Update on Activities to expand GME in

Ben Robinson, MPA Primary Care Summit April, 16, 2015 The Way We Were – cir. 2010

. Physician Shortages across nation Projected Supply & Demand of expected to exceed 90,000 in next Physicians, 2010 - 2025 decade 950,000 Shortage of . Georgia per capita physician 130,600 900,000 workforce ranks 40th in US (2009) Physicians 850,000 by 2025 . * GA per capita rate – 204.5 . * US per capita rate – 254.5 800,000 Physician Supply (All . Georgia’s rank in terms of active 750,000 Specialties) primary care physicians was even 700,000 Physician lower. Demand 650,000 (All 2010 2015 2020 2025 Specialties) The Way We Were – cir. 2010

• GA’s response at UME level robust –1 new medical school in GA –2 new 4 year campuses –Increase in class size at all GA medical schools • Will result in over 80% growth in medical school enrollment by 2020. • Per capita medical student numbers improving (18.5/100,000 in 2000, 21.8/100,000 in 2010) The Way We Were – cir. 2010

• But one sided –Growth in UME occurring at twice the rate seen in GME –UME enhancements by 2020 - 81% –Growth in GME (at current rate) by 2020 – 47% –Per capita GME capacity has barely grown in last decade – 21.74 in 2000 – 21.86 in 2010 The Way We Were – cir. 2010

. In 2010 Georgia: . Ranked 39th among the 50 states in total residents per 100,000 population. . Georgia had 20.8 residents per 100,000 . US had 35.7 residents per 100,000 . To meet the national average of 35.7 residents per 100,000 population, Georgia would have to add a total of approximately 1,450 residency positions. . Only one state surrounding Georgia (Florida at 17.9) had a resident to population ratio lower than Georgia’s. . To reach the Southeast average of 24.0 residents per 100,000 population, Georgia would have to add a total of approximately 315 residency positions. The Way We Were – cir. 2010 . Growth in core specialty programs has been limited . Primary care/general training capacity has diminished, factoring for population growth . Growth in per capita GME numbers has been driven by growth in GME outside of core specialties

Change in Residency Education (GME) Capacity, 2000 - 2010 2000 - 2001 2010 - 2011 Change % change Total Residency Positions 1,780 2,201 421 23.7% Total Primary Care Positions 782 847 65 8.3% Total General Surgery Positions 169 176 7 4.1% Total Core Specialty Positions 951 1,023 72 7.6% Total Positions All Other 829 1,178 349 42.1% Total Residency Positions per 100,000 21.74 21.86 0.11 0.5% Total Primary Care Positions per 100,000 9.55 8.41 -1.14 -11.9% Total General Surgery Positions per 100,000 2.06 1.75 -0.32 -15.3% Total Core Specialty Slots per 100,000 11.62 10.16 -1.46 -12.5% Total All Other Positions per 100,000 10.13 11.70 1.57 15.5% The Way We Were – cir. 2010

. Location of GME programs plays a strong role in predicting practice location . GME programs in Georgia poorly distributed . Majority of GME efforts occurring in Atlanta, Macon, Savannah and Augusta . 2/3 of GME slots are in Atlanta and Augusta . Predominately modest sized family medicine programs outside of these areas . Albany, Rome, Columbus Plan moving forward .Goal - Increase number of GME programs in Georgia .Create 400 new residency positions in GME naïve Georgia hospitals: .Increasing the number of residents in Georgia to match the southeastern rate .Ensure concentration on primary care and general surgery .Better distribute GME across the state Plan moving forward

. Goal - Increase return on In State Retention: investment made to medical 50th Percentile education in Georgia (% Active physicians practicing in state, 2008) . Georgia has a high overall retention rate for graduates 67% of its medical education 45% system 37% . GME programs have a well understood impact on retention . Likelihood of retention maximized when combine Completed Completed Completed both UME and GME in state UME in state GME in state both GME and UME in state Plan moving forward . Strategy – . Bridge the GME knowledge gap facing hospitals considering GME . Provide “consulting services” on GME as requested by hospitals: . Facilitate conversion of GME “naive” hospitals into teaching hospitals . Maximize financial supports for new GME programs . Facilitate better distribution of new GME programs across the state . Monitor policy landscape and devise policy responses to render GME more cost effective . Utilize GME expertise within state of Georgia to facilitate effective GME growth Plan moving forward . Strategy – . Create a pool of matching funds to support GME start-up costs for strategically positioned Georgia hospitals . Designate funds for start up costs . Require match by hospitals to access these funds . Prioritize primary care specialties and general surgery Progress to date

