Georgia has a primary care physician shortage totaling 200 physicians per 100,000 population, not unlike many other states. Other parts of the country, certainly in the northern part, may have as many as 350 per 100,000 population. This puts the state 39th in ranking.
The Other Georgia, as rural Georgia is often referred to, has serious shortages. Six counties have no family physician, 31 have no general internist and 63 are without a pediatrician. Seventy-nine lack an OB/GYN and 66 counties have no general surgeon.
Shortage tied to reduced residency slots
The shortage in physicians is due mostly to a cap placed on Medicare-funded residency slots at teaching hospitals from the Balanced Budget Act way back in 1997. Levels increasing from that year were required to be funded by hospitals.
Apparently, teaching hospitals have been reluctant to take on the added cost of this residency training, so as the state’s population grew and the number of physicians stayed static, the ratio fell as Georgia became a net importer of doctors. Physicians finishing medical school in Georgia had no choice but to seek residency out of state. And as medical schools expanded, as Georgia’s have recently, the problem grew.
Georgia would need to add approximately 1,450 additional residency slots to meet the national average and 360 slots to meet the contiguous state average of 25 positions per 100,000 population. The Georgia Board of Physician Workforce has several state-funded programs in place to address both ends of the “physician pipeline.” Early phases have to do with recruiting students for medical professions in high school and in colleges, with the middle phase as medical school and the end of the pipeline being residency training and finally practice.
How we recruit
The undergraduate medical education program provides grants to medical schools to incentivize the recruitment of Georgia residents into primary care specialties. The participating schools are Mercer School of Medicine, Emory University School of Medicine, and Philadelphia College of Osteopathic Medicine, located in Georgia. Grant awards are approximately $6,300 per student with part of the agreement being that at least 50 percent of students choose a primary care or core specialty, including family medicine, internal medicine, general pediatrics, OB/GYN, preventive medicine and general surgery. This program covered approximately 300 students in fiscal year 2014.
Private medical colleges who focus on primary care are also supported by the state. Mercer graduates 55 percent of physicians into primary care, and Morehouse graduates 72 percent into primary care professions as well. Those grants total $22 million for Mercer and $16 million for Morehouse.
The rural areas scholarship is a serviceable-repayable scholarship providing up to $20,000 per year of service in a rural practice and totals around 25 per year. The loan repayment program provides $25,000 per year commitment for a year’s practice in a rural community and funded 26 awards in the FY2015 budget.
Graduate medical education
Grants totaling from $14,000-$18,000 in capitation grants are awarded per resident for primary care and core specialties. General capitation grants of around $7,000 are awarded for all other specialties. These grants offset the cost of hospital or medical school for the training of residents.
The total number of capitation grants awarded in FY14 totaled approximately 1,500. These grants are administered by the Board for Physician Workforce, but most of the growth in residency grants are now included in the Board of Regents budget and administered by the board.
Expanding residency programs around the state
Gov. Deal began in FY13 a five-year plan to create an additional 400 residency slots and so far the increases total $5.2 million for start-up costs. Since residency programs can take three-to-five years to fully activate, this funding would continue until federal funding for Medicare patients would take over. The grants require participation by the hospitals on a matching basis and have so far included expansion at Gwinnett Medical Center, Athens Regional Medical Center, St. Mary’s Health Care System and the South Georgia Medical Education and Research Consortium.
2014 legislative session shows progress
Several initiatives in the 2014 session advanced primary care physician initiatives. Senate Bill 391 approved an additional $2 million in the Board of Regents budget to allow a tax-deduction for $1,000 for community-based physicians who take physicians and nurse-practitioner students into their practice for required clinical rotations. House Bill 998 allowed the physicians workforce some latitude to establish population and sparcity rules for medical student scholarships without legislative approval.
The General Assembly added $2 million in additional funds for residency program development and increased the number of rural loan repayments to 26 and approved an additional $333 per capitation payment for contracted students. The FY15 budget also added an additional $300,000 in housing and travel funds for medical students performing community-based rotations.
Georgia is making progress on meeting its stated goal of 400 new additional medical residents and will hopefully begin to improve on its 39th ranking of primary care physicians.
I may be reached at
234 State Capitol, Atlanta, GA 30334
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E-mail at Jack.Hill@senate.ga.gov
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