMARY PRACTICE SETTING AND PRACTICE AREA
Exhibit 15 Primary Practice Setting for Graduates with Confirmed Plans

Military 1%

Clinic, HMO, Nursing Home Other
Solo Practice Partnership Hospital
Group Practice - Owner/Partner Group Practice - Employee

5% 5% 10% 5% 6% 8% 10%
8%

15%

20% 22%

35%

0%

5% 10% 15% 20% 25% 30% 35% 40%

N = 172

2002

2003 N = 245

47% 45% 50%

Exhibit 16 Practice Area for Graduates with Confirmed Plans

35

30

25

20

18%

14%

15

27% 27%

31% 27%

17% 18% 16%

10

6%

5

20003 Grads

Inner City

Major City

N = 172

Suburban

Small City

2002

20N03= 245

Rural

14

COMPENSATION PACKAGE AND SATISFACTION WITH COMPENSATION

Exhibit 17 Type of Compensation Package for Graduates with Confirmed Practice Plans

Type of Compensation Package
Salary with Incentive Salary Without Incentive Fee for Service Other

Number of Graduates
133
79
25
8

Percentage of Graduates
54.3%
32.2%*
10.2%
3.3%

Total Respondents With Confirmed Practice

245

Plans

100%

Exhibit 18 Level of Satisfaction with Compensation of Graduates with Confirmed Practice Plans
(N=245)

Of the graduates with confirmed practice plans:
122 (50%) indicated they were "Very Satisfied" with their compensation
101 (41%) were "Somewhat Satisfied"
15 (6%) were "Not Too Satisfied"
0 (0%) were "Very Dissatisfied
7 (3%) Not Reported

50%
Very Satisfied Not Too Satisfied Not Reported

41%
6% 0% 3%
Somewhat Satisfied Very Dissatisfied

15

FIRST YEAR SALARY BY SPECIALTY

Exhibit 19 Average Starting Salary by Specialty for Graduates Providing
Expected Gross Income for First Year of Practice
(N=252)

Pyschiatry (n=13) Endocrinology (n=3)
Pediatrics (n=14) Neurology (n=8)
Urology (n=4) Internal Med (n=34) Opthalmology (n=3) Family Practice (n=51)
Nephrology (n=6) Pulmonary/CCM (n=1)
Infectious Dis (n=4) Otolaryngology (n=1)
Rheumatology (n=2) Pathology (n=7)
Dermatology (n=4) OB/GYN (n=17)
Ortho Surgery (n=3) Gen Surgery (n=12) Emergency Med (n=16)
Hem/Onc (n=6) Gastroenterology (n=3)
Neonatology (n=1) Plastic Surgery (n=1)
Cardiology (n=11) Anesthesiology (n=14) Vascular Surgery (n=1)
Neurosurgery (n=1) Radiology (n=11)
$0

$50,000

111,692 112,333 113,357
117,750 126,520 127,522 130,000 133,275 138,333 150,000 155,000 155,000 155,000 155,143 160,000 162,471 181,867 191,250 191,563 192,500 193,333 200,000 200,000 209,545 211,429 220,000 242,000 245,909

$100,000

$150,000

$200,000

$250,000

$300,000

16

PERCEPTION OF JOB MARKET

Exhibit 20

Graduates' Perception of State and National Job Market

70 63%
60

(All Graduates)

50

40

38%

30 25%
20 10
0

21%

8% .5%

8.5%

18% 15%

.75% 1.26% .25%

Many Jobs Some Jobs Few Jobs

Very

Few

No Jobs

Jobs

Unknown

Jobs Within 50 Miles of Training Site N = 366

Jobs Nationally N = 369

17