Physician supply and demand indicators in Georgia: a survey of Georgia's GME graduates completing training in June 2004 [Sept. 2005]

PHYSICIAN SUPPLY AND DEMAND INDICATORS IN GEORGIA
A SURVEY OF GEORGIA'S GME GRADUATES COMPLETING TRAINING IN JUNE 2004
THE GEORGIA BOARD FOR PHYSICIAN WORKFORCE SEPTEMBER 2005
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

5

Demographic Characteristics

5

Residence Upon Graduation from High School

7

Type of Medical Education

7

Location of Medical School

8

Educational Debt

9

Primary Activity Following Completion of Training

10

Location of Primary Activity

10

Active Job Search

11

Offered/Accepted Job

11

Difficulty Finding Practice Opportunity

12

Changed Plans Due to Limited Practice Opportunities

12

Primary Practice Setting

13

Practice Area

13

Type of Compensation Package

14

Level of Satisfaction with Compensation

14

Average Starting Salary by Specialty

15

Perception of Job Market

16

1

EXECUTIVE SUMMARY AND KEY FINDINGS 2004 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 and 2004. 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 2004 survey are discussed below, along with comparisons to the fiscal year 2002 and 2003 GME Exit Surveys.
9 The physician marketplace needs new physicians. o 78 percent (76% in 2003) of respondents had actively searched for a job, and 89% (85% in 2003) of these job seekers had already received and accepted an offer; o Those graduates who had actively searched for employment typically received 3 job offers, the same as 2003; o Jobs for physicians still appear to be plentiful, as 66% (63% in 2003) of respondents indicated there were some, if not many, jobs available within 50 miles of their residency program. Similarly, 86% (84% in 2003) indicated there were some, if not many, jobs available nationally. o More graduates are entering subspecialty training (18% in 2002, 21% in 2003, and 27% in 2004).
9 Georgia is not training enough physicians for its own use. o Only 19% of 2004 respondents graduated from high school in Georgia, compared to 26% in 2002 and 23% in 2003. o Only 24% (28% in 2002 and 25% in 2003) percent graduated from a Georgia medical school. o Only 38% (39% in 2003) of those physicians with confirmed plans to practice in Georgia attended medical school in Georgia.
9 Serious pressures continue to challenge new physicians and Georgia's physician workforce. o Approximately 49% (42% in 2002 and 2003) of responding GME graduates had educational debt totaling $80,000 or more. o Only 8% of respondents planned to practice in a rural area (6% in 2003, 16% in 2002).
2

Other Key Findings
1. The strength of Georgia's job market for physicians appears strong. Only 25% (down from 29% in 2003) of respondents who had actively searched for a job reported having difficulty finding a satisfactory position. Of those respondents with confirmed practice plans, 12% (13% in 2003) indicated having to change plans because of limited practice opportunities.
2. 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 364 respondents, 230 (63%) lived in another state upon graduation from high school (up from 60% in 2003). Eighteen percent (up from 17% in 2003) of respondents indicated they graduated from a high school in another country. Fifty four percent (53% in 2003) of survey respondents attended medical school in another state, with 22% (same as 2003) attending medical school in another country. Fifty-four percent (same in 2003) of the graduates with confirmed practice plans are remaining in Georgia.
3. The face of medicine is changing, as new physicians continue to reflect diverse backgrounds. Forty percent of respondents were female (up from 36% in 2003). The reported race and ethnicity of physicians completing training appears to be increasingly diverse, with 39% of respondents indicating they were of AfricanAmerican, Asian, or other races (up from 35% in 2003).
4. Respondents entering practice in Georgia reported satisfaction with their salary/compensation packages. Average starting salaries for 2004 graduates ranged from $101,250 to $250,000, depending on the specialty. The average starting salary range in 2003 was between $112,000 and $246,000.
3

