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