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