Physician Supply and Demand Indicators in Georgia A Survey of Georgia's GME Graduates Completing Training in June 2011 GEORGIA BOARD FOR PHYSICIAN WORKFORCE MAY 2012 2 PEACHTREE STREET, NW, 36TH FLOOR, ATLANTA, GA 30303 PHONE (404) 232-7972 / FAX (404) 656-2596 Cherri Tucker, Executive Director, Colette Jeffery, Carla Graves, Cheryl Culp, and G.E. Alan Dever, M.D., Ph.D., contributors. www.gbpw.georgia.gov 2011 Georgia GME Exit Survey Report Table of Contents Executive Summary ..................................................................................................... 3 Indication of Practice Maps.......................................................................................... 6 Table 1: Distribution of graduates by gender ................................................................ 7 Table 2: Distribution of graduates by citizenship status ................................................ 7 Table 3: Distribution of graduates by race .................................................................... 8 Table 4: Distribution of graduates by ethnicity ............................................................. 8 Table 5: Location of residence upon graduation from high school................................. 9 Table 6: Medical school graduates by geographic location and medical school ........... 10 Table 7: Distribution of medical education debt ......................................................... 11 Table 8: Type of primary activity after completion of training..................................... 12 Table 9: Job search Information ................................................................................. 13 Table 10: Job offers.................................................................................................... 13 Table 11: Job search approaches ................................................................................ 14 Table 12: Difficulty in finding a job ............................................................................. 14 Table 13: Graduates going into patient care by location ............................................. 15 Table 14: Graduates going for additional training with plans to return to Georgia ...... 16 Table 15: Practice location by where respondents attended high school..................... 17 Table 16: Top reasons cited for leaving Georgia.......................................................... 18 Table 17: Type of patient care practice setting ........................................................... 19 Table 18: Plans to be at principal practice for more than four years ............................ 20 Table 19: Plans to be at principal practice for more than four years by GME program . 20 Table 20: Description of practice area ........................................................................ 21 First Year Salary Trends ............................................................................................. 22 2 2011 Georgia GME Exit Survey Report Executive Summary and Key Findings The Georgia Board for Physician Workforce (GBPW) has conducted an annual survey of graduating physician residents over the past ten years. The purpose of this survey is to inform the medical education community and state physician workforce planners about the experiences of graduates and the supply and demand for new physicians in Georgia. The survey offers insight into residents' demographic characteristics; compensation levels; retention rates; graduates planning to practice in underserved areas; assessment of job market; and training information. There were 518 respondents to the survey in 2011, with a response rate of 88.2%. All Georgia graduate medical education programs participate in the survey: Atlanta Medical Center Emory University School of Medicine Floyd Medical Center Medical Center of Central Georgia Medical College of Georgia @ GHSU Memorial Health University Medical Center Morehouse School of Medicine Phoebe Putney Memorial Hospital Satilla Regional Medical Center The Medical Center Key findings from the 2011 survey: Geography: 53.4% are remaining in Georgia to practice, and 19.8% are going to a contiguous state (AL, FL, NC, SC, or TN) 81.9% are remaining in the Southeast to practice 94.7% are native born, naturalized residents or permanent residents Most respondents did not graduate high school in Georgia (78.2%) Of those that graduated high school in Georgia, 23.3% graduated from an off-shore medical school 3 2011 Georgia GME Exit Survey Report Geography (cont): Of the graduates that completed high school outside the United States, almost