Nevada Health Workforce Research Center Graduate Medical Education Trends in Nevada 2009 to 2018 Tabor Griswold, PhD, and John Packham, PhD October 2018 Key Findings Graduate Medical Education Trends in Nevada 2009 to 2018 contains current information about physicians (MDs and DOs) who have completed residency and fellowship programs in Nevada. This research brief utilizes data from an annual survey of physicians completing graduate medical education (GME) in Nevada over the past decade. The survey has been undertake by the Office of Statewide Initiatives (OSI) at the University of Nevada, Reno School of Medicine since 2004. The OSI survey data contained in this report is supplemented with licensure data from the Nevada State Board of Medical Examiners and the Nevada State Board of Osteopathic Medicine. Table 1: Post Residency Employment, Training, and Location Plans of Physicians Completing GME in Nevada 2018 Begin Clinical Practice Continue Training Total Remaining in Nevada Leaving Nevada Total 58 (37.7%) 51 (33.1%) 109 (70.8%) 5 (3.2%) 40 (26.0%) 45 (29.2%) 63 (40.9%) 91 (59.1%) 154 (100.0%) Table 1 highlights the post-residency plans of the 154 physicians who graduated from GME programs in Nevada in 2018. In 2018, 40.9% of physicians completing GME training report that they will remain in Nevada upon graduation, where as a majority of graduates (59.1%) intend to relocate to another state. A key finding of this report is that 40 of the 45 physicians pursuing additional training (88.9%) are leaving the state for fellowship and subspecialty training that does not exist in Nevada. This finding suggests that the development of fellowship programs in Nevada holds the potential for increasing the number and percent of GME graduates who ultimately remain in Nevada to begin practice. Finally, 58 physicians or 37.7% of GME graduates in 2018 will begin practice or continue training in Nevada. Nevada Health Workforce Research Center https://med.unr.edu/statewide/hwrp
Figure 1 presents data on the post-residency plans of physicians completing GME in Nevada from 2009 to 2018. Over the past decade, the number of GME graduates in Nevada has increased significantly by 197.4% from 78 graduates in 2009 to 154 graduates in 2018. However, over the decade, the proportion of GME graduates who remained in Nevada upon graduation has varied widely from 29.5% to 61.3%. Moreover, the retention rate has exceeded 50.0% in only four years over the past decade. These trend data highlight the substantial proportion of GME graduates leaving the state for fellowship training that does not exist in Nevada. Figure 1: Post Residency Employment, Training, and Location Plans of Physicians Completing GME in Nevada 2009 to 2018 N=78 N=75 N=81 N=81 N=88 N=79 N=104 N=106 N=122 N=154 100% 90% 80% 32.4 27.0 25.8 41.7 42.7 37.5 34.6 28.3 39.3 33.1 70% 60% 50% 40% 30% 20% 10% 28.2 7.0 32.4 12.9 14.9 10.8 16.1 7.1 3.6 47.3 45.2 47.6 22.9 4.2 30.2 20.0 8.8 33.8 15.4 30.2 7.7 3.8 42.3 37.7 31.1 3.3 26.2 26.0 3.2 37.7 0% 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Percent of GME Graduates Leaving Nevada to Begin Practice Percent of GME Graduatesf Leaving Nevada to Continue Training Percent of GME Graduates Remaining in Nevada to Continue Training Percent of GME Graduates Remaining in Nevada to Begin Practice in Nevada Figure 2 presents data on the post-residency plans of physicians completing primary care residency programs Family Medicine, Internal Medicine, and Pediatrics in Nevada from 2009 to 2018. Over the past decade, the number of primary care GME graduates in Nevada has increased by 220.0% from 45 graduates in 2009 to 99 graduates in 2018. 2 UNR Med Office of Statewide Initiatives
