Physician supply and demand indicators in Georgia: a survey of Georgia's GME graduates completing training in June 2005 [Apr. 2006]

PHYSICIAN SUPPLY AND DEMAND INDICATORS IN GEORGIA
A SURVEY OF GEORGIA'S GME GRADUATES COMPLETING TRAINING IN JUNE 2005
THE GEORGIA BOARD FOR PHYSICIAN WORKFORCE APRIL 2006
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 2005 GME EXIT SURVEY
Fiscal year 2005 marks the fourth year the Georgia Board for Physician Workforce (GBPW) has conducted an annual survey of physicians completing their final year of residency training in Georgia. The responses provided through this survey give policy makers, planners, and educators insight into market forces and other factors, which impact physicians completing training in Georgia. 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 2005 survey are discussed below, along with comparisons to the findings from previous GME Exit Surveys.
9 The physician marketplace needs new physicians. o 79 percent (78% in 2004) of respondents had actively searched for a job, and 87% (89% in 2004) 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 2004; o Jobs for physicians still appear to be plentiful, as 64% (66% in 2004) of respondents indicated there were some, if not many, jobs available within 50 miles of their residency program. Similarly, 87% (86% in 2004) indicated there were some, if not many, jobs available nationally. o More graduates are entering subspecialty training (18% in 2002, 21% in 2003, 27% in 2004, and 23% in 2005), which is consistent with national concerns about a movement away from primary care.
9 Georgia is not training enough physicians for its own use. o As in 2004, only 19% of 2005 respondents graduated from high school in Georgia, compared to 26% in 2002 and 23% in 2003. o Only 21% (28% in 2002, 25% in 2003, and 24% in 2004) percent graduated from a Georgia medical school. o Only 27% (down from 39% in 2003 and 38% in 2004) 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 50% (42% in 2002 and 2003; 49% in 2004) of responding GME graduates had educational debt totaling $80,000 or more. o Only 7% of respondents planned to practice in a rural area (16% in 2002, 6% in 2003, and 8% in 2004).
2

Other Key Findings
1. The strength of Georgia's job market for physicians continues to be strong.
Only 26% of respondents who had actively searched for a job reported having difficulty finding a satisfactory position. This rate has been fairly consistent over the last four years.
Of those respondents with confirmed practice plans, just 14% indicated having to change plans because of limited practice opportunities (comparable with previous years).
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 412 respondents, 251 (61%) lived in another state upon graduation from high school (down slightly from 63% in 2004).
Twenty percent (up from 18% in 2004) of respondents indicated they graduated from a high school in another country.
Fifty three percent (54% in 2004) of survey respondents attended medical school in another state, with 26% (up from 22% in 2003 and 2004) attending medical school in another country.
Fifty percent (down from 56% in 2002 and 54% in years 2003 and 2004) 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.
Thirty seven percent of respondents were female (down slightly from 40% in 2004).
The reported race and ethnicity of physicians completing training appears to be increasingly diverse, with 42% of respondents indicating they were of AfricanAmerican, Asian, or other races (up from 35% in 2003 and 39% in 2004).
4. Respondents entering practice in Georgia reported satisfaction with their salary/compensation packages.
Average starting salaries for 2005 graduates ranged from $100,000 to $252,500, depending on the specialty. (In 2003, the range was $112,000 to $246,000 and in 2004, the range was $101,250 to $250,000.)
3

Fifty three percent (50% in 2003, 51% in 2004) of the respondents entering clinical practice, who had accepted a position, indicated they were "Very Satisfied" with their compensation package (133 of 250 respondents). Only 6 (down from 15 in 2003 and 8 in 2004) of the 250 applicable respondents (or 2%) 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 $100,000 for Forensic Psychiatrist to $252,500 for Vascular Surgery (compared with a range of $111,692 to $245,909 in 2003 and $101,250 to $250,000 in 2004.)
Salaries for new primary care physicians (Family Medicine, General Internal Medicine, General Pediatrics, and Obstetrics and Gynecology) ranged from $110,636 to $162,714 (compared with a range of $113,357 to $162,471 in 2003 and $116,500 to $164,444 in 2004).
4

BACKGROUND
This report presents the results of the Georgia Board for Physician Workforce's fourth annual GME Exit Survey of physicians completing a Georgia residency or fellowship training program in June 2005. Comparisons with the results from previous years are shown throughout the report where appropriate.
A total of 545 surveys were electronically distributed and 418 were returned, yielding an overall response rate of 77% (up from 65.5% in 2004).

DEMOGRAPHIC CHARACTERISTICS Exhibit 1
Gender of Respondents (N=412)
37%
63%

Of the respondents: 258 (63%) were Male 154 (37%) were Female

Male

Female

Results showed a lower percentage of female respondents entering the job market in 2005. The percentage was 37%, down from 40% in 2004.

