Physician supply and demand indicators in Georgia: a survey of Georgia's GME graduates completing training in June 2006 [May 2007]

PHYSICIAN SUPPLY AND DEMAND INDICATORS IN GEORGIA
A SURVEY OF GEORGIA'S GME GRADUATES COMPLETING TRAINING IN JUNE 2006
THE GEORGIA BOARD FOR PHYSICIAN WORKFORCE MAY 2007
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 2006 GME EXIT SURVEY
Fiscal year 2006 marks the fifth 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 2006 survey are discussed below, along with comparisons to the findings from previous GME Exit Surveys.
9 The physician marketplace needs new physicians. o 81 percent (79% in 2005) of respondents had actively searched for a job, and only 77% (87% in 2005) 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 2005; o Jobs for physicians still appear to be plentiful, as 67% (64% in 2005) of respondents indicated there were some, if not many, jobs available within 50 miles of their residency program. Similarly, 90% (87% in 2005) indicated there were some, if not many, jobs available nationally. o The number of graduates entering subspecialty training (21% in 2006) seems to be on the decline after peaking in 2004. Rates for previous years were as follows: 18% in 2002, 21% in 2003, 27% in 2004, and 23% in 2005.
9 Georgia is not training enough physicians for its own use. o In 2006, 21% of respondents graduated from high school in Georgia, which is an increase from 18.5% in 2004 and 19% in 2005. o Only 23% (28% in 2002, 25% in 2003, 24% in 2004, and 21% in 2005) percent graduated from a Georgia medical school. o Approximately 38% (38% in 2002, 39% in 2003, 38% in 2004, and 27% in 2005) 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 51% (42% in 2002, 42% in 2003, 49% in 2004, and 50% in 2005) of responding GME graduates had educational debt totaling $80,000 or more. o Only 4% of respondents planned to practice in a rural area (10% in 2002, 6% in 2003, 8% in 2004, and 7% in 2005).
2

Other Key Findings
1. The strength of Georgia's job market for physicians continues to be strong.
Only 22% 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 11% 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 444 respondents, 254 (57%) lived in another state upon graduation from high school (down slightly from 61% in 2005).
Twenty two percent (up slightly from 20% in 2005) of respondents indicated they graduated from a high school in another country.
Fifty one percent (53% in 2005) of survey respondents attended medical school in another state, with 26% (up from 22% in 2004 and equivalent to 2005) attending medical school in another country.
Fifty percent (56% in 2002, 54% in 2003 & 2004, and 50% in 2005) 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 two percent of respondents were female (up from 37% in 2005).
The reported race and ethnicity of physicians completing training appears to be increasingly diverse, with 45% of respondents indicating they were of AfricanAmerican, Asian, or other races (40% in 2002, 35% in 2003, 39% in 2004, 42% in 2005).
4. Respondents entering practice in Georgia reported satisfaction with their salary/compensation packages.
The average starting salary for 2006 graduates was $160,790 and the median salary was $150,000.
3

Fifty two percent (56% in 2002, 50% in 2003, 51% in 2004, and 53% in 2005) of the respondents entering clinical practice, who had accepted a position, indicated they were "Very Satisfied" with their compensation package (149 of 285 respondents). Only 16 (up from 8 in 2004 and 6 in 2005) of the 285 applicable respondents (or 6%) 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 $96,300 for Opthalmology to $255,500 for Radiologist (compared with a range of $101,250 to $250,000 in 2004 and $100,000 to $252,500 in 2005.)
Salaries for new primary care physicians (Family Medicine, General Internal Medicine, General Pediatrics, and Obstetrics and Gynecology) ranged from $98,667 to $159,737 (compared with a range of $116,500 to $164,444 in 2004 and $110, 636 to $162,714 in 2005).
4

BACKGROUND
This report presents the results of the Georgia Board for Physician Workforce's fifth annual GME Exit Survey of physicians completing a Georgia residency or fellowship training program in June 2006. Comparisons with the results from previous years are shown throughout the report where appropriate.
A total of 550 surveys were electronically distributed and 458 were returned, yielding an overall response rate of 83% (up from 77% in 2005).

DEMOGRAPHIC CHARACTERISTICS
Exhibit 1 Gender of Respondents
(N=445)

42%

58%

Of the respondents: 258 (58%) were Male 187 (42%) were Female

Male

Female

Results showed a slightly higher percentage of female respondents entering the job market in 2005. The percentage was 42%, up from 37% in 2005.

5

Of the respondents:
244 (55.0%) were White
64 (14.4%) were Black/African American
84 (18.9%) were Asian/Pacific Islander
40 (9.0%) were Other
10 (2.3%) were Multi-Race
2 (.5%) were Native American/Alaskan Native

Exhibit 2 Race/Ethnicity of Respondents
(N=444)

55.0%

14.4%

0.5% 2.3%

9.0%

18.9%

White Black/African American Asian/Pacific Islander Other Multi-Race Native American/Alaskan Native

The reported race and ethnicity of physicians completing training appears to be increasingly diverse, with 45% of respondents indicating they were African-American, Asian, Multi-Race, or other race (up from 42.5% in 2005 and 39% in 2004).

