The Future of Georgia’s Primary Care Medical Workforce

What is a health workforce shortage?Workforce demographics compared to the population served

Distribution of providersSupply of providers

Why do shortages matter? Studies show when patients have

the option, they are more likely to choose a physician of their own racial and ethnic background

Why would this be true? What impact does this have on the

health care of people?

Direct impact on an ethnic group For example, there has been an

increase in graduating Black female physicians, which may be a contributing factor in the documented decrease in rates of late-stage breast cancer among Black women.

(Assoc. of American Medical Colleges, Facts &

Figures 2006)

Potential benefits of a diversified and distributed physician workforce Increased satisfaction in patient care Broadened approaches to patient care Expanded options to patient care Increased understanding in medical research Increased cultural competence in practice Greater physician empathy toward patients Better communication Improved accuracy of diagnosis and treatment Improved access to patient care Greater healthcare for all

Demographics of GeorgiaAnd of Georgia’s Medical Workforce

General Population Between 1998 and 2008, the population in

Georgia increased by 24.8%. The overall rate of physician increase was

29.2% between 1998 and 2008 (slightly higher than the population increase).

The rate of increase for physicians in the five primary care/core specialties was 21.6%.

The rate of increase of specialist physicians was 35.9% during the ten year period.

Snapshot of Georgia: Race

Percent

WhiteBlackAsianHipsanicOther

Georgia’s Medical Workforce:Race

Percent

WhiteBlackAsianOther

Snapshot of Georgia: Gender

Percent

FemaleMale

Georgia’s Medical Workforce:Gender

Percent

FemaleMale

Gender by Specialty Pediatrics had the highest percentage of

female physicians. This is the only specialty where females constitute >50% of the workforce.

Surgical specialties have the lowest percentage of females in the workforce. Females comprise 8.3% of the general surgery workforce.

Snapshot of Georgia: Education

% of residents age 25+, 2006-2010 with a

bachelors or higher degree: 27.2%

Aging workforce The physician workforce is aging. In 2008,

30.7% of the physician workforce was 55 and over. In comparison, 22.8% of the workforce was 55 and over in 1998.

Of the five primary care/core specialties, general surgery had the largest percentage (37.5%) of physicians age 55 and over. Family Medicine had the second highest percentage of physicians 55 and over with 32.5%.

Young workforce Pediatrics had the youngest cohort of

physicians, with 10.3% being less than 35 years old.

Georgia’s GeographyAnd the distribution of Georgia’s Medical Workforce

Georgia: Rural vs. Urban Fifty-two percent of all Georgia’s

physicians are located in five Primary Care Service Areas (PCSAs). These five PCSAs represent 38.1% of the state’s population.

Georgia’s Physician SpecialtiesDistribution of Georgia’s Medical Workforce

Primary Care Service Areas Primary Care Service Area - Ninety-six

(96) areas were designated by the 30% rule using the Georgia Hospital Questionnaire

30% Rule: (1) a PCSA was designated if at least 20% of the patients received care in their county of residence or (2) if a county received less than 30% of its residents as patients, it was assigned to the county where the majority of its residents go for primary care.

Family Physicians There are 74 PCSAs that have an

adequate number of family medicine physicians, but geographic distribution continues to be a problem.

The top 10 PCSAs for number of practicing family medicine physicians have all or most of the area located in a Metropolitan Statistical Area.

Internal Medicine In 2008, there were three PCSAs that

had no internal medicine physicians in their region. Five counties do not have an Internist.

There are 55 PCSAs that have an adequate number of internal medicine physicians, and 33 that have a deficit.

Pediatricians In 2008, there were 22 PCSAs that did not have a

pediatrician in their region (this is approximately 22.9% of the state's PCSAs and 3.4% of Georgia's population). There are 25 counties without a pediatrician.

The top four PCSAs for number of practicing pediatricians are in the Atlanta Metropolitan Statistical Area.

In 2008, there were 53 (55.2%) of the PCSAs in deficit. This worsened since 2006, where 48 (50.0%)PCSAs were in deficit.

OB/GYN In 2008, there were 28 PCSAs that

had no OB/GYN in their region (this is 29.2% of the state's PCSAs and 4.5% of the state's population).

There are 34 counties without an OB/GYN.

General Surgery In 2008, there were 22 PCSAs with no

general surgery physician in their region (this is approximately 22.9% of the state's PCSAs and 3.1% of the state's population).

The top five PCSAs for number of practicing general surgery physicians are in Metropolitan Statistical Areas.

There are 22 PCSAs that have no general surgery physicians. There are 25 counties that do not have a general surgeon.

General Physician InfoMore than one-third (34.1%) of the physician workforce are not accepting new Medicaid patients.

Physician ShortagesNationally and in Georgia

Aligning GME Policy with the Nation’s Health Care Workforce Need

-ACP position paper 9/2011

“Systems dominated by primary care have better outcomes at lower cost. Yet the nation is facing a severe shortage of primary care physicians for adults… 44,000-46,000 by 2025… this does not take into account 32 million uninsured who will obtain coverage in the ACA.”

General Accounting Office Senate Testimony 2/12/2008

“Ample research in recent years concludes…reliance on specialty care

services at the expense of primary care…is less efficient.”

