Physician supply and demand indicators in Georgia: a survey of Georgia's GME graduates completing training in June 2008 [Feb. 2009]

PHYSICIAN SUPPLY AND DEMAND INDICATORS IN GEORGIA
A SURVEY OF GEORGIA'S GME GRADUATES COMPLETING TRAINING IN JUNE 2008
THE GEORGIA BOARD FOR PHYSICIAN WORKFORCE FEBRUARY 2009
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 2008 GME EXIT SURVEY
Fiscal year 2008 marks the seventh 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 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 for physicians in training to ensure that Georgia has the physician workforce it needs in the future. Important findings from the 2008 survey are discussed below, along with comparisons to the findings from previous GME Exit Surveys.
9 The physician marketplace needs new physicians. o Eighty three percent (80% in 2007) of respondents had actively searched for a job, and 89% (91% in 2007) of these job seekers had already received and accepted an offer. o Those graduates who had actively searched for employment typically received 4 job offers (3 offers from 2005 to 2007). o Jobs for physicians still appear to be plentiful, as 75% (72% in 2007) of respondents indicated there were some, if not many, jobs available within 50 miles of their residency program. In 2008, 92% (93% in 2007) indicated there were some, if not many, jobs available nationally. o The number of graduates entering subspecialty training continues to decline (19% in 2008 down from 22% in 2007). Rates for previous years were as follows: 27% in 2004, and 23% in 2005, 21% in 2006.
9 Georgia is not training enough physicians for its own use. o In 2008, 27% of respondents graduated from high school in Georgia (18% in 2004, 19% in 2005, 21% in 2006, 18% in 2007). This is the highest percentage reported since 2002. o Only 26% (24% in 2004, 21% in 2005, 23% in 2006, and 21% in 2007) graduated from a Georgia medical school. o Approximately 34% (38% in 2004, and 27% in 2005, 38% in 2006, and 32% in 2007) 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 In 2008, approximately 51% of responding GME graduates had educational debt totaling $80,000 or more. Rates for previous years are as follows: 49% in 2004, 50% in 2005, 51% in 2006, and 50% in 2007. o In 2008, only 7% of respondents with confirmed plans planned to practice in a rural area (8% in 2004, 7% in 2005, 5% in 2006 and 2007).
2

Other Key Findings
1. Georgia's job market for physicians continues to be strong. Only 22% (17% in 2007, 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 10% 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 461 respondents, 240 (52%) lived in another state upon graduation from high school (down from 307 (61%) in 2007). Twenty one percent (same as 2007) of respondents indicated they graduated from a high school in another country. Forty five percent (50% in 2007) of survey respondents attended medical school in another state, with 30% (22% in 2004, 26% in 2005 & 2006, 29% in 2007) attending medical school in another country. For the first time in six years, there has been an increase in the number of graduates with confirmed practice plans to remain in Georgia (59% in 2008, 46% in 2007, 50% in 2006 & 2005, 54% in 2004).
3. The physician workforce is becoming increasingly diverse. Forty five percent of respondents were female (consistent with 45% in 2007). The reported race and ethnicity of physicians completing training reflects diversity, with 46% of respondents indicating they were of African-American, Asian, or other races (39% in 2004, 42% in 2005, 45% in 2006, 47% in 2007).
4. Respondents entering practice in Georgia reported satisfaction with their salary/compensation packages. The average starting salary for 2008 graduates was $175,775 (down from $181,410 in 2007) and the median salary was $165,000 ($165,000 in 2007).
3

Fifty two percent (51% in 2004, 53% in 2005, 52% in 2006, 58% in 2007) of the respondents entering clinical practice, who had accepted a position, indicated they were "Very Satisfied" with their compensation package (172 of 330 respondents). Only 14 of the 330 applicable respondents (or 4%) reported they were "Not Too Satisfied" or "Very Dissatisfied" with their compensation package. For previous years, the number of respondents dissatisfied with their compensation was as follows: 8 in 2004; 6 in 2005; 14 in 2006; and, 16 in 2007.
Specialists enjoyed higher overall starting salaries. The average starting salaries for specialists ranged from $110,000 for Preventive Medicine to $320,500 for Orthopedic Surgery (compared with a range of $101,250 to $250,000 in 2004, $100,000 to $252,500 in 2005, $96,333 to $255,000 in 2006, $104,571 to $320,000 in 2007).
Salaries for new primary care physicians (Family Medicine, General Internal Medicine, General Pediatrics, and Obstetrics and Gynecology) ranged from $124,575 to $168,242. (The range for primary care physicians in previous years was as follows: $116,500 to $164,444 in 2004; $110,636 to $162,714 in 2005; $98,667 to $159,737 in 2006; and $112,470 to $188,143 in 2007.)
4