5

Of the respondents:
233 (57.5%) were White
58 (14.3%) were Black/African American
81 (20%) were Asian/Pacific Islander
29 (7.2%) were Other
4 (1%) were Multi-Race

Exhibit 2 Race/Ethnicity of Respondents
(N=407)

57.5%

14.3%

1.0% 7.2%
White Asian/Pacific Islander Multi-Race

20.0%
Black/African American Other

The reported race and ethnicity of physicians completing training appears to be increasingly diverse, with 42.5% of respondents indicating they were African-American, Asian, Multi-Race, or other race (up from 39% in 2004 and 35% in 2003).

Of the respondents: 19 (5%) were of Hispanic
origin
388 (95%) were not of Hispanic origin

Exhibit 3 Respondents of Hispanic Origin
(N = 407)
95% Yes No
5%

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% 61%

60

53%

50

Of the respondents:
80 (19%) lived in Georgia

40
30 26% 23% 19% 19%
20

21% 17%18% 20%

251 (61%) lived in Another State
81 (20%) lived in Another Country

10

0 Georgia
2002
N = 271

Other State

Other Country

2003

2004

2005

N = 397

N = 363

N = 412

Eighty one (81%) of physicians completing training in Georgia attended high school in another state or country (the same as 2004, but up from 77% in 2003 and 74% in 2002). The percentage of respondents that attended an allopathic medical school remained fairly consistent from 20022005, though there was a 2% increase in Osteopathic graduates from 2004 to 2005.

Exhibit 5 Type of Medical Education
(N=409)

Of the 356 respondents: 385 (94%) went to an

Allopathic Medical School

94%

and received an M.D. degree

24 (6%) attended an Osteopathic Medical School and received a D.O. degree

6%

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% 21%

53% 54% 53% 48%

24% 22% 22% 26%

0% Georgia
2002 N = 264

Other State

Other Country

2003 N = 396

2004 N = 358

2005 N = 412

Less than a quarter (21%) of respondents answering this question in 2005 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%

42% 43% 43% 43%

35%39% 31%

21%

0% MCG
2002 N = 71

Emory 2003 N = 100

28% 20% 15%
8%

9% 6% 7% 10%

Mercer

Morehouse

2004 N = 85

2005 N = 105

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
120

Percentage of Respondents
30%

Less than $20,000

15

4%

$20,000-$39,999

20

5%

$40,000-$59,999

20

5%

$60,000-$79,999

23

6%

$80,000-$99,999

30

8%

$100,000-$124,999

65

16%

$125,000-$149,999

27

7%

$150,000-$199,999

42

11%

Over $200,000

33

8%

TOTAL Respondents (n =)

395

100%

As illustrated in Exhibit 8, 50% of Georgia's GME graduates have educational debt totaling $80,000 or more, up from 49% in 2004 and 42% in 2002 and 2003. Forty two percent (42%) of the graduates have educational debt of $100,000 or more (up from 41% in 2004, 34% in 2003, and 30% in 2002).
As shown in Exhibit 9 on the next page, there was a marked decrease in graduates reportedly entering sub-specialty training in 2005 after several years of increases. The percentage of graduates remaining in Georgia to practice upon completion of training also dropped 4% over the previous year as seen in Exhibit 10.

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

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

Patient Care

23% 27%
21% 18%

Temp Out of

0% 1%

Medicine

2002 0% N = 26130% 202003% N = 3309%2

65% 66% 66% 65%
4200%04 N =503%62 60%2005 N70=%404

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

60% 50% 40%

56% 54% 54% 50%

49% 45% 46%

38%

30%

20%

10%
0% Georgia
2002 N = 97

2% 2% 0% 1%

7% 5% 0% 0%

Other State

Other Country Not Reported

2003 N = 250

2004 N = 232

2005 N = 258

10

JOB SEARCH AND ACCEPTANCE

Exhibit 11 Graduates Who Had Actively Searched for a Job
(N=356)

79%

21%

Of the respondents:
281 (79%) indicated "Yes" they had actively searched for a job
75 (21%) 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, 87% 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=280)

Of the respondents who had actively searched for a job:
242 (87%) indicated "Yes" they had received and accepted a job offer
20 (7%) indicated "Yes" they had received but rejected a job offer and are still searching
18 (6%) indicated they had actively searched but not received any offers

87%
7% 6% 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=267)

Of the graduates who had actively searched for a job:
74%
69 (26%) indicated "Yes" they had experienced difficulty finding a job

198 (74%) indicated "No" they did

not have any difficulty

26%

Yes

No

Among those who had actively searched, 26% indicated difficulty with finding a job (consistent with 2004 results and down from 29% in 2003). Of the 2005 graduates experiencing difficulty finding a job, 14% reported having to change plans because of limited practice opportunities (comparable to results in 2003 and 2004).

