Physician supply and demand indicators in Georgia: a survey of Georgia's GME graduates completing training in June 2007 [Apr. 2008]

PHYSICIAN SUPPLY AND DEMAND INDICATORS IN GEORGIA
A SURVEY OF GEORGIA'S GME GRADUATES COMPLETING TRAINING IN JUNE 2007
THE GEORGIA BOARD FOR PHYSICIAN WORKFORCE APRIL 2008
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 2007 GME EXIT SURVEY
Fiscal year 2007 marks the sixth 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 2007 survey are discussed below, along with comparisons to the findings from previous GME Exit Surveys.
9 The physician marketplace needs new physicians. o Eighty percent (81% in 2006) of respondents had actively searched for a job, and 91% (86% in 2006) 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 and 2006; o Jobs for physicians still appear to be plentiful, as 72% (67% in 2006) of respondents indicated there were some, if not many, jobs available within 50 miles of their residency program. Similarly, 93% (90% in 2006) indicated there were some, if not many, jobs available nationally. o There was a slight increase in the number of graduates entering subspecialty training (22% in 2007 up from 21% in 2006). 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 2007, only 18% of respondents graduated from high school in Georgia, which is the lowest percentage reported since 2004 (26% in 2002, 23% in 2003, 19% in 2004 and 19% in 2005, 21% in 2006). o Only 21% (28% in 2002, 25% in 2003, 24% in 2004, 21% in 2005, 23% in 2006) percent graduated from a Georgia medical school. o Approximately 32% (38% in 2002, 39% in 2003, 38% in 2004, and 27% in 2005 and 38% in 2006) of those physicians with confirmed plans to practice in Georgia attended medical school in Georgia. This is a 6% decrease from 2006.
9 Serious pressures continue to challenge new physicians and Georgia's physician workforce. o In 2007, approximately 50% of responding GME graduates had educational debt totaling $80,000 or more. Rates for previous years are as follows: 42% in 2002, 42% in 2003, 49% in 2004, 50% in 2005 and 51% in 2006. o Only 5% of respondents planned to practice in a rural area (16% in 2002, 6% in 2003, 8% in 2004, 7% in 2005, and 5% in 2006).
2

Other Key Findings
1. The strength of Georgia's job market for physicians continues to be strong.
Only 17% (down 22% in 2006) 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 9% 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 504 respondents, 307 (61%) lived in another state upon graduation from high school (up slightly from 254 (57%) in 2006).
Twenty one percent (down slightly from 22% in 2006) of respondents indicated they graduated from a high school in another country.
Fifty percent (51% in 2006) of survey respondents attended medical school in another state, with 29% (up from 22% in 2004, 26% in 2005 & 2006) attending medical school in another country.
Continuing the downward trend, 46% (56% in 2002, 54% in 2003 & 2004, and 50% in 2005 & 2006) 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 five percent of respondents were female (up from 42% in 2006).
The reported race and ethnicity of physicians completing training appears to be increasingly diverse, with 46% of respondents indicating they were of AfricanAmerican, Asian, or other races (35% in 2003, 39% in 2004, 42% in 2005, 45% in 2006).
4. Respondents entering practice in Georgia reported satisfaction with their salary/compensation packages.
The average starting salary for 2007 graduates was $181,410 and the median salary was $165,000.
3

Fifty eight percent (56% in 2002, 50% in 2003, 51% in 2004, 53% in 2005, 52% in 2006) of the respondents entering clinical practice, who had accepted a position, indicated they were "Very Satisfied" with their compensation package (198 of 344 respondents). Only 16 (up from 8 in 2004, 6 in 2005 and 14 in 2006) of the 344 applicable respondents (or 5%) 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 $104,571 for Ophthalmology to $320,000 for Thoracic Surgery (compared with a range of $101,250 to $250,000 in 2004, $100,000 to $252,500 in 2005 and $96,333 to $255,000 in 2006.)
Salaries for new primary care physicians (Family Medicine, General Internal Medicine, General Pediatrics, and Obstetrics and Gynecology) ranged from $112,470 to $188,143 (compared with a range of $116,500 to $164,444 in 2004, $110, 636 to $162,714 in 2005 and $98,667 to $159,737 in 2006).
4

