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