BACKGROUND
This report presents the results of the Georgia Board for Physician Workforce's seventh annual GME Exit Survey of physicians completing a Georgia residency or fellowship training program in June 2008. Comparisons with the results from previous years are shown throughout the report where appropriate.
A total of 539 graduates were surveyed and 462 responses were received, yielding an overall response rate of 86% (81% in 2007, 83% in 2006 and 77% in 2005).

DEMOGRAPHIC CHARACTERISTICS
Exhibit 1 Gender of Respondents
(N=460)

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

60% 63%

58%

55%

55%

40%

37%

42% 45%

45%

2004 2005 2006 2007 2008

Of the respondents: 254 (55%) were Male 208 (45%) were Female

Results showed the same percentage of female respondents entering the job market in 2008, from the previous year. The percentage was 45%, up from 37% in 2005 and 42% in 2006.

5

Of the respondents:
247 (53.6%) were White
76 (16.5%) were Black/African American
88 (19.1%) were Asian/Pacific Islander
43 (9.3%) were Other
6 (1.3%) were Multi-Race
1 (0.2%) were Native American/Alaskan Native

Exhibit 2 Race/Ethnicity of Respondents
(N=461)

53.6%

16.5%

0.2% 1.3%

9.3%

19.1%

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 diverse with 46% of respondents indicating they were African-American, Asian, Multi-Race, or other race (47% in 2007, 42% in 2006, 43% in 2005 and 39% in 2004).

Of the respondents: 24 (5%) were of Hispanic
origin
436 (95%) were not of Hispanic origin

Exhibit 3 Respondents of Hispanic Origin
(N = 460)
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

63% 61% 61%

60

57%

52%

50

40

30

27% 21%

19%

20 18%

18%

21% 18%20% 22%21%

10

0
2004
N = 363

Georgia
2005
N = 412

Other State
2006
N = 444

Other Country

2007

2008

N = 502

N = 461

Of the respondents:
124 (27%) lived in Georgia
240 (52%) lived in Another State
97 (21%) lived in Another Country

In 2008, 73% of the physicians completing training in Georgia attended high school in another state or country (82% in 2007, 79% in 2006, 81% in 2005 and 77% in 2004). Additionally, 19.2% of those respondents coming from another U.S. state came from surrounding states (i.e., FL, AL, NC, SC, TN). The percentage of respondents that attended an allopathic medical school remained fairly consistent from 20032008 (96% in 2004, 94% in 2005, 96% in 2006, 97% in 2007, and 97% in 2008), with a one to two percent fluctuation from year-to-year.

Of the 460 respondents:
444 (97%) went to an Allopathic Medical School and received an M.D. degree
16 (3%) attended an Osteopathic Medical School and received a D.O. degree

Exhibit 5 Type of Medical Education
(N=460)
97%
3%

Allopathic (M.D.)

Osteopathic (D.O.)

7

LOCATION OF MEDICAL SCHOOL
Exhibit 6 Location of Medical School
80%

60% 40% 20%

24%

23% 21% 21%

26%

54% 53% 51% 50% 45%

29% 30% 26% 26% 22%

0% Georgia

Other State

2004 N = 358

2005 N =412 2006 N = 445

Other Country

2007 N = 502

2008 N = 454

Only 26% of respondents answering this question in 2008 graduated from a Georgia medical school, which is a 5% increase from 2007 (23% in 2006, 21% in 2005). The majority of these respondents (35%) graduated from MCG, a 16% decrease. Emory saw a 5% increase in the number of graduates this year after a 15% decline in 2007. In 2008, 20.8% of "Other State" medical school graduates came from the surrounding states. The majority of respondents that attended medical school in another country were from India.