BACKGROUND
This report presents the results of the Georgia Board for Physician Workforce's sixth annual GME Exit Survey of physicians completing a Georgia residency or fellowship training program in June 2007. Comparisons with the results from previous years are shown throughout the report where appropriate.
A total of 589 surveys were electronically distributed and 504 were returned, yielding an overall response rate of 81% (83% in 2006 and 77% in 2005). Due to an error in the distribution of the surveys the response rate for MCG was reported to be the same as last year.

DEMOGRAPHIC CHARACTERISTICS
Exhibit 1 Gender of Respondents
(N=502)

70% 60% 50% 40% 30% 20% 10% 0%

64% 52%

60%

63%

58% 55%

47% 36%

40% 37%

45% 42%

2002 2003 2004 2005 2006 2007

Of the respondents: 274 (55%) were Male 228 (45%) were Female

Results showed a slightly higher percentage of female respondents entering the job market in 2007. The percentage was 45%, up from 37% in 2005 and 42% in 2006.

* Due to an error in the distribution of the surveys, the response rate for MCG was reported to be the same as last year.
5

Of the respondents:
271 (53%) were White
74 (15%) were Black/African American
88 (18%) were Asian/Pacific Islander
55 (11%) were Other
10 (2%) were Multi-Race
3 (1%) were Native American/Alaskan Native

Exhibit 2 Race/Ethnicity of Respondents
(N=501)

53%

15%

1% 2%

11%

18%

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 47% of respondents indicating they were African-American, Asian, Multi-Race, or other race (42% in 2006, 43% in 2005 and 39% in 2004).

Of the respondents: 39 (8%) were of Hispanic
origin
441 (92%) were not of Hispanic origin

Exhibit 3 Respondents of Hispanic Origin
(N = 480)
92% Yes No
8%

6

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

70

60

60%

63%

61% 61% 57%

50

Of the respondents:
90 (18%) lived in Georgia

40

30 23%

20

18.51%9%21%18%

10

17%18%20% 22%21%

307 (61%) lived in Another State
105 (21%) lived in Another Country

0
2003

Georgia
2004

Other State
2005

Other Country

2006

2007

N = 397

N = 363

N = 412

N = 444

N = 502

Eighty two percent (82%) of physicians completing training in Georgia attended high school in another state or country (79% in 2006, 81% in 2005 & 2004, 77% in 2003, and 74% in 2002). The percentage of respondents that attended an allopathic medical school remained fairly consistent from 2002-2007 (96% in 2006 and 97% in 2007), though there was a 2% decrease in Osteopathic graduates from 2005 to 2006 and a 1% decline from 2006 to 2007.

Exhibit 5 Type of Medical Education
(N=500)

Of the 500 respondents:

483 (97%) went to an

97%

Allopathic Medical School

and received an M.D. degree

17 (3%) attended an Osteopathic Medical School and received a D.O. degree
3%

Allopathic (M.D.)

Osteopathic (D.O.) 7

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

80%

60%

53% 54% 53% 51% 50%

40% 20%

25% 24% 21%23%21%

26% 26% 29% 22%22%

0% Georgia

Other State

Other Country

2003 N = 396 2004 N = 358

2005 N = 412 2006 N = 445

2007 N = 502

Only 21% of respondents answering this question in 2007 graduated from a Georgia medical school, (23% in 2006, 21% in 2005) down from previous years. The majority of these respondents graduated from MCG 51%. This year, only 28% of respondents graduated from Emory, which is a 15% decline from the 43% reported in 2006.