Of the graduates with confirmed practice plans:
34 (14%) indicated they had to change plans because of limited practice opportunities
217 (86%) respondents with confirmed plans reported no changes being made because of limited practice opportunities

Exhibit 14 Graduates with Confirmed Practice Plans Having to
Change Plans because of Limited Opportunities (N=251)

86%

14%

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 Clinic, HMO, Nursing Home
Other Solo Practice
Partnership Hospital

1% 3%

1% 3% 4%

5%

5% 6%

5%6%

10%

3% 5%

5% 6%

6% 8%

8% 10%

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

15%

22% 22% 20%
23%
21% 22%

33% 33%35%

47%

0%

5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

2002 N = 172

2003 N = 245

2004 N = 229

2005 N = 255

Over the last four years, there has been a shift to more graduates entering group practice as an owner/partner (23% 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 2005, up from 15% in 2002). Distribution across practice areas has remained fairly constant, with the exception of fluctuations in the percentage of graduates entering major city and rural practices between 2002 and 2005.

Exhibit 16

Practice Area for Graduates with Confirmed Plans

35

33% 31%

31%

30

27% 27%

27%

27% 26%

25

20

18% 17%

16%

14%

15

18% 17%

17%17%

16%

10

6%8% 7%

5

Grad0s Inner City

Major City

Suburban

Small City

Rural

2002 N = 172

2003 N = 245

2004 N = 230

2005 N = 254

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
159
60
25
12

Percentage of Graduates
62%
23%
10%
5%

Total Respondents With Confirmed Practice

256

Plans

100%

No noticeable changes have occurred in the type of compensation packages being offered to graduates between 2002 and 2005. 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 (97% in 2005). This trend in satisfaction with compensation has been consistent over the last four years (20022005).

Of the graduates with confirmed practice plans:
133 (53%) indicated they were "Very Satisfied" with their compensation
111 (44%) were "Somewhat Satisfied"
4 (2%) were "Not Too Satisfied"
2 (1%) were "Very Dissatisfied"

Exhibit 18 Level of Satisfaction with Compensation of Graduates with Confirmed Practice Plans
(N=250)
44%

53%
Very Satisfied Not Too Satisfied

2% 1%
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=250)

Fore nsic Psych (n=2) Pain Me d (n=1) Pre v Me d (n=1) Pe ds (n=11) Endocrin (n=3) O cc Me d (n=2) Rhe um (n=2) Psych (n=11) FM (n=35) IM (n=26) Infec Dis (n=4) Ne ph (n=10) Ne ur (n=9) He m/O nc (n=2) A&C Path (n=4) Alle rgy (n=1) Nuc Me d (n=2) O B/GYN (n=14) Gen Sur (n=7) De rm (n=2) Path (n=2)
Plastic Sur (n=3) Gastro (n=4)
Pulm & CC (n=4) O tolaryn (n=4) Rad O nc (n=2) EM (n=24)
Trauma/Sur CC (n=1) Urol (n=4)
Card (n=11) Ane s (n=18)
PMR (n=6) O rtho (n=4) Inte r Card (n=3)
Rad (n=8) Vas Sur (n=2)

100,000 110,000 110,000 110,636 121,667 130,000 130,000 131,364 134,886 137,308 137,500 141,500 142,679 145,000 147,500 150,000 162,500 162,714 166,429 167,500 167,500 173,333 175,000 177,500 181,250 187,500 199,583 200,000 207,500 213,182 216,137 223,833 238,750 250,000 250,875 252,500

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

SPaElaRriCesEPfTorIOnNewOFprJimOaBryMcAarReKpEhTysicians (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

Exhibit 20

Graduates' Perception of State and National Job Market

80%

(2005 - All Graduates)

70%

68%

60%

50%

40%

37%

30% 27%

20% 10%
0%

19% 14% 3%

10% 2%

10% 8%
2% 0%

Many Jobs Some Jobs Few Jobs

Very

Few

No Jobs

Jobs

Unknown

Jobs Within 50 Miles of Training Site N = 369

Jobs Nationally N = 370

Graduates of Georgia's residency training programs continue to have favorable perceptions of the state and national job market. Approximately 64% of respondents indicated there were some, if not many, jobs available within 50 miles of their training site. (The percentage was 66% in 2004 and 63% in 2003). Similarly, an even higher percentage of respondents, 87%, indicated there were some, if not many jobs, for physicians at the national level. (This percentage was 86% in 2004 and 84% in 2003.)

16