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In Sickness and in Health: Georgia’s Physician Shortage - Jacob Funk-Sheppard

Hello all. My name is Jacob Funk-Sheppard, and I’m the Policy Journal Coordinator for API. I’m a second-year student from Houston, Texas, and this week, I will be focusing on the physician shortage in rural Georgia and the new medical school coming to UGA. 


Georgia is experiencing an unprecedented shortage of qualified medical personnel. Georgia is projected to be short over 8,000 doctors, with 142 of Georgia’s 159 counties designated as “health professional shortage areas.”[1] Furthermore, Georgia is facing a significant shortage of medical schools relative to its population. A third of Georgians (about 3.3 million residents) live in an area with a primary care shortage, and nearly 50% of healthcare graduates come from the same 20 institutions.[2,3] Despite being one of the most populous states in the U.S., the physician-to-patient ratio is 23 percent worse than the national average.[4] Population growth in Georgia and increased life spans have led to a shortage of physicians, especially primary care physicians. 


To address this issue, Gov. Brian Kemp created the Healthcare Workforce Commission in 2022 to help address the ongoing healthcare workforce shortage exacerbated by the COVID-19 pandemic. The Commission found that “Projected healthcare workforce needs entail adding 66,000 new positions through 2022” and that “Georgia’s growing demand for healthcare services is primarily driven by three factors: overall population growth, an aging population, and increasing disease burden among Georgians. On overall population growth, Georgia outpaced the nation’s change in population from 2010-2020 (10.6% vs. 7.4%). Further, the state’s population older than 65 years has also grown faster than the national average; this population is associated with higher per capita demand for health care services.”[5


But health care services are not just doctors. Creating a new medical school at UGA is undoubtedly needed; however, it fails to address the more significant issue of a shortage of medical professionals. According to the report by the Healthcare Workforce Commission in 2022: “Georgia faces impending challenges as 20% of nurses, behavioral health, and specialty care workers are over 55 years old and likely to retire over the next decade,” and the most significant obstacles to replacing these workers are “faculty shortages, cost of education, and access to desired programs.”[6] Therefore, the new UGA medical school needs to focus on increasing access to programs needed by the state, emphasizing volunteering in rural Georgia communities.


Furthermore, fewer and fewer recent medical school graduates are willing to work in underserved areas of rural Georgia. In a 2020 Georgia Board of Healthcare Workers survey of medical school students from five Georgia medical schools, less than a quarter of students wanted to practice in a rural hospital in an underserved community. Far more expressed interest in working in larger urban areas in larger hospitals.[7] But this issue is emblematic of a much larger problem facing the American medical community. The nation is undergoing a shortage of physicians in rural areas, estimated by the American Medical Association to fall between 37,800 and 124,000 physicians nationwide within the next 12 years.[8]


Further increasing the physician shortage is the process of training doctors. Despite a 17.8% increase in medical students, U.S. medical schools require completing at least one year of residency after graduation and passing Step 3 of the standardized U.S. Medical Licensing Exam to get a license to practice as a nonspecialist general practitioner.[9,10] Yet, the number of medical school graduates exceeds the number of residency positions. This leaves several willing medical professionals stuck with no means of practicing their medical knowledge, yet the demand from communities for these professionals has never been greater. Although it might seem that simply adding more residency positions would fill the problem, it is a deceptively costly process. Residency spots are primarily funded by the Center for Medicare and Medicaid Services (CMS) based on the amount of care provided to Medicare patients at each hospital. Therefore, increasing the number of residency positions would require the CMS to designate more money to create residency positions and hospitals to care for more Medicare patients.[11]


There may be a solution to the shortage of physicians, especially those practicing in rural areas. Creating a new category of licensure called assistant physicians (not to be confused with physician assistants) in Missouri may hold the answer. This designation allows medical school graduates who did not match to a residency on their first try to practice primary care in rural and underserved areas under the supervision of a licensed physician.[12] There is evidence that this program works. As of early 2023, nearly 300 assistant physicians were licensed in the state, about 3% of the number of primary care doctors. Six other states now have similar laws allowing for unmatched medical school graduates to practice while they continue trying to match with a residency.[13] A similar program needs to be implemented in Georgia to reduce the barriers to entry into the medical field and address the physician problem in rural counties. 


Georgia could also turn to doctors outside of its borders for relief. According to the ​​Foundation for Research on Equal Opportunity, in 2023, Tennessee signed HB 1312 into law. Alabama later passed a similar law, which aimed “to fix the physician shortage by allowing international medical graduates (IMGs) to practice medicine without needing to repeat their residency training. Under these laws, eligible international medical graduates who have already completed their training abroad, have been practicing medicine independently in their country of origin, and who have passed the U.S. medical licensing exams can apply to practice medicine in American hospitals without having to go through a domestic residency program. Waiving the American residency requirement shaves off between three to nine years of additional training time, depending on the residency program.”[14] This could be a smart bridge to temporarily provide relief while long-term efforts are made to increase medical professional numbers domestically. 


Moreover, the medical school shortage also contributes to Georgia's "brain drain" phenomenon. Despite Georgia retaining 58% of its healthcare graduates, many of the state's brightest students who aspire to become doctors have to leave the state for medical school, and a significant proportion of these students do not return to practice medicine in Georgia. [15] This exacerbates the physician shortage and represents a loss of human capital for the state. Therefore, it is paramount that the new UGA medical school promotes staying in Georgia and for Georgia’s leadership to incentivize students to remain in the state. 


On Feb. 13, the University System of Georgia Board of Regents authorized the UGA to establish a new independent School of Medicine in Athens to correct this increasing issue.[16] Enrolling students as early as 2026, the school looks to be funded as part of Gov. Brian Kemp's $2 billion plan. The proposal for the school is to consider transitioning the partnership with Augusta University to an independently accredited medical school. Currently, the Medical College of Georgia, the only public medical school in the state, maintains a campus in Athens with a current class size of 60 students.[17] This number looks to grow significantly in the future as the proposed school looks to capitalize on a vast amount of medical school applications, with UGA being the ninth-highest producer of medical school applicants in the U.S., according to the Association of American Medical Colleges (AAMC).[18]


Actions are finally being taken in Georgia to correct the disturbing trend of communities being medically underserved. Although not much is known about the exact nature and specifications of the new UGA medical school, the mere presence of one is an acknowledgment of the burgeoning issue in Georgia and America in general. However, there are certain areas that the school must address if the project will adequately address the needs of communities in rural Georgia. Beyond the medical school, there are steps to be taken in Athens and Georgia to bolster the number of nurses and other medical professionals retiring soon. 

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