In contrast to the general retention trends presented in the previous figure, Figure 2 highlights the fact that a majority of primary care GME graduates remain in Nevada upon graduation. Primary care retention rates have exceeded 50% over the past decade, ranging from 50.1% to 75.8%. In 2018, 65.6% of physicians completing primary care GME programs report that they will remain in Nevada upon graduation, as compared to only 34.3% of primary care GME graduates who plan to relocate to another state to begin practice or pursue additional training. Figure 2: Post Residency Employment, Training, and Location Plans of Primary Care Physicians Completing GME in Nevada 2009 to 2018 N=45 N=40 N=46 N=46 N=51 N=47 N=64 N=62 N=68 N=99 100% 90% 80% 70% 60% 50% 40% 26.7 8.9 28.9 20.0 19.6 37.0 15.0 17.4 4.3 12.5 21.7 6.5 45.1 42.6 3.9 6.4 25.5 23.4 76.9 19.2 46.2 19.4 4.8 30.6 36.8 2.9 30.9 30.3 4.0 31.3 30% 20% 10% 35.6 52.5 41.3 52.2 25.5 27.7 103.8 45.2 29.4 34.3 0% 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Percent of GME Graduates From Primary Care Residencies Leaving Nevada to Begin Practice Percent of GME Graduates From Primary Care Residencies Leaving in Nevada to Continue Training Percent of GME Graduates From Primary Care Residencies Remaining in Nevada to Continue Training Percent of GME Graduates From Primary Care Residencies Remaining in Nevada to Begin Practice Figures 3 and 4 illustrate, respectively, the variety of job search tools used by GME graduates and the level of debt of incurred by physicians completing GME in Nevada key factors that affect a physician s decision to remain or leave the state to begin practice or purse additional training. UNR Med Office of Statewide Initiatives 3
Figure 3 suggests important differences in job search strategies utilized by physicians remaining in Nevada, as compared those who leave the state after completing GME. In 2018, physicians remaining in Nevada used personal networking (37.8%) much more than those leaving the state (26.8%). Figure 3: Job Search Tools Used by Physicians Completing GME in Nevada 2018 50% 45% 42.9% N=93 40% 37.8% 35% 30% 26.8% 26.8% 27.0% 25% 20% 15% 13.5% 13.5% 10% 5% 0% Personal Networking Physician Recruiter Internet Residency Program 1.8% 1.8% 5.4% GME Office 0.0% 2.7% Specialty Society GME Graduates Leaving Nevada (n=56) GME Graduates Remaining in Nevada (n=37) Source: OSI Annual Survey of Physicians Completing Residency and Fellowship Programs in Nevada (May 2018) Likewise, physicians leaving Nevada used physician recruiters (42.9%) much more than those who remain in the state (13.5%). Data from previous GME exit surveys undertaken by the Office of Statewide Initiatives suggest an overall decline in the use of personal networking and a steady increase in the use of physician recruiters by GME graduates in their professional job searches. 4 UNR Med Office of Statewide Initiatives
Figure 4 summarizes the average level of debt of physicians completing residencies and fellowships in Nevada over the past decade. The figure highlights the fact that a significant proportion of GME graduates primarily foreign medical students have no debt upon graduation. For example, while the average level of debt for all physicians completing GME in Nevada has decline over the past three years, the level of debt for those reporting any level of debt has exceeded $250,000 for the past four years. Figure 4: Educational Debt of Physicians Completing GME Programs in Nevada 2009 to 2018 300 250 257.6 261.2 272.3 251.8 200 150 121.2 171.2 198.6 157.5 156.1 153.1 128.2 113.3 115.4 114.1 149.7 205.4 168.1 204.5 167.0 133.9 100 50 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 All GME Physicians ($1,000) GME Graduates with Debt ($1,000) Discussion The purpose of this research brief is to summarize key trends in the retention of physicians completing residencies and fellowships in Nevada, as well as some of the important factors affecting a physician s decision to remain in or leave Nevada. While the report highlights a steady increase in the number of physicians completing GME in Nevada over the past decade, it also underscores opportunities to improve retention and increase the supply of physicians in Nevada through the continued expansion of fellowship programs and subspecialty training in surgery, emergency medicine, internal medicine, and pediatrics. UNR Med Office of Statewide Initiatives 5