HRSA estimates in 2020 a need for 337,400 PCPs and a supply of 271,440 Shortage = 65,960

Georgia: FQHC workforce Needs

To meet the expanded care goals of the National Association of Community Health

Centers, Georgia would need an additional 622 – 1,430 primary care

providers, approximately 2/3 of which will be physicians, by 2015. Nationally,

an additional 10,000 primary care physicians will be needed to meet CHC needs.

--Access Transformed: Building a Primary Care Workforce for the 21st Century, NACHC, 2008

Georgia: General supply“Georgia ranks 9th in population but 39th in total

physician supply per 100,000 population”GBPW, Fact Sheet on Medical Education in Georgia.

February 2008

In 2006, Georgia had 18,422 licensed physicians; of these 13% were family physicians, 13% were

general internists, 8% were pediatricians, 6% were OB/GYNs, and 4% were general surgeons.

GBPW. Physicians by Specialty by County, Georgia, 2006

Effect of GME “FUNNEL”Am. J. Med. 12/08

AAMC 12/08 Estimates if NO increase of GME:- 124,000 Physician shortage by 2025- 37% will be in primary care or 45,800- If started expansion of residencies now could not graduate primary care physicians till 2015- To catch up MUST expand primary care slots by 5,000 /yr and total PGY1 GME slots by 12,500 /yr to 37,500/yr- Must continue to expand med schools to 32,500 grads per year and keep IMGs entering at 5,000 /yr

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Loss of Primary Care Residency Positions Since BBA AFP 7/15/2010

Since 1997, Growth of GME + 7.8% Internal Medicine SPECIALTY + 1,150 Radiology + 394 Anesthesiology + 117 Dermatology + 62 Family Medicine - 390 Internal Medicine PRIMARY CARE - 865

Origins of GME Crisis in Georgia

Medicare GME Cap 12/31/96 -BBA 1997 1990-2010 Georgia grew 6.4-9.7 M (+77%) 1990-2010 USA grew 248-308 M (+36%) New England has all states with > 50

residents/100,000 and Georgia is capped at 20.8 residents/100,000

New England: 350 Physician/100,000 Georgia: 200 Physician/100,000

Fixing the DisparitiesPossible solutions to Georgia’s challenges

Executive Summary

2012 PRIMARY CARE MEDICAL SHORTAGE

SUMMIT RECOMMENDATIONS:

Recommendation #1

Adopt a Primary Care Physician Plan for Georgia

with a timeline of implementation and clear

(measureable) outcome goals articulated

Recommendation #2

Launch a coordinated, statewide messaging campaign to address challenges in recruiting students

into primary care (across all phases), and to educate policy

leaders and consumers about the impact of failure to act in this

environment

Recommendation #3

Continue to seek funding for 400 new residency slots

in Georgia. ($1.2 million appropriated

in FY 13.)

Recommendation #4

Provide tax credits for primary care community based faculty

providing uncompensated community based clinical

training for 3rd and 4th year Georgia medical students.

Recommendation #5

Create a revolving fund to support new GME Program

Start-Up and to support pairing of hospitals / programs to expand or establish primary

care residency slots. ($853,265 appropriated in FY 13.)

Recommendation #6

Create capacity to award provisional service cancellable

loan forgiveness during residency training for primary

care residents in Georgia primary care residency

programs.

Recommendation #7

Increase post residency primary care loan forgiveness

programs (with service commitments) to be

competitive with National Health Service Corps and

programs in other contiguous states.

Recommendation #8

Expand the Pathways to Medicine program from

southwest Georgia to other AHEC regions to increase

early commitment to primary care medicine

STRATEGY AND TACTICS

RECOMMENDATION #1

Adopt a Primary Care Physician Plan for Georgia with a timeline of implementation and clear (measureable) outcome goals articulated

DASHBOARD BASELINE

 Primary Care Medical Workforce Plan Released

DESIRED GOAL  Unified voice advocating consensus recommendations

TACTICS Draft circulated to Summit participants by September 1 for commentsComments incorporated and Plan Released, September 30, 2012

COMMUNICATIONS / MESSAGE

 Wide distribution electronically and in publications; op-eds in local newspapers; uniform presentation developed for use by all partners; presentation to legislative and budget policy leaders

EXAMPLES OF PRIMARY CARE DASHBOARD COMPONENTS

# of Georgia Medical School graduates selecting Georgia Residency Programs

# of GA Medical School grads selecting GA Primary Care Residency Programs

# of GA Medical School graduates selecting PC residencies nationwide # of Georgia Medical School Graduates returning to practice in

Georgia # of GA Residency Grads remaining in GA to practice (2011 baseline) State Funding for GME # of college students in pre-med pipeline # of Georgia Medical School graduates who graduated from GA high

schools # of GA Residency graduates who graduated from a GA high school Total (2011 baseline) number of GME slots, by discipline # of Loan Forgiveness Recipients completing service component in

rural GA

There are too many pieces to the workforce issue to

await resolution of all before we begin. To take

no steps forward is in essence to move further

back.

Contact information

Denise Kornegay, MSWExecutive Director, Georgia Statewide AHEC

NetworkAssociate Professor, Family Medicine, MCG-GHSU

Assistant Professor, MUSM

dkornega@georgiahealth.edu706.721.8331