Fifty one percent (50% in 2003) of the respondents entering clinical practice, who had accepted a position, indicated they were "Very Satisfied" with their compensation package (114 of 224 respondents). Only 8 (down from 15 in 2003) of the 224 applicable respondents (or 4%) reported they were "Not Too Satisfied" or "Very Dissatisfied" with their compensation package.
Specialists also enjoyed higher overall starting salaries. The average starting salaries for specialists ranged from $101,250 for Infectious Disease (the low in 2003 was $111,692 for Psychiatry) to $250,000 for Thoracic Surgery (the high in 2003 was $245,909 for Radiology). Salaries for new primary care physicians (Family Medicine, General Internal Medicine, General Pediatrics, and Obstetrics and Gynecology) ranged from $116,500 to $164,444 (compared with a range of $113,357 to $162,471 in 2003).
4

BACKGROUND
This report presents the results of the Georgia Board for Physician Workforce's third annual GME Exit Survey of physicians completing a Georgia residency or fellowship training program in June 2004. 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 and 2003 results are shown throughout the report where appropriate.
A total of 556 surveys were electronically distributed and 364 were returned, yielding an overall response rate of 65.5% (down from 79% in 2003, but still well above the 42% response rate of 2002).

DEMOGRAPHIC CHARACTERISTICS
Exhibit 1 Gender of Respondents
(N=364)

40%

60%

Of the respondents: 217 (60%) were Male 147 (40%) were Female

Male

Female

Results showed a higher percentage of female respondents entering the job market in 2004. The percentage was 40%, up from 36% in 2003.

5

Of the respondents:
220 (60.4%) were White
53 (14.6%) were Black/African American
49 (13.5%) were Asian/Pacific Islander
34 (9.3%) were Other
7 (1.9%) were Multi-Race

Exhibit 2 Race/Ethnicity of Respondents
(N=363)
60.6%

14.6%

1.9% 9.4%
White Asian/Pacific Islander Multi-Race

13.5%
Black/African American Other

The reported race and ethnicity of physicians completing training appears to be increasingly diverse, with 39% of respondents indicating they were of African-American, Asian, or other races (up from 35% in 2003).

Of the respondents: 23 (6%) were of Hispanic
origin
341 (94%) were not of Hispanic origin

Exhibit 3 Respondents of Hispanic Origin
(N = 364)
94% Yes No
6%

6

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

70

60% 63%

60

53%

50

Of the respondents:
67 (19%) lived in Georgia

40

30

26% 23% 19%

20

10

21% 17% 18%

230 (63%) lived in Another State
66 (18%) lived in Another Country

0 Georgia

Other State

Other Country

2002 N = 271

2003 N = 397

2004 N = 363

Eighty one (81%) of physicians completing training in Georgia attended high school in another state or country (up from 77% in 2003 and 74% in 2002). The percentage of respondents that attended an allopathic medical school remained consistent from 2002-2004.

Exhibit 5 Type of Medical Education
(N=356)

Of the 356 respondents: 343 (96%) went to an

Allopathic Medical School

96%

and received an M.D. degree

13 (4%) attended an Osteopathic Medical School and received a D.O. degree

4%

Allopathic (M.D.)

Osteopathic (D.O.)

7

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

80%

60% 40% 20%

28% 25% 24%

53% 54% 48%

24% 22% 22%

0% Georgia

Other State

Other Country

2002 N = 264

2003 N = 396

2004 N = 358

Slightly less than a quarter (24%) of respondents answering this question in 2004 graduated from a Georgia medical school, down from the previous years. The majority of these respondents graduated from MCG.
Exhibit 7 Respondents by Georgia Medical School
100%

80%

60% 40% 20%
0%

42% 43% 43%

31% 21%

35%

28% 20% 15%

MCG 2002

Emory N = 71

2003

Mercer N = 100

9% 6% 7%
Morehouse 2004 N = 85

8

EDUCATIONAL DEBT OF SURVEY RESPONDENTS

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

Amount of Debt None

Number of Respondents
92

Percentage of Respondents
29%

Less than $20,000

8

2%

$20,000-$39,999

18

6%

$40,000-$59,999

22

7%

$60,000-$79,999

24

7%

$80,000-$99,999

26

8%

$100,000-$124,999

43

13%

$125,000-$149,999

19

6%

$150,000-$199,999

41

13%

Over $200,000

29

9%

TOTAL Respondents (n =)

322

100%

As illustrated in Exhibit 8, approximately 49% of Georgia's GME graduates have educational debt totaling $80,000 or more, up from 42% in 2002 and 2003. Forty one percent (41%) of the graduates have educational debt of $100,000 or more (up from 34% in 2003 and 30% in 2002).

