Physician Supply and Demand Indicators in Georgia A Survey of Georgia's GME Graduates Completing Training in June 2012 GEORGIA BOARD FOR PHYSICIAN WORKFORCE FEBRUARY 2013 2 PEACHTREE STREET, NW, 36TH FLOOR, ATLANTA, GA 30303 PHONE (404) 232-7972 / FAX (404) 656-2596 Cherri Tucker, Executive Director, Colette Jeffery, Cheryl Culp, and G.E. Alan Dever, M.D., Ph.D., contributors. www.gbpw.georgia.gov 2012 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 2012 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 eleven 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 560 respondents to the survey in 2012, with a response rate of 91.1%. 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 at Georgia Regents University Memorial Health University Medical Center Morehouse School of Medicine Phoebe Putney Memorial Hospital The Mayo Clinic (formerly Satilla Regional Medical Center) The Medical Center Key findings from the 2012 survey: Geography: 50.0% are remaining in Georgia to practice, and 16.4% are going to a contiguous state (AL, FL, NC, SC, or TN); nationally 48% percent of residents practice in the state where they completed their GME 70.7% are remaining in the Southeast to practice 90.4% are native born, naturalized residents or permanent residents Most respondents did not graduate high school in Georgia (75.6%) Of those that graduated high school in Georgia, 11.9% graduated from an overseas medical school 3 2012 Georgia GME Exit Survey Report Geography (cont): Of the graduates that completed high school outside the United States, (39.1%) plan to stay in Georgia to practice 7.4% of graduates have an obligation or visa requirement to practice in a Health Professional Shortage Area (HPSA), and 9.9% will practice in a HSPA Demographics: 50.2% of the respondents were male (less than in previous years) The average age of graduates was 33 years old. Medical School: 95.3% of graduates attended an allopathic school In 2012, 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 41.9% of all responding Georgia's GME graduates going into practice in 2012 are going into primary care 23.6% of graduates attended medical school in Georgia 32.9% of graduates attended medical school in another country (highest number being from India) Debt and Salary: 29.9% 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 average starting salary of graduates going into cardiovascular surgery was $321,000 The average starting salary of graduates going into pediatrics was $132,125 Of the graduates with confirmed practice plans, on a scale of 1 to 10, with 10 being completely satisfied, respondents averaged 7.8 for satisfaction with their compensation The percentage of graduates being compensated as fee for service has decreased from 12.0% in 2006 to 10.8% in 2012 4 2012 Georgia GME Exit Survey Report Retention: 50.0% of graduates with confirmed practice plans are staying in Georgia 74.1% of graduates that graduated high school in Georgia and graduated from a Georgia GME program plan to stay in Georgia to practice Graduates that went to high school, medical school and GME in Georgia had an 81.8% retention rate Of those graduates that are going on for additional training/fellowship, 29.5% plan to return to Georgia to practice and 56.1% are uncertain The top reasons for graduates leaving Georgia are "Proximity to Family;" "Better jobs in desired location outside Georgia;" and "Better Salary offered outside of Georgia" 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 5.5. 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 2012 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 7.4. 5 2012 Georgia GME Exit Survey Report Where responding graduates from Georgia's residency programs indicate they will practice. Overall percent by geographical region. 6.54.%1% 1882..66.%5%% 8.6% 59.7.%6% 7067.700%..73%% Where responding graduates from Georgia's residency programs indicate they plan to practice. Percent by Georgia, Georgia border states, and states with more than 2.0%. Georgia States where more than 2% of the new physicians plan to practice 6.54.%1% 2.7% 182.6.