Exhibit 7 Respondents by Georgia Medical School

100%

80%

60% 40% 20%

43% 43%43% 51% 41%

39% 43% 35%

31%

28%

20%

15% 8% 10% 10%

6%

10% 7%

6%

12%

0% MCG

Emory

Mercer

Morehouse

2003 N = 100

2004 N = 85

2005 N = 105

2006 N = 111

2007 N = 122 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
153

Percentage of Respondents
32%

Less than $20,000

18

4%

$20,000-$39,999

20

4%

$40,000-$59,999

23

5%

$60,000-$79,999

25

5%

$80,000-$99,999

31

6%

$100,000-$124,999

54

11%

$125,000-$149,999

30

6%

$150,000-$199,999

73

15%

Over $200,000

54

11%

TOTAL Respondents (n =)

481

100%

As illustrated in Exhibit 8, 50% of Georgia's GME graduates have educational debt totaling $80,000 or more (51% in 2006, 50% in 2005, 49% in 2004, 42% in 2003 & 2002). 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).

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

12%% 2% 11%%
3%5% 4% 3%4% 1% 2% 11%%4%
3%4% 2%4%
5%

Sub-Specialty Training

Patient Care

1%

Temp Out of Medicine

1% 0%1%

0%

22% 212%3% 21% 27%

68% 67% 65% 66% 66%

2003 N = 3920% 200140%N = 36220% 200305% N = 44004% 205006% N =6404%3

27000%7 N = 499

Over all, all areas of activity have consistently displayed only one to three percent fluctuations. The largest increase was in Sub-Specialty Training with a 4% increase from 21% in 2003 to 27% in 2004. Georgia experienced a gradual decline in physicians with confirmed plans (54% in 2003 to 46% in 2007) while there has been an increase in physicians with confirmed practice plans in Other States (45% in 2003 up to 52% in 2007).

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

60% 50%

54%54% 50%50%

49%49% 52%

46% 45%45%

40%

30%

20%

10%
0%
Georgia

Other State

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

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

2003 N = 250

2004 N = 232

2005 N = 258

2006 N = 288

2007 N = 34150

JOB SEARCH AND ACCEPTANCE

Exhibit 11 Graduates Who Had Actively Searched for a Job
(N=440)

80%

20%

Of the respondents:
352 (80%) indicated "Yes" they had actively searched for a job
88 (20%) 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, 91% 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=350)

Of the respondents who had actively searched for a job:
318 (91%) indicated "Yes" they had received and accepted a job offer

91%

24 (7%) indicated "Yes" they had received but rejected a job offer and are still searching
8 (2%) indicated they had actively searched but not received any offers

7%
2% 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=339)

Of the graduates who had actively searched for a job:

59 (17%) indicated "Yes" they had

83%

experienced difficulty finding a job

280 (83%) indicated "No" they did

17%

not have any difficulty

Yes

No

Among those who had actively searched, 17% indicated difficulty with finding a job (a decrease from 22% in 2006, 26% in 2005 & 2004, 29% in 2003 and 2002). Of the 2007 graduates experiencing difficulty finding a job, 20% reported having to change plans because of limited practice opportunities (a slight increase from 14% in 2003, 2004 and 2005, and 11% in 2006).

Of the graduates with confirmed practice plans:
30 (9%) indicated they had to change plans because of limited practice opportunities
297 (91%) 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=327)
91% 9%
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

1%2%3% 0%1%
5% 3%4%
5%

6% 5%66%%

10%

4%

3% 5%

6% 4% 6%7%8%8%10%

Hospital

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

15%

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

27%

32% 31% 33%
33%35%

0%

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

2002 N = 172

2003 N = 245

2004 N = 229

2005 N = 255

2006 N = 286

47%
45% 50% 2007 N = 342

Between 2003 and 2007, the most common practice settings for graduates continued to be group practice as an employee or partner and hospital-based settings. There has been a slight increase in graduates entering inner city settings (18% in 2007 up from 20% in 2006) yet the percent going into rural practice remains low at 5%.

Exhibit 16 Practice Area for Graduates with Confirmed Plans

35%

35

33% 33%

31%

31%

30

27%

27%

26% 25%

25%

25

20 18% 17%18%20%
16%

18% 18% 18% 17%17%

15

10

8%

6%

7% 5% 5%

5

Grad0s Inner City

Major City

Suburban

Small City

Rural

2003 N =

2004 N = 230

2005 N = 254

2006 N =

2007 N = 343

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
197
98
30
18

Percentage of Graduates
57%
29%
9%
5%

Total Respondents With Confirmed Practice

343

Plans and a Defined Compensation Package

100%

Between 2006 and 2007, there has been a shift from the number of graduates being offered salary with incentive (57% in 2007 up from 50% in 2006) versus salary without incentive (29% in 2007 down from 33% in 2006). Consistent with previous years (from 2003 to 2006), 95% of the graduates in 2007 were satisfied with their compensation.

Of the graduates with confirmed practice plans:
198 (57.6%) indicated they were "Very Satisfied" with their compensation
129 (37.5%) were "Somewhat Satisfied"
16 (4.7%) were "Not Too Satisfied"
1 (0.3%) were "Very Dissatisfied"

Exhibit 18 Level of Satisfaction with Compensation of Graduates with Confirmed Practice Plans
(N=344)
37.5%

57.6%
Very Satisfied Not Too Satisfied

4.7% 0.3%
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=364)

Ophthal (n=7) Pediatric Neurology n=1 Pediatric Surgery (n=1)
Peds (n=17) Infec Dis (n=3)
Psych (n=24) Geriatrics (n=3)
Otolaryn (n=5) Path (n=10)
Allg & Imun (n=3) F P (n=56) I M (n=28)
Gastro (n=6) Urology (n=3)
Derm (n=9) Rheum (n=2) Neuro (n=17)
Neph (n=4) General Surgery (n=18) Phys Med & Rehab (n=8) Endo/Diab/Metab (n=4)
Pul Disease (n=5) Plastic Surg (n=6)
OB/GYN (n=17) Hem/Onc (n=8) Nuclear Med (n=1)
E M (n=24) Card Dis (n=15)
Anesth (n=22) Ortho Surg (n=4) Card Surg (n=4) Radiology (n=28) Thoracic Surgery (n=1)

104,571 110,000 110,000 112,470 118,666 121,875 130,000 131,200 133,900 140,000 142,957 145,889 159,166 160,000 160,888 162,500 164,176 170,000 177,804 178,750 181,250 183,000 183,333 188,143 198,750 200,000

237,833 242,600 246,590 250,000 255,250 279,000

320,000

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

15

PERCEPTION OF JOB MARKET
Salaries for new primary care physicians (Family Medicine, General Internal Medicine, General Pediatrics, and Obstetrics and Gynecology) have significantly increased over previous years. For example, there was a $28,406 increase in the starting salaries for OB/GYN ($188,143 in 2007 up from $159,737 in 2006) and an $13,803 difference in Pediatrics starting salaries ($112,470 in 2007 up from $98,667 in 2006). Consistent with previous years, specialists in 2007 have enjoyed higher overall starting salaries.

Exhibit 20

Graduates' Perception of State and National Job Market

80%

75%

(2007 - All Graduates)

70%

60%

50%

40% 35%

37%

30%

20% 10%
0%

18% 11%
1%

6% 1%

9%

2% 0%

5%

Many Jobs Some Jobs Few Jobs

Very

Few

No Jobs

Jobs

Unknown

Jobs Within 50 Miles of Training Site N = 480

Jobs Nationally N = 484

Graduates of Georgia's residency training programs continue to have favorable perceptions of the state and national job market. Approximately 72% of respondents indicated there were some, if not many, jobs available within 50 miles of their training site (67% in 2006, 64% in 2005 and 66% in 2004). Similarly, an even higher percentage of respondents, 93% (90% in 2006 and 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