9

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

Chief Resident Teaching/Research
Undecided Other
Sub-Specialty Training

1% 1% 1%
4% 3%
7% 1%
4% 7%
2% 5%
0.50%

Patient Care Temp Out of Medicine 1%

27% 21% 18%

65%
66% 65%

0%

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

2002 N = 263

2003 N = 392

2004 N = 362

The most notable trend is the increase in graduates reportedly entering sub-specialty training. The percentage of graduates remaining in Georgia to practice upon completion of training has remained fairly consistent.
Exhibit 10 Location of Primary Activity for Graduates with Confirmed Practice Plans

60% 50% 40%

56% 54% 54% 45% 46%
38%

30%

20% 10% 0%

2% 2% 0%

7% 5% 0%

Georgia

Other State Other Country Not Reported

2002 N = 97

2003 N = 250

2004 N = 232 10

JOB SEARCH AND ACCEPTANCE

Exhibit 11 Graduates Who Had Actively Searched for a Job
(N=320)

78%

22%

Of the respondents:
249 (78%) indicated "Yes" they had actively searched for a job
71 (22%) indicated "No" they had not actively searched for a job

Yes

No

The majority of respondents actively searched for a job prior to graduation. Of those who actively searched, 89% reportedly received and accepted an offer upon completion of training. These results were consistent with previous years.
Exhibit 12 Graduates Receiving/Accepting Job Offer Among Those Who Had Actively Searched
(N=248)

Of the respondents who had actively searched for a job:
220 (89%) indicated "Yes" they had received and accepted a job offer
20 (8%) indicated "Yes" they had received but rejected a job offer and are still searching
8 (3%) indicated they had actively searched but not received any offers

89%
8% 3% Yes, Accepted Offer Declined Offer and Still Searching No Offers Received

11

EASE OF FINDING PRACTICE OPPORTUNITY
Exhibit 13 Difficulty Finding Practice Opportunity Among
Graduates Who Had Actively Searched
(N=240)

Of the graduates who had actively searched for a job:
75%
60 (25%) indicated "Yes" they had experienced difficulty finding a job

180 (75%) indicated "No" they did

not have any difficulty

25%

Yes

No

Among those who had actively searched, 25% indicated difficulty with finding a job (down from 29% in 2003). Of the 2004 graduates experiencing difficulty finding a job, 12% reported having to change plans because of limited practice opportunities (comparable to 13% in 2003).

Of the graduates with confirmed practice plans:

Exhibit 14 Graduates with Confirmed Practice Plans Having to Change Plans because of Limited Opportunities
(N=229)

27 (12%) indicated they had to

change plans because of limited

practice opportunities
88%

202 (88%) respondents with

confirmed plans reported no

12%

changes being made because of

limited practice opportunities

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

12

PRIMARY PRACTICE SETTING AND PRACTICE AREA

Exhibit 15 Primary Practice Setting for Graduates with Confirmed Plans

Military

1% 1%

0%

Clinic, HMO, Nursing Home

Other

Solo Practice

Partnership

4% 5% 5%

6%

5%

10%

5%

5% 6%

8%

8%10%

Hospital

Group Practice - Owner/Partner
8%
Group Practice - Employee

15%

22% 20%
21% 22%

0%

5% 10% 15% 20% 25% 30%

2002 N = 172

2003 N = 245

33% 35%

47%

35% 40% 45% 50%

2004 N = 229

Over the last three years, there has been a shift to more graduates entering group practice as an owner/partner (21% in 2004, up from 8% in 2002) versus as an employee. There has also been an increase in graduates entering hospital-based settings (22% in 2004, up from 15% in 2002). Distribution across practice areas has remained fairly constant, with the exception of fluctuations in the percentage of graduates entering rural practice between 2002 and 2004.

