How do we get more Georgia grown physicians? 

For Georgia fans of a certain age that follow college football recruiting, and especially ones who remember those wilderness years prior to winning national championships, the concept of “building a recruiting fence around Georgia” is a familiar one. If only Mark Richt, and later Kirby Smart, could keep all of the top players in state, Georgia would be in the national title race every year. 

Similarly, we might be entering an age of reconsidering how we produce and retain physicians in Georgia.  

According to the Georgia Board for Healthcare Workforce, less than a third of Georgia’s 2024 medical school graduates chose to do their residency in Georgia. Put another way, that means almost 70% of the graduating classes at Emory, Medical College of Georgia, Mercer, Morehouse and PCOM Georgia began their final path towards practicing medicine outside of the state. 

For a state that has added a million new residents each decade since 1980, and is currently on pace to reach that mark again during the 2020s, that is a worrisome trend. It also helps explain why Georgia currently ranks 40th in the nation for the number of active physicians per capita. 

So, how do we create an environment that ensures we produce enough physicians to meet our state’s needs?

Cultivating homegrown physicians is a worthwhile, yet demanding endeavor. Despite recent innovations like the accelerated programs for primary care physicians at Mercer and the Medical College of Georgia, most doctors undergo at least 11 years of post-secondary education. Still, certain factors influence how likely a physician is to practice in a specific place, such as the location of their medical school or residency. 

The Association of American Medical Colleges’ most recent physician survey in 2023 found that nearly 38% of U.S. physicians practice in the state where they completed medical school.  By comparison, that number increases to over 48% of physicians who practice in the same state as they completed their residency. 

This holds even more true for areas that traditionally have provider shortages: One study in the Journal of Graduate Medical Education found that family medicine residents who spent half of their training time in a rural setting were five times more likely to practice in a rural setting. 

Notably, more than 68% of U.S. physicians who completed their medical school and residency in the same state remained in that state to practice medicine. For physicians that completed their medical school and residency in Georgia, over 73% of them practice in the state