one-half (48.8%) plan to stay in Georgia to practice 4.5% of graduates have an obligation or visa requirement to practice in a Health Professional Shortage Area (HPSA), and 7.4% will practice in a HSPA Demographics: 56.9% of the respondents were male (consistent with previous years) The average age of graduates was 33 years old. Medical School: 95.7% of graduates attended an allopathic school In 2011, 80.0% of the U.S. medical students were enrolled in an allopathic medical school, and 20.0% were enrolled in an osteopathic medical school 44.4% of all responding Georgia's GME graduates going into practice in 2011 are going into primary care Since 2000, 23 medical schools have been established. Fifty-two percent of those schools are osteopathic schools Only 19.9% of graduates attended medical school in Georgia Debt and Salary: 31.6% of graduates had debt over $200,000 In 2006, 10.0% of residents had educational debt of over $200,000 Salaries of specialists were higher: The lowest average salary of graduates was infectious disease at $107,500 The highest was pediatric surgery at $475,000 Of the graduates with confirmed practice plans, on a scale of 1 to 10, with 10 being completely satisfied, respondents averaged 7.3 for satisfaction with their compensation The percentage of graduates being compensated as fee for service has decreased from 12.0% in 2006 to 8.3% in 2011 4 2011 Georgia GME Exit Survey Report Retention: 53.4% of graduates with confirmed practice plans are staying in Georgia 73.4% of graduates that graduated high school in Georgia and graduated from a Georgia GME program plan to stay in Georgia to practice Of those graduates that are going on for additional training/fellowship, 24.6% plan to return to Georgia to practice and 48.8% are uncertain The top reasons for graduates leaving Georgia are "Proximity to Family;" "Better jobs in desired location outside Georgia;" and "Never Intended to practice in Georgia" (consistent with previous years) Assessment of Practice Opportunities: GME graduates were asked to provide an overall assessment of the number of practice opportunities in their specialty within 50 miles of their training site. Using a scale of 1 to 10, where 1 means very few jobs and 10 means many jobs, the average rating was 5.9. GME graduates were also asked to provide an overall assessment of practice opportunities in their specialty nationally. Using the same scale where 1 indicates very few jobs and 10 indicates many jobs, the average for respondents was 7.6. Satisfaction with Training GME graduates were asked if they were satisfied overall with the training they received. Using a scale of 1 to 10, where 1 indicates strongly disagree (or very dissatisfied) and 10 equals strongly agree (or very satisfied), the average rating among 2011 respondents was 8.5. Respondents for 2011 were asked if they would choose to train at the same site again using a rating scale of 1 to 10 (where 1 indicates strongly disagree and 10 indicates strongly agree). The average rating among respondents was 8.3. 5 2011 Georgia GME Exit Survey Report 6 2011 Georgia GME Exit Survey Report Table 1: Distribution of graduates by gender: Gender Number Male Female TOTAL 294 223 517 Distribution of graduates by age 2011 - Average age of graduates was 33.04 years 2006 - Average age of graduates was 33.13 years Table 2: Distribution of graduates by citizenship status: Percent 56.9 43.1 100.0 Citizenship Status Native Born U.S. Naturalized U.S. Permanent Resident J-1, J-2 Exchange Visitor H-1, H-2, H-3, Temporary Worker Other TOTAL Number 312 140 39 19 6 2 518 Percent 60.2 27.0 7.5 3.7 1.2 0.4 100.0 7 2011 Georgia GME Exit Survey Report Table 3: Distribution of graduates by race: Race White Asian or Pacific Islander Black/African American Other Multi-Race TOTAL Table 4: Distribution of graduates by ethnicity: Ethnicity Yes (Hispanic) No (Non-Hispanic) TOTAL Number 258 106 86 53 12 515 Number 32 485 517 Percent 50.1 20.6 16.7 10.3 2.3 100.0 Percent 6.2 93.8 100.0 8 2011 Georgia GME Exit Survey Report Table 5: Where was your residence upon graduation from high school? Residence upon Graduation from High School Georgia Other U.S. State Florida Texas North Carolina Alabama New York All Other States Canada Other Country TOTAL Number 113 303 42 22 21 19 17 183 9 93 518 Percent 21.8 58.5 7.9 4.2 4.1 3.7 3.3 35.3 1.7 18.0 100.0 23.3% of the respondents that graduated from high school in Georgia went overseas to medical school and come back to Georgia for their residency Of the graduates that graduated from a Georgia high school 18% come from a Non-MSA (rural) county Of the