Of the respondents: 30 (7%) were of Hispanic
origin
415 (93%) were not of Hispanic origin

Exhibit 3 Respondents of Hispanic Origin
(N = 445)
93% Yes No
7%

6

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

70

63%

60%

61%

60

57%

53%

50

40

Of the respondents:
92 (21%) lived in Georgia
254 (57%) lived in Another State

30 26% 23%

18.5% 19%

21%

20

98 (22%) lived in

21% 18% 20% 22% 17%

Another Country

10

0

Georgia

2002

2003

N = 271

N = 397

Other State
2004
N = 363

Other Country

2005

2006

N = 412

N = 444

Seventy nine (79%) of physicians completing training in Georgia attended high school in another state or country (down from 81% in 2005 and 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 2002-2006, though there was a 2% decrease in Osteopathic graduates from 2005 to 2006.

Exhibit 5 Type of Medical Education
(N=443)

Of the 443 respondents: 425 (96%) went to an

Allopathic Medical School

96%

and received an M.D. degree

18 (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%

53% 48%

54% 53% 51%

28%25% 24% 21%23%

24%22%22% 26%26%

0% Georgia

Other State

2002 N = 264 2003 N = 396

2004 N = 358

Other Country

2005 N = 412

2006 N = 445

Less than a quarter (23%) of respondents answering this question in 2006 graduated from a Georgia medical school, a 2% increase from 2005, but down from the previous years. The majority of these respondents graduated from Emory (last year it was MCG).
Exhibit 7 Respondents by Georgia Medical School
100%

80%

60% 40% 20%
0%

42%43%43%43%41%

35%39%43% 31%

21%

28% 20% 15%
8%10%

MCG

Emory

Mercer

9% 6% 7%10%6%
Morehouse

2002 N = 71

2003 N = 100

2004 N = 85

2005 N = 105 2006 N = 111

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
127

Percentage of Respondents
30%

Less than $20,000

18

4%

$20,000-$39,999

17

4%

$40,000-$59,999

21

5%

$60,000-$79,999

23

6%

$80,000-$99,999

29

7%

$100,000-$124,999

58

14%

$125,000-$149,999

25

6%

$150,000-$199,999

62

15%

Over $200,000

41

10%

TOTAL Respondents (n =)

421

100%

As illustrated in Exhibit 8, 51% of Georgia's GME graduates have educational debt totaling $80,000 or more (42% in 2002 & 2003, 49% in 2004 and 50% in 2005). Forty four percent (44%) of the graduates have educational debt of $100,000 or more (up from 42% in 2005, 41% in 2004 and 34% in 2003, 31% 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 and 2006 after years of increases. The percentage of graduates remaining in Georgia to practice upon completion of training also dropped 2% 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% 2% 1% 1% 1%
5% 4%
4% 3%
7%
2% 1% 1% 4%
7%
4% 2% 4% 0.50% 5%

Patient Care

Temp Out of

1% 0%1%

Medicine

0% 0%

21%23%
27% 21% 18%

67%
65% 66% 66% 65%

2002 0%

102%003 20%

N = 263

N = 392

23000%4

40% 200550%

60% 2006 70%

N = 362

N = 404

N = 443

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

60% 50% 40%

56%54%54% 50%50%

49% 49% 45%45%

38%

30%

20%

10%
0%
Georgia

Other State

2% 2% 0% 1% 1%
Other Country

7% 2% 0%0% 0%
Not Reported

2002 N = 97

2003 N = 250 2004 N = 232 2005 N = 258 2006 N = 288

10

JOB SEARCH AND ACCEPTANCE

Exhibit 11 Graduates Who Had Actively Searched for a Job
(N=389)

81%

19%

Of the respondents:
314 (81%) indicated "Yes" they had actively searched for a job
75 (19%) 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, 81% 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=312)

Of the respondents who had actively searched for a job:
269 (86%) indicated "Yes" they had received and accepted a job offer
31 (10%) indicated "Yes" they had received but rejected a job offer and are still searching
12 (4%) indicated they had actively searched but not received any offers

86%
10% 4% 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=306)

Of the graduates who had actively searched for a job:

66 (22%) indicated "Yes" they had

78%

experienced difficulty finding a job

240 (78%) indicated "No" they did

not have any difficulty

22%

Yes

No

Among those who had actively searched, 22% indicated difficulty with finding a job (a decrease from 26% in 2005 & 2004, 29% in 2003 and 2002). Of the 2006 graduates experiencing difficulty finding a job, 11% reported having to change plans because of limited practice opportunities (a decrease from 14% in 2003, 2004 and 2005).