ATHENS REGIONAL MEDICAL CENTER ATHENS REGIONAL MEDICAL CENTER CANDLER HOSPITAL CANDLER HOSPITAL CARTERSVILLE MEDICAL CENTER CARTERSVILLE MEDICAL CENTER COLISEUM MEDICAL CENTER COLISEUM MEDICAL CENTER COLISEUM COLISEUM NORTHSIDE HOSPITAL DOCTORS HOSPITAL of Augusta DOCTORS HOSPITAL of Augusta GWINNETT MEDICAL CENTER HAMILTON MEDICAL CENTER HAMILTON MEDICAL CENTER HENRY MEDICAL CENTER, INC HENRY MEDICAL CENTER, INC JOHN D ARCHBOLD MEMORIAL HOSPITAL JOHN D ARCHBOLD MEMORIAL HOSPITAL NORTH FULTON REGIONAL HOSPITAL NORTH FULTON REGIONAL HOSPITAL NORTHEAST GEORGIA MEDICAL CENTER NORTHEAST GEORGIA MEDICAL CENTER NORTHSIDE HOSPITAL NORTHSIDE HOSPITAL NORTHSIDE HOSPITAL CHEROKEE NORTHSIDE HOSPITAL CHEROKEE NORTHSIDE HOSPITAL FORSYTH NORTHSIDE HOSPITAL FORSYTH PALMYRA MEDICAL CENTERS PALMYRA MEDICAL CENTERS PIEDMONT FAYETTE HOSPITAL PIEDMONT FAYETTE HOSPITAL , INC PIEDMONT NEWNAN HOSPITAL, INC REDMOND REGIONAL MEDICAL CENTER REDMOND REGIONAL MEDICAL CENTER SAINT JOSEPH'S HOSPITAL OF ATLANTA, INC SAINT JOSEPH'S HOSPITAL OF ATLANTA, INC SOUTH GEORGIA MEDICAL CENTER SOUTHEAST GEORGIA HEALTH SYSTEM- SOUTH GEORGIA MEDICAL CENTER BRUNSWICK CAMPUS SOUTHEAST GEORGIA HEALTH SYSTEM- BRUNSWICK CAMPUS SOUTHERN REGIONAL MEDICAL CENTER ST FRANCIS HOSPITAL, INC SOUTHERN REGIONAL MEDICAL CENTER ST JOSEPH'S HOSPITAL - SAVANNAH ST FRANCIS HOSPITAL, INC ST MARY'S HOSPITAL OF ATHENS ST JOSEPH'S HOSPITAL - SAVANNAH TANNER MEDICAL CENTER - CARROLLTON ST MARY'S HOSPITAL OF ATHENS TIFT REGIONAL MEDICAL CENTER TANNER MEDICAL CENTER - CARROLLTON WELLSTAR - Kennestone TIFT REGIONAL MEDICAL CENTER UNIVERSITY HOSPITAL - Augusta Progress to date

Minimum Maximum Number of Number of Number of Programs Residents Residents

Specialty Internal 6 180 213 Medicine Family 5 63 84 Medicine OB/GYN 2 28 28 General 2 35 35 Surgery Emergency 1 24 24 Medicine Psychiatry 1 12 12 Transitional 4 22 46 Year Total 19 359 422 Progress to date

Total New Residents Per Year/with Gwinnett Expansion FY 15 FY 16 FY 17 FY 18 FY 19 FY 20 FY 21 FY 22 ARMC 15 51 79 92 99 102 St. Mary's 10 20 30 30 30 30 30 Gwinnett 5 16 39 50 56 58 58 58 South GA 3 6 9 9 9 9 Redmond Regional 10 30 40 40 40 40 Tanner 13 26 39 42 42 Wellstar 26 77 110 125 129 129 University 4 8 12 12 12 Total 5 26 113 261 358 405 419 422 Progress to date

. As of July 1, 2015, Georgia will have 26 new GME slots filled . Strong Georgia focus seen in background of these residents . Gwinnett Family Medicine . PGY1 – . 5 from Georgia . PGY2 – . 4 from Georgia . The other strong family ties to Georgia (partner from GA.) . Gwinnett Internal Medicine . PGY1 – . 3 from Georgia . 1 from Chattanooga . PGY 2 . Is from Georgia . St. Mary’s Internal Medicine . PGY1 . 6 from Georgia (academic or family ties) . 2 from the Southeast Moving forward:

. Georgia seems to be succeeding in expanding GME . On target with number of new residencies slots . Vast bulk of new programs in target specialties . All new programs are at hospitals that are new to Medicare GME (or are reclaiming Medicare GME cap space) . Expansion occurring in areas not normally impacted by GME . Moultrie, Athens, Lawrenceville, Carrollton . Effort in Rome would more than triple current GME outputs . Additional success still potential and pending . Additional hospitals considering GME . Spalding Regional . Northeast Georgia Healthcare System . Other medical schools consulting with potential hospital partners

.Success is within reach Moving forward: . Required to ensure success with current partner hospitals . Additional time needed to “land” several new programs . Continue funding to the Board of Regents . Ensure long term state funding for new residency slots . Expand funding and capitated slots provided by the Georgia Board for Physician Workforce . New funds should cover new slots created in a given year while maintaining prevailing capitation rate . Communicate need to expand/remove existing cap on Medicare GME funding . Develop additional methods to make Georgia GME programs attractive to Georgians Moving forward:

. Required to ensure success with current partner hospitals . Funding removed from the Board of Regents GME expansion budget will need to be restored if Northeast Georgia….. Confirm their desire(s) to establish GME programs Questions?