graduates who graduated from another U.S. state, 33.3% went to medical school in a contiguous state to Georgia (includes NC, SC, TN, AL, and FL) 9 2011 Georgia GME Exit Survey Report Table 6: Medical school graduates by geographic location and medical school Medical School Location Georgia Emory University School of Medicine Medical College of Georgia Mercer University School of Medicine Morehouse School of Medicine Other U.S. State Florida North Carolina Texas Ohio Alabama All Other States Other Country TOTAL Number 103 39 31 21 12 250 23 22 21 13 12 159 164 517 Percent 19.9 37.8 30.1 20.4 11.7 48.4 4.4 4.3 4.1 2.5 2.3 30.8 31.7 100.0 13.7% of the respondents graduated medical school in a state contiguous to Georgia (includes FL, NC, SC, AL and TN) 23.3% of Georgia high school graduates in this study attended medical school overseas Of those graduates that graduated from a medical school in another country (164), most went to medical school in India (27), Dominican Republic (20), Grenada (9), and Pakistan (8) Of the respondents that graduated from an overseas medical school, 40.1% came from a Caribbean medical school 10 2011 Georgia GME Exit Survey Report Table 7: Distribution of medical education debt by number and percent Amount of Debt None Less than $20,000 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$124,999 $125,000-$149,999 $150,000-$199,999 Over $200,000 TOTAL Number 62 3 17 14 8 19 46 29 83 130 411 Percent 15.1 0.7 4.1 3.4 1.9 4.6 11.2 7.1 20.2 31.6 100.0 Average debt of Georgia GME graduate respondents = $138,831.51 in 2011 Nationally, the average medical student debt at time of graduation was $141,132 in 2009 www.usnews.com 10.0% of the respondents had education debt over $200,000 in 2006, and 31.6% of the respondents had education debt over $200,000 in 2011 11 2011 Georgia GME Exit Survey Report Table 8: Type of primary activity after completion of training Primary Activity Patient Care/Clinical Practice Additional Sub-Specialty Training Other Teaching/Research Chief Resident Undecided Temporarily Out of Medicine TOTAL Number 322 148 15 11 7 7 2 512 Percent 62.9 28.9 2.9 2.1 1.4 1.4 0.4 100.0 12 2011 Georgia GME Exit Survey Report Table 9: If you are planning to enter patient care/clinical practice, have you actively searched for a job? Have actively job searched Yes No TOTAL Table 10: Have you been offered a job? Number 346 114 460 Percent 75.2 24.8 100.0 Offered a Job Yes, Accepted Offer Yes, but Declined Offer and Still Searching No Offers Received TOTAL The average number of offers received = 4 Number 312 32 72 416 Percent 75.0 7.7 17.3 100.0 13 2011 Georgia GME Exit Survey Report Table 11: Types of approaches that were used in your job search Job Search Approaches Independent Online Search Activities Third Party Representation Announcements/Career Fairs Want Ads Word of Mouth Personal Contact Networking Other Physicians TOTAL Number 147 125 27 13 3 1 1 1 318 Table 12: Did you have any difficulty finding a practice position you were satisfied with? Difficulty Finding Job Yes No TOTAL Number 68 298 366 Percent 46.2 39.3 8.5 4.1 0.9 0.3 0.3 0.3 100.0 Percent 18.6 81.4 100.0 14 2011 Georgia GME Exit Survey Report Table 13: Graduates going into patient care by practice location Location of Primary Activity Georgia Other State Florida Texas South Carolina North Carolina Alabama Other States Other Country TOTAL Number 156 135 27 11 9 9 8 71 1 292 Percent 53.4 46.2 9.2 3.8 3.1 3.1 2.7 24.3 0.3 100.0 15 2011 Georgia GME Exit Survey Report Table 14: Graduates going for additional training with plans to return to Georgia by program: Plans to Return to Georgia Georgia GME Program Atlanta Medical Center Emory University School of Medicine Floyd Medical Center Medical Center of Central Georgia Medical College of Georgia Memorial Health University Medical Center Morehouse School of Medicine Phoebe Putney Memorial Hospital Satilla Regional Medical Center The Medical Center Yes # % 4 30.7 12 13.8 1 100.0 9 64.3 10 16.1 3 18.8 3 20.0 0 - 0 - 2 33.3 No # % 3 23.1 28 32.2 0 - 3 21.4 30 48.4 6 37.5 3 20.0 0 - 0 - 1 16.7 Don't Know # % 6 46.2 47 54.0 0 - 2 14.3 22 35.5 7 43.8 9 60.0 0 - 0 - 3 50.0 16 2011 Georgia GME Exit Survey Report Table 15: Practice location by where respondents attended high school Location of Primary Activity Georgia Other State Outside of U.S. TOTAL Georgia # % 80 73.4 29 26.6 0 0.0 109 100.0 Where was your residence upon graduation from high school? Other U.S. State # % 104 35.5 Canada # % 5 55.6 Other Country # % 42 48.8 189 64.5 2 22.2 41 47.7 0 0.0 2 22.2 3 3.5 293 100.0 9 100.0 86 100.0 Total 231 261 5 497 