Of the graduates with confirmed practice plans:
32 (11%) indicated they had to change plans because of limited practice opportunities
252 (89%) 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=284)

89%

11%

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% 3% 1%

0% Clinic, HMO, Nursing Home

3%45%%5%

5% 6%

Other

5%66%%

10%

Solo Practice

33%%5% 5%6%

Partnership

6%7%8%

8% 10%

Hospital

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

15%

22% 20%22%
21%23% 212%2%

27%
31% 33% 33%35%

47%

0%
2002 N = 172

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

2003 N = 245

2004 N = 229

2005 N = 255

45% 50%
2006 N = 286

Between 2002 and 2005, there was a shift to more graduates entering group practice as an owner/partner (23% in 2005, up from 8% in 2002) versus as an employee. In 2006 there was a 2-3% decline in both. There has been an increase in graduates entering hospital-based settings (27% in 2006, up from 15% in 2002). Distribution across practice areas has remained fairly constant in small cities, with increases in the percentage of graduates entering major city and inner city. Rural and suburban practices between 2003 and 2006 are showing declining trends.

Exhibit 16

Practice Area for Graduates with Confirmed Plans

35

33% 35%

31%

31%

30

27% 27%

27%

27% 26%

25%

25

20 18% 17% 18%
16%
15 14% 10
5

18% 18% 17% 17%17% 16%
8% 6% 7%
5%

Grad0s Inner City

Major City

Suburban

Small City

Rural

2002 N = 172 2003 N = 245 2004 N = 230 2005 N = 254 2006 N = 286

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
144
93
34
15

Percentage of Graduates
50%
33%
12%
5%

Total Respondents With Confirmed Practice

286

Plans and a Defined Compensation Package

100%

Between 2005 and 2006, there has been a shift from the number of graduates being offered salary with incentive (50% in 2006 down from 62% in 2005) versus salary without incentive (32% in 2006 up from 23% in 2005). In previous years, salary with incentive was the most common form of compensation for new physicians entering the job market. Consistent with previous years (from 2002 to 2005), 94% of the graduates in 2006 were satisfied with their compensation.

Of the graduates with confirmed practice plans:
149 (52%) indicated they were "Very Satisfied" with their compensation
120 (42%) were "Somewhat Satisfied"
14 (5%) were "Not Too Satisfied"
2 (1%) were "Very Dissatisfied"

Exhibit 18 Level of Satisfaction with Compensation of Graduates with Confirmed Practice Plans
(N=285)
42%

52%
Very Satisfied Not Too Satisfied

5% 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=326)(1)

Ophthal (n=6) Peds (n=15)
Rheum (n=3) Prev Med (n=1) Card Surg (n=2) Infec Dis (n=4)
Psych (n=20) Plastic Surg (n=6)
I M (n=27) Geriatrics (n=7)
F P (n=56) Allg & Imun (n=3)
Hem/Onc (n=1) Neuropath (n=1)
Path (n=8) Diag Rad (n=2) Ped Hem/Onc (n=2) Otolaryn (n=1)
Neph (n=5) Neuro (n=11) Neuro Sur (n=2) Clin Path (n=3) OB/GYN (n=19) Dermtpath (n=1) Phys Med & Rehab (n=5) Endo/Diab/Metab (n=2)
Derm (n=6) General Surgery (n=11)
Urology (n=3) Ped Rad (n=1) Ped Surg (n=1) Pul Disease (n=6) Neo-Perinat Med (n=3)
Gastro (n=3) Anesth (n=29) Card Dis (n=11)
E M (n=23) Ortho Surg (n=2) Radiology (n=14)

96,333 98,667
101,667 103,000
122,500 123,000
130,300 134,167 134,926 135,000 137,821 140,000 140,000 140,000 140,000 142,500 142,500 144,000 146,000 146,272 150,000 151,000 159,737 160,000 163,400 167,500 184,500 184,545 197,500 200,000 200,000 201,667 206,667 211,667 212,310 217,272 226,195 250,000 255,000

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

(1) Two additional respondents answered this question; however, those respondents are continuing their education and are not reflected in the graph.

15

PERCEPTION OF JOB MARKET
Salaries for new primary care physicians (Family Medicine, General Internal Medicine, General Pediatrics, and Obstetrics and Gynecology) have decreased slightly over previous years. For example, there was a slight decline in the starting salaries for OB/GYN ($159,737 in 2006 down from $162,714 in 2005) and an $11,969 difference in Pediatrics starting salaries ($98,667 in 2006 down from $110,636 in 2005). Consistent with previous years, specialists in 2006 have enjoyed higher overall starting salaries.

Exhibit 20

Graduates' Perception of State and National Job Market

80%

(2006 - All Graduates)

70%

70%

60%

50%

40%

38%

30% 29% 20% 10%
0%

20%
10% 2%

8% 2%

14%

2% 0%

6%

Many Jobs Some Jobs Few Jobs

Very

Few

No Jobs

Jobs

Unknown

Jobs Within 50 Miles of Training Site N = 424

Jobs Nationally N = 426

Graduates of Georgia's residency training programs continue to have favorable perceptions of the state and national job market. Approximately 67% of respondents indicated there were some, if not many, jobs available within 50 miles of their training site (64% in 2005 and 66% in 2004). Similarly, an even higher percentage of respondents, 90% (consistent with 2005) indicated there were some, if not many jobs, for physicians at the national level. This percentage was 86% in 2004, 84% in 2003, 67% in 2002.

16