Georgia s Primary Care Dashboard Update. Where were we? Where are we now?

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2 Georgia s Primary Care Dashboard Update Where were we? Where are we now?

3 Goal Increasing the number of primary care physician to population ratio to 100/100,00 population, by 2020

4 Primary Care Medical Pipeline: Current Model MEDICAL EDUCATION PIPELINE PHASE 1 PHASE 2 PHASE 3 PHASE 4 K-12 Education Undergraduate / College Medical School GME / Residency Training Years K-12 Years Years Years 23-28

5 FACTORS REVIEWED Population Physician/ Population Ratios Primary Care Physician/ Population Ratios Medical School Admissions / Class Size GME Graduates Retained to practice in state AHEC Housing PTIP Loan Repayment GME Expansion

6 State Population Rankings Population grew 18.3 % between 2000 and 2010 Census In 2010, Georgia ranked 9 th nationally (3.14 % of US population) In 2015, Georgia ranked 8 th nationally (3.18% of total US population) (comparable to the size of Portugal)

7 State Variability in Supply of Office-based Primary Care Providers: United States, 2012 Hing E, Hsiao CJ. State variability in supply of office-based primary care providers: United States, NCHS data brief, no 151. Hyattsville, MD: National Center for Health Statistics

8 Key Findings In 2012, 46.1 primary care physicians and 65.5 specialists were available per 100,000 population. From 2002 through 2012, the supply of specialists consistently exceeded the supply of primary care physicians. Compared with the national average, the supply of primary care physicians was higher in Massachusetts, Rhode Island, Vermont, and Washington; it was lower in Arkansas, Georgia, Mississippi, Nevada, New Mexico, and Texas.

9 Key Findings (continued) In 2012, 53.0% of office-based primary care physicians worked with physician assistants or nurse practitioners. Compared with the national average, the percentage of physicians working with physician assistants or nurse practitioners was higher in 19 states and lower in Georgia. The supply of primary care physicians per 100,000 population varied by state, ranging from 26.5 in Mississippi to 93.7 in Hawaii (Georgia was 31.0)

10 Number of primary care physicians per 100,000 population: United States, 2012 SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, Electronic Health Records Survey.

11 Medical Experts Say Physician Shortage Goes Beyond Primary Care AAMC Reporter: February 2014 The AAMC s Center for Workforce Studies estimates that by 2020, the United States will face a shortage of 45,000 primary care physicians and 46,100 surgeons and medical specialists. These estimates take into account an aging physician workforce, as well as the 15 million patients who will become eligible for Medicare and the 32 million younger patients who will become newly insured through the Affordable Care Act.

12 The percentage of primary care physicians with physician assistants or nurse practitioners in their practices varied by state. Overall, 53.0% of primary care physicians worked with physician assistants or nurse practitioners in their practices in The percentage of primary care physicians working with physician assistants or nurse practitioners varied by state, ranging from 33.4% in the District of Columbia to 89.6% in South Dakota In 19 states (Alaska, Arizona, Idaho, Iowa, Kansas, Maine, Massachusetts, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, South Dakota, Tennessee, Vermont, Wisconsin, and Wyoming), the percentage of physicians having physician assistants or nurse practitioners in their practices exceeded the national average; in Georgia, this percentage was lower than the national average. The percentage of primary care physicians with physician assistants or nurse practitioners in their practices in 2012 (53.0%) was similar to that in 2006 (51.2%), the first year in which NAMCS collected this information.

13 Percentage of office-based primary care physicians with physician assistants or nurse practitioners in their practices: United States, 2012

14 AAMC: Georgia Physician Data Profile, 2015 Physician to population ratio: 220.9/100,000 (rank- 39) (ranked 40 th in 2009) Primary Care Physician to population ratio: 77.8 (rank 41) % of Physicians aged 60 or older: 21.3% (rank- 40) Medical Student to population ratio: 27.9 (rank- 30) (22.3 in 2010 but no change in ranking from 2010) % of Medical Students matriculating in state: 72% (rank- 18) % change in medical school enrollment, : 69.9% (rank- 8)

15 AAMC: Georgia Physician Data Profile, 2015 Total residents per 100,000 population: 20.6 (rank- 40) (ranked 39 th in 2010 with 20.8 residents/100k) Total residents per population in primary care: 7.2% (rank- 44) % of physicians retained in the state from UME: 45.7% (rank 13) % of physicians retained in the state from GME: 48.4% (rank- 16) % of physicians in the state retained from UME and GME Combined: 72.2% (rank 17)

16 Georgia s Medical School Enrollment and Medical School Projected Expansions Past Enrollment, 2000 / 2001 Past Enrollment 2010 / 2011 Past Current Enrollment Enrollment 2011 / Projected Enrollment, 2020 Emory MCG and MCG / UGA Partnership Campus Mercer Morehouse PCOM Total GBPW: Fact Sheet on Georgia s Medical Schools, January 2012; AAMC, 2016

17 GME Board of Regents Start-up funding: FY13 - $1.2 million FY14 - $3.275 million FY15 - $5.275 million FY16 - $4.275 million FY17 - $3,136,925 $17,161,925