Exhibit 16

Practice Area for Graduates with Confirmed Plans

35

31%

31%

30

27% 27%

27%

27%

25

20

18% 17%

14%
15

18% 17%

17%

16%

10

6% 8%

5

Grad0s Inner City

Major City

Suburban

Small City

Rural

2002 N = 172

2003 N = 245

2004 N = 230

13

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
132
69
25
5

Percentage of Graduates
57%
30%
11%
2%

Total Respondents With Confirmed Practice

231

Plans

100%

No noticeable changes have occurred in the type of compensation packages being offered to graduates between 2002 and 2004. Salary with incentive remains the most common form of compensation for new physicians entering the job market. More importantly, an overwhelming majority of graduates were satisfied with their compensation (96% in 2004). This trend in satisfaction with compensation has been consistent over the last three years (20022004).

Of the graduates with confirmed practice plans:

Exhibit 18 Level of Satisfaction with Compensation of Graduates with Confirmed Practice Plans
(N=224)
45%

114 (51%) indicated they

were "Very Satisfied" with

their compensation

51%

3%

102 (45%) were "Somewhat

1%

Satisfied"

6 (3%) were "Not Too Satisfied"
2 (1%) were "Very Dissatisfied"

Very Satisfied Not Too Satisfied

Somewhat Satisfied Very Dissatisfied

14

FIRST YEAR SALARY BY SPECIALTY
Exhibit 19 Average Starting Salary by Specialty for Graduates Providing
Expected Gross Income for First Year of Practice
(N=209)

Infec Dis (n=4) Ophthal (n=1)
Peds (n=20) Endocrin (n=3) Otolaryn (n=2)
Urol (n=1) Neur (n=7) Psych (n=16) Hem/Onc (n=2) Rheum (n=2) IM (n=28) FM (n=28) Path (n=10) Gastro (n=4) Gen Sur (n=1) Nephro (n=1) Ortho Sur (n=1) Plastic Sur (n=4) A&C Path (n=4) PMR (n=4) OB/GYN (n=9) Derm (n=6) Anes/Pain (n=13) Surg CC (n=1) Pulm (n=2) EM (n=12) Repro Endo (n=1) Rad (n=8) Vas Sur (n=1) Card (n=12) Thoracic (n=1)
$0

$50,000

101,250 110,000 116,500 121,667 125,000 125,000 126,429 126,469 130,000 130,000 130,036 133,321 135,000 143,750 150,000 150,000 150,000 150,000 151,250 156,250 164,444 178,333 183,750 190,000 194,500 200,417 215,000 228,750 240,000 245,000 250,000

$100,000

$150,000

$200,000

$250,000

$300,000

Salaries for new primary care physicians (Family Medicine, General Internal Medicine, General Pediatrics, and Obstetrics and Gynecology) have increased slightly over previous years. Specialists also enjoyed higher overall starting salaries.

15

PERCEPTION OF JOB MARKET

Exhibit 20

Graduates' Perception of State and National Job Market

70%

65%

(2004 - All Graduates)

60%

50%

40%

37%

30% 29%

20% 10%
0%

21%

11%

10%

3%

2%

13% 9%
1% 0%

Many Jobs Some Jobs Few Jobs

Very

Few

No Jobs

Jobs

Unknown

Jobs Within 50 Miles of Training Site N = 343

Jobs Nationally N = 345

Graduates of Georgia's residency training programs continue to have favorable perceptions of the state and national job market. Approximately 66% of respondents indicated there were some, if not many, jobs available within 50 miles of their training site. (The percentage was 63% in 2003). Similarly, an even higher percentage of respondents, 86%, indicated there were some, if not many jobs, for physicians at the national level. (This percentage was 84% in 2003.)

16