Of the respondents that graduated high school in Georgia and graduated from a Georgia GME program, 73.4% will stay in Georgia to practice Of the respondents that graduated high school in another state, 35.5% will stay in Georgia 17 2011 Georgia GME Exit Survey Report Table 16: Top reasons cited for leaving Georgia Reason Number Proximity to family 129 Better jobs in desired location outside Georgia 70 Never intended to practice in Georgia 58 Better job for spouse/partner outside Georgia 52 Better jobs in desired practice setting outside Georgia 49 Better salary offered outside Georgia 46 Overall lack of jobs/practice opportunities in Georgia 39 Other service obligation 15 Better jobs outside of Georgia that meet visa requirements 7 Cost of starting a practice 4 Cost of malpractice insurance in Georgia 1 TOTAL 470 Respondents that had plans to practice outside of Georgia were able to select their top three reasons for leaving, and for the past several years, proximity to family has been the top reason Georgia's residents moved out of state to practice 18 2011 Georgia GME Exit Survey Report Table 17: Type of patient care practice setting Practice Setting Number Percent Hospital* In-Patient 141 Group Practice as Employee 114 Other 53 Group Practice as Owner/Partner 44 Hospital* Ambulatory Care 37 Hospital* Emergency Room 28 Partnership (2 person) 22 Solo Practice 16 Military 8 Freestanding Health Center/Clinic 7 HMO 1 TOTAL 471 *43.7% entering a hospital-based practice setting 29.9 24.2 11.3 9.3 7.9 5.9 4.7 3.4 1.7 1.5 0.2 100.0 Merritt Hawkins reports 32% residents indicated they would prefer to be employed by a hospital than any other option (2011 Survey of Final Year Medical Residents) 19 2011 Georgia GME Exit Survey Report Table 18: Do you expect to be at your principal practice for 4 or more years? Expect to be at Principal Practice for 4 or more years Yes No TOTAL Number 311 148 459 Percent 67.8 32.2 100.0 Table 19: Do you expect to be at principal practice for 4 or more years by Georgia GME Program: Georgia GME Program Atlanta Medical Center Emory University School of Medicine Floyd Medical Center Medical Center of Central Georgia Medical College of Georgia Memorial Health University Medical Center Morehouse School of Medicine Phoebe Putney Memorial Hospital Satilla Regional Medical Center The Medical Center Number 12 145 5 29 69 24 16 3 0 7 Percent 66.7 65.8 71.4 82.9 67.0 80.0 55.2 75.0 0.0 70.0 20 2011 Georgia GME Exit Survey Report Table 20: Which best describes the area in which you will be practicing? Description of Area Number Percent Inner City Other Area within a Major City Suburban Small City (city pop < 50,000) Rural (county pop < 35,000) TOTAL 124 25.9 147 30.8 120 25.1 50 10.5 37 7.7 478 100.0 The percentage of graduates going to practice in a small city decreased from 14.0% in 2010 to 10.5% in 2011 The percentage also decreased for graduates going into rural areas from 11.0% in 2010 to 7.7% in 2011 21 2011 Georgia GME Exit Survey Report Salary of graduates going into practice: Inf e c t io us D is e a s e ( n=2 ) A lle rg y & Immuno lo g y ( n=1) P hy s ic a l M e d ic ine & R e ha b ilit a t io n ( n=1) Pain M e d ic ine ( n=2 ) Pe d iat ric s ( n=3 4 ) A d d ic t io n P s y c hia t ry ( n=1) Op ht halmo lo g y ( n=3 ) Ps yc hiat ry ( n=9 ) Ge riat ric s ( n=3 ) Traumat ic S urg e ry ( n=2 ) Ne p hro lo g y ( n=6 ) R he umat o lo g y ( n=2 ) Nuc le ar M e d ic ine ( n=2 ) Family M e d ic ine ( n=3 7) Int e rna l M e d ic ine ( n=4 7 ) Eme rg e nc y M e d ic ine ( n=15 ) End o c rino lo g y ( n=2 ) Pre ve nt ive M e d ic ine ( n=2 ) Ge ne ral S urg e ry ( n=3 ) OB / GY N ( n=14 ) Ane s t he s io lo g y ( n=2 0 ) Pulmo nary D is e as e ( n=2 ) D e rmat o lo g y ( n=4 ) The rap e ut ic Rad io lo g y ( n=3 ) Pat ho lo g y ( n=6 ) He ma t o lo g y / Onc o lo g y ( n=6 ) Ne uro lo g y ( n=5) Uro lo g y ( n=4 ) Gas t ro e nt e ro lo g y ( n=3 ) Plas t ic S urg e ry ( n=3 ) C a rd io lo g y ( n=11) R a d io lo g y ( n=12 ) Ort ho p e d ic S urg e ry ( n=6 ) Ne uro lo g ic al S urg e ry ( n=2 ) P e d ia t ric S urg e ry ( n=1) $0 10 7 , 5 0 0 115 , 0 0 0 13 0 , 0 0 0 13 6 , 5 0 0 14 3 , 5 0 0 15 0 , 0 0 0 15 6 , 6 6 7 15 6 , 7 7 8 16 4 , 16 7 17 0 , 0 0 0 17 1, 6 6 7 17 2 , 5 0 0 17 5 , 0 0 0 17 6 , 5 9 4 17 7 , 9 5 7 18 8 , 6 6 6 2 0 0 ,0 0 0 2 0 3 ,50 0 2 0 6 ,6 6 7 2 14 , 4 2 8 2 2 2 ,2 0 0 2 2 5,0 0 0 2 3 2 ,50 0 2 3 8 ,3 3 3 2 3 9 ,0 0 0 2 4 2 ,50 0 2 53 ,0 0 0 2 55,0 0 0 2 6 3 ,3 3 3 2 73 ,3 3 3 2 9 3 ,6 3 6 2 9 7,0 8 3 3 8 3 ,3 3 3 4 2 5,0 0 0 4 75,0 0 0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 $450,000 $500,000 22