%5% 2.0% 8.6% 9.6% 4.4% 3.0% 2.4% 4.7% 60.3% 3.0% 70.7% 3.3% 50.0% 5.4% 6 2012 Georgia GME Exit Survey Report Table 1: Distribution of graduates by gender: Gender Number Male Female TOTAL 281 279 560 Distribution of graduates by age 2012 - Average age of graduates was 32.78 years 2007 - Average age of graduates was 32.90 years Table 2: Distribution of graduates by citizenship status: Percent 50.2 49.8 100.0 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 351 105 49 33 20 1 559 Percent 62.8 18.8 8.8 5.9 3.6 0.2 100.0 7 2012 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 272 154 73 46 12 559 Number 24 531 555 Percent 48.7 27.5 13.1 8.2 2.1 100.0 Percent 4.3 95.7 100.0 8 2012 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 New York California Ohio All Other States Canada Other Country TOTAL Number 135 294 47 22 18 15 14 178 2 123 554 Percent 24.4 53.1 8.5 4.0 3.2 2.7 2.5 32.2 0.4 22.1 100.0 11.9% 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 11.5% come from a Non-MSA (rural) county Of the graduates who graduated high school from another U.S. state, 29.0% 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 PCOM Other U.S. State Florida New York Texas Pennsylvania Tennessee All Other States Other Country TOTAL Number 131 37 64 18 6 6 241 26 18 18 16 14 149 182 554 Percent 23.6 6.7 11.6 3.2 1.1 1.1 43.5 4.7 3.2 3.2 2.9 2.6 26.9 32.9 100.0 13.0% of the respondents graduated medical school in a state contiguous to Georgia (includes FL, NC, SC, AL and TN) 11.9% of Georgia high school graduates in this study attended medical school overseas Of those graduates that graduated from a medical school in another country (182), most went to medical school in India (38), Dominican Republic (22), Netherland Antilles (14), and Pakistan (8) Of the respondents that graduated from an overseas medical school, 34.1% 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 88 11 14 14 20 8 42 25 87 132 441 Percent 20.0 2.5 3.2 3.2 4.5 1.8 9.5 5.7 19.7 29.9 100.0 Average debt of Georgia GME graduate respondents = $132,167.96 in 2012 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 29.9% of the respondents had education debt over $200,000 in 2012 11 2012 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 Teaching/Research Other Undecided Chief Resident TOTAL Number 337 162 22 17 13 7 558 Percent 60.4 29.0 3.9 3.0 2.3 1.3 100.0 12 2012 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 309 25 334 Percent 92.5 7.5 100.0 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 297 16 17 330 Percent 90.0 4.8 5.2 100.0 13 2012 Georgia GME Exit Survey Report Table 11: Types of approaches that were used in your job search Job Search Approaches Number Independent Online Search Activities 239 Third Party Representation 130 Announcements/Career Fairs 120 Want Ads 78 Other 95 TOTAL 662 Respondents could choose multiple approaches. Most respondents used two or more approaches when searching for a job. Nationally, 78% of new physicians received at least 50 job solicitations during training. (Merritt Hawkins, 2011 Survey of Final-Year Medical Residents) Table 12: If you are planning to enter patient care/clinical practice, did you have difficulty finding a practice position you were satisfied with? Difficulty Finding Job Yes No TOTAL Number 61 259 320 Percent 19.1 80.9 100.0 14 2012 Georgia GME Exit Survey Report Table 13: Graduates going into patient care by practice location Location of Primary Activity Georgia Other State Florida North Carolina Texas South Carolina Tennessee Other States Other Country TOTAL Number 148 144 16 14 13 10 9 82 4 296 Percent 50.0 48.6 5.4 4.7 4.4 3.3 3.0 27.7 1.4 100.0 15 2012 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 at Georgia Regents University Memorial Health University Medical Center Morehouse School of Medicine Phoebe Putney Memorial Hospital The Mayo Clinic (formerly Satilla Regional Medical Center) The Medical Center Yes # % 1 16.7 18 25.7 0 - 5 50.0 13 30.2 1 33.3 2 33.3 1 100.0 0 - 0 - No # % 0 0.0 13 18.6 0 - 0 - 6 14.0 1 33.3 0 - 0 - 0 - 0 - Don't Know # % 5 83.3 39 55.7 0 - 5 50.0 24 55.8 1 33.3 4 66.6 0 - 0 - 0 - 16 2012 Georgia GME Exit Survey Report Table 15: Practice location of graduates entering patient care/clinical practice by where