18 Change in Georgia s GME Capacity, Total Residency Positions 1,780 2,514/ (2,315 filled) Total Primary Care Residency Positions % Change 2,586 31% 782 1,019 1,091 29% Census Population Est. 8,186,453 10,214,860 10,214,860* 20% Total Residency Positions/ 100,000 Total Primary Care Residency Positons / 100, % * 11% SOURCE: GBPW, 2016; US CENSUS DATA, 2016

19 Medical School Graduates Choosing Primary Care in PGY 1, 2010 & 2014 % choosing Primary Care Number Choosing Primary Care % 54% Source: GBPW 2010 and 2014 Georgia Medical School Graduate Surveys. June 2010 and June 2014

20 Comparison of GME Graduates, Average Starting Salary of Graduates Median Starting Salary of Graduates Primary Care Starting Salary Range (GBPW 2010, 2014) $179,663 $233,710 $170,000 $216,667 $119,681 to $172,370 $187,656 (average) % Remaining in GA to practice 49% 54% % Graduated HS in GA 22% 21.8% % with Debt over $200,000 26% (13.4% in 2008) 42% Average Debt $144,787 $142,220

21 AHEC Housing Support FY 12- $693,750 added to Statewide AHEC Network contract to support expanded housing for students FY 15- $300,000 added to the Statewide AHEC Network contract to support expanded housing for students

22 AHEC SUPPORT FOR UME: STUDENT HOUSING, /2015 TOTAL BEDS PROVIDED IN REGION MEDICAL STUDENTS ROTATIONS WITH HOUSING BLUE RIDGE FOOTHILLS MAGNOLIA SPCC ATLANTA* SOWEGA THREE RIVERS TOTAL Percent change from FY 11- FY 14/ FY 15 33% 38%

23 Preceptor Tax Incentive Program (PTIP), (six months) 2015 (2 months) Registered Preceptors / received letter 563/ / 243 Reported but unregistered preceptors # of Medical Schools Reporting 5 5 # of APRN Programs Reporting 8 13 # of PA Programs Reporting 5 5 Total number of hours reported 438, ,552 Total amount of deductions certified $883,000 $1,513,000

24 Others are emulating us Maryland passed its own PTIP legislation in 2016 Kentucky and South Carolina have legislation pending from other states have requested our assistance in creating similar programs for their constituents.

25 Loan Repayment Programs Georgia Board for Physician Workforce, 2016 # of awards funded (physician) LRP* Change also made giving preference to 4 sequential years of funding for eligible recipients FY 2013 FY Amount of awards authorized $20,000 $25,000 Total Funding (APRN/PA) LRP -0- $200,000

26 Did we move the needle?

27 Update on Best Practices Pipeline Initiatives in Georgia Kathy English and Mary Kate Pung

28 Emerging Trends and Issues in Primary Care Workforce Impact of Hospital System(s) merging on training of primary care providers Impact of adoption of Primary Care Medical Home (PCMH) model on primary care workforce needs Impact of emergence of hospitalists as a specialty area on primary care practice environment and workforce Impact of the closure and /or fragility of rural health facilities on the primary care workforce and rural populations

29 Potential Questions to Address What policy(ies), funding, legislative, and/or regulatory initiatives are influencing these areas? What data do we need to obtain to understand these issues? Are there national thought leaders and / or innovators we can research to aid our work? What barriers are these scenarios causing or will potentially occur as these trends become more entrenched? Are these trends to watch? Are there other trends not identified that need closer scrutiny?

30 Expanding our Work What is next?

31 Primary Care Education Pipeline: Proposed Expanded Model PHASE 1 PHASE 2 PHASE 3 PHASE 4 (MD and DO) PHASE 5 K-12 Education Undergraduate Degree / College MD / DO School APRN and PA Graduate Programs GME / Residency Training PRACTICE / RETENTION YEARS K-12 YEARS YEARS YEARS PRACTICE LIFESPAN

32 ASSUMPTIONS: Items to remain on Agenda Conversion of the PTIP Program to a Tax Credit and expanding the eligible recipients Support continued GME residency slot expansion(s) Support continued increase of / transfer of funds to the Georgia Board for Physician Workforce for residency capitation dollars to support GME expansions and existing slots Continued support for the GBPW administered LRP programs

33 Breakout groups Key Questions Breakout Groups (30 minutes each) Parameters: Broaden our thinking to the core Primary Care Team and what it will take to recruit, educate, train, and retain these essential providers: MD / DO / APRN / PA Breakout Groups will not rotate- Facilitators will

34 Are we admitting the right students into our Programs? (Phase 1 and Phase 2) How can we (or should we)develop true Interdisciplinary Training and Education? (Phase 3) How do we create / increase / prepare our Preceptor pools? (Phase 3) How do we recruit students to Georgia Residency Programs and Retain them for practice? (Phase 4) What, if any, is our role in Phase 5?

35 OUTCOMES DESIRED To-Do list moving forward Clarification / affirmation of assumptions Priority Areas identified