Exhibit 7 Respondents by Georgia Medical School
80%

60% 40%

51% 43% 43%
41%
35%

43%

39%

35%

33% 28%

20%

17% 15% 10% 10%
8%

12% 14% 7% 10%6%

0% MCG

Emory

Mercer

Morehouse

2004 N = 85

2005 N = 105 2006 N = 111

2007 N = 122

2008 N = 133

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
145

Percentage of Respondents
33%

Less than $20,000

7

2%

$20,000-$39,999

31

7

$40,000-$59,999

13

3%

$60,000-$79,999

18

4%

$80,000-$99,999

15

3%

$100,000-$124,999

57

13%

$125,000-$149,999

32

7%

$150,000-$199,999

64

15%

Over $200,000

59

13%

TOTAL Respondents (n =)

441

100%

As illustrated in Exhibit 8, 51% of Georgia's GME graduates have educational debt totaling $80,000 or more (50% in 2007, 51% in 2006, 50% in 2005, and 49% in 2004). Forty eight percent (48%) of the graduates have educational debt of $100,000 or more, which is the highest perentage reported in the last five years (43% in 2007, 45% in 2006, 42% in 2005, and 41% in 2004).

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

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

Sub-Specialty Training

Patient Care
Temp Out of Medicine 1110%%%%
1%

19% 212%2% 23% 27%

72% 68% 67% 65% 66%

2004 N = 3620% 200510%N = 40420% 200630%N = 44340% 200750%N = 49960% 2008 70%N = 460
All areas of activity have consistently displayed only one to four percent fluctuations. The most significant change was the four percent increase in the number of graduates practicing in the area of "Patient Care." From 2004 to 2007, graduates were increasingly leaving the state to practice. However, this year there was a 13% increase in physicians with plans to practice in Georgia (46% in 2007 to 59% in 2008). Of those going to practice in another state, 32% are going to a surrounding state.

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

60% 50%

59% 54% 50% 50%
46%

52% 49% 49% 45%

40%
40%

30%

20%

10%
0% Georgia

Other State

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

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

2004 N = 232

2005 N = 258

2006 N = 288

2007 N = 345

2008 N = 339

10

JOB SEARCH AND ACCEPTANCE

Exhibit 11 Graduates Who Had Actively Searched for a Job
(N=426)

83%

17%

Of the respondents:
353 (83%) indicated "Yes" they had actively searched for a job
73 (17%) indicated "No" they had not actively searched for a job

Yes

No

The majority of respondents (83%) actively searched for a job prior to graduation. Of those who actively searched, 89% reportedly received and accepted an offer upon completion of training, which was down from 91% in 2007.

Of the respondents who had actively searched for a job:
312 (89%) indicated "Yes" they had received and accepted a job offer
27 (8%) indicated "Yes" they had received but rejected a job offer and are still searching

Exhibit 12 Graduates Receiving/Accepting Job Offer Among Those Who Had Actively Searched
(N=352)
89%

13 (4%) indicated they had actively searched but not received any offers

8% 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=343)

Of the graduates who had actively searched for a job:
78% 75 (22%) indicated "Yes" they had
experienced difficulty finding a job

268 (78%) indicated "No" they did

22%

not have any difficulty

Yes

No

Among those who had actively searched, 22% indicated difficulty with finding a job (an increase from 17% in 2007). Of the 2008 graduates, 10% reported having to change plans because of limited practice opportunities.

Of the graduates with confirmed practice plans:
33 (10%) indicated they had to change plans because of limited practice opportunities
302 (90%) 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=335)

90%

10%

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

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

5% 6% 6% 6% 6%
33%%3%4% 5%

3% 4%

7% 6% 8%

Group Practice - Owner/Partner

Group Practice - Employee

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

36% 27%

28%

32%

31% 33%

33%

0%

5%

10%

15%

20%

25%

30%

35%

40%

2004 N = 245

2005 N = 229

2006 N = 255

2007 N = 342

2008 N = 338

Between 2004 and 2008, the most common practice settings for graduates continued to be hospital-based settings, group
practice as an employee, or group practice as owner/partner. There was a 14% increase from 22% in 2007 to 36% in
2008 for graduates with confirmed plans to practice in a hospital setting. There has been a slight increase in graduates entering rural and suburban settings between 2007 and 2008 (up by 2% in Rural settings and 4% in Suburban settings).

Exhibit 16

Practice Area for Graduates with Confirmed Plans

35%

35

33% 33%

31%

31%

29%

30

27% 25%

26%

25%
25

20%
20 17% 18% 18%
16%

17%17%18%18%

15%

15

10

8% 7% 5% 7%

5%

5

0 Inner City

Major City

Suburban

Small City

Rural

2004 N = 230

2005 N =254

2006 N = 286

2007 N = 343

2008 N = 338

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
207
93
23
13

Percentage of Graduates
62%
27%
7%
4%

Total Respondents With Confirmed Practice

336

Plans and a Defined Compensation Package

100%

Between 2006 and 2008, there has been a shift from the number of graduates being offered salary with incentive (62% in 2008, 57% in 2007, and 50% in 2006) versus salary without incentive (28% in 2008, 29% in 2007, and 33% in 2006). Slighter lower than previous years (95% from 2003 to 2007), 93.9% of the graduates in 2008 were satisfied with their compensation.

Of the graduates with confirmed practice plans:
172 (52%) indicated they were "Very Satisfied" with their compensation
138 (42%) were "Somewhat Satisfied"
14 (4%) were "Not Too Satisfied"
6 (2%) were "Very Dissatisfied"

Exhibit 18 Level of Satisfaction with Compensation of Graduates with Confirmed Practice Plans
(N=330)
42%

52%
Very Satisfied Not Too Satisfied

4% 2%
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=354)

Prev Med (n=1) Infect Dis (n=4)
Peds (n=33) Urology (n=3) Peds Neuro (n=1) Geri Medicine (n=5) Endocrin (n=1) Neuro Surg (n=1) Nuclear Med (n=1) Phys Med & Rehab (n=6) Hem/Onc (n=6) Nephrology (n=8) Neurology (n=9) Family Med (n=56) Psychiatry (n=15) Pathology (n=8) Ophthal (n=4) OB/GYN (n=9)
IM (n=66) Allg & Immun (n=3)
Derm (n=6) Rheum (n=6) Pulm Dis (n=5) Gen Surg (n=10)
EM (n=17) Plastic Sugery (n=5)
Gastroentr (n=4) Card Dis/Card (n=19)
Neonatology (n=1) Pain Med (n=3) Anesthes (n=18)
Radiology (n=16) Ortho Surg (n=4)

110,000 118,750 124,575 135,000 135,000 140,000 145,000 150,000 150,000 151,666 155,000 155,625 157,777 158,876 161,803 163,125 165,000 166,944 168,242 168,333 186,666 204,000 204,800 209,500 216,830 245,000 247,500 247,736 250,000 258,333 275,833 280,937

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

322,500
$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. However, the 2008 starting salaries for OB/GYN physicians decreased by $21,199. The starting salary respondents reported for an OB/GYN in 2008 was $166,944 down from $188,143 in 2007. In previous years, there was a $28,406 increase in the starting salaries for OB/GYN ($188,143 in 2007 up from $159,737 in 2006). The most significant increases in starting salaries for physicians between 2007 and 2008 were in plastic surgery (a $61,667 increase) gastroenterology (an $88,334 increase) and orthopedic surgery (a $72,000 increase). Overall, specialists in 2008 have enjoyed higher overall starting salaries.

Exhibit 20

Graduates' Perception of State and National Job Market

80%

75%

(2008 - All Graduates)

70%

60%

50% 41%
40% 34%
30%

20% 10%
0%

17% 9% 2%

7% 1%

9%

1% 0%

6%

Many Jobs Some Jobs Few Jobs

Very

Few

No Jobs

Jobs

Unknown

Jobs Within 50 Miles of Training Site N = 445

Jobs Nationally N = 444

Graduates of Georgia's residency training programs continue to have favorable perceptions of the state and national job market. Approximately 75% of respondents indicated there were some, if not many, jobs available within 50 miles of their training site (72% in 2007, 67% in 2006, 64% in 2005 and 66% in 2004). Compared to last year, a lesser percentage of respondents, 91% (93% in 2007, 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