respondents attended high school Practice Location of Graduates Entering Patient Care/ Clinical Practice Georgia # % Where was your residence upon graduation from high school? Other U.S. State # % Canada # % Other Country # % Total Georgia Other State Outside of U.S. TOTAL 60 74.1 74 42.3 21 25.9 100 57.1 0 0.0 1 0.6 81 100.0 175 100.0 2 100.0 0 0.0 0 0.0 2 100.0 27 39.1 163 39 56.5 160 3 4.3 4 69 100.0 327 Of the respondents that graduated high school in Georgia and graduated from a Georgia GME program, 74.1% will stay in Georgia to practice. Of the respondents that graduated high school in another state, 42.3% will stay in Georgia to practice. 17 2012 Georgia GME Exit Survey Report Table 16: Top reasons cited for leaving Georgia Reason Number Proximity to family 105 Better jobs in desired location outside Georgia 77 Better salary offered outside Georgia 55 Better jobs in desired practice setting outside Georgia 54 Overall lack of jobs/practice opportunities in Georgia 46 Better job for spouse/partner outside Georgia 43 Never intended to practice in Georgia 39 Better jobs outside of Georgia that meet visa requirements 21 Other service obligation 15 Cost of malpractice insurance in Georgia 4 Cost of starting a practice 2 TOTAL 461 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 2012 Georgia GME Exit Survey Report Table 17: Type of patient care practice setting by graduates entering patient care/clinical practice Practice Setting Number Percent Group Practice as Employee 133 Hospital* In-Patient 78 Hospital* Ambulatory Care 25 Group Practice as Owner/Partner 24 Hospital* Emergency Room 19 Partnership (2 person) 16 Other 13 Solo Practice 11 Military 6 Freestanding Health Center/Clinic 4 HMO 3 TOTAL 332 *36.7% entering a hospital-based practice setting 40.1 23.5 7.5 7.2 5.7 4.8 3.9 3.3 1.8 1.2 0.9 100.0 Merritt Hawkins reports 32% of residents indicated they would prefer to be employed by a hospital than any other option and 1% of residents said they prefer a solo setting as their first practice (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 327 176 503 Percent 65.0 35.0 100.0 Table 19: Graduates that 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 at Georgia Regents University Memorial Health University Medical Center Morehouse School of Medicine Phoebe Putney Memorial Hospital The Mayo Clinic (formerly Satilla Regional Medical Center) The Medical Center Number 10 181 2 20 67 20 16 3 1 7 Percent 58.8 66.1 50.0 62.5 62.0 76.9 61.5 60.0 100.0 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 149 28.7 173 33.3 90 17.3 69 13.3 38 7.3 519 100.0 The percentage decreased for graduates going into rural areas from 11.0% in 2010 to 7.3% in 2012. Merritt Hawkins reports the majority of residents (94%) would prefer to practice in communities of 50,000 or more. Further, 9% of residents said they wanted to practice in communities of <50,000 (2011 Survey of Final Year Medical Residents) 21 2012 Georgia GME Exit Survey Report Average salary of graduates going into practice: Pediatrics (n=24) Rheumatology (n=1) Psychiatry (n=14) Forensic Pathology (n=1) Allergy & Immunology (n=2) Infectious Disease (n=5) Pediatric Nephrology (n=2) Nephrology (n=7) Neuropathology (n=1) Preventative Medicine (n=1) Endocrinology (n=3) Addiction Psychiatry (n=2) Pathology (n=5) Family Medicine (n=36) Neonatal/ Perinatal Medicine (n=2) Geriatrics (n=4) OB/GYN (n=16) Internal Medicine (n=49) Physical Medicine & Rehabilitation (n=4) Plastic Surgery (n=4) Neurology (n=10) Cardiology (n=9) Hematology/ Oncology (n=7) Emergency Medicine (n=23) Dermatopathology (n=1) Anesthesiology (n=16) Pulmonary Diseases (n=4) Dermatology (n=4) Pain Management (n=5) General Surgery (n=7) Gastroenterology (n=4) Radiology (n=8) Cardiovascular Surgery (n=10) Traumatic Surgery (n=1) Urology (n=1) Pediatric Surgery (n=1) 0 132,125 135,000 149,500 150,000 150,000 157,800 170,000 171,429 180,000 180,000 180,000 180,000 182,000 184,181 192,500 192,500 195,000 195,429 197,500 207,500 212,200 217,778 218,571 231,500 250,000 265,813 273,750 275,000 289,000 292,857 301,250 310,625 321,000 335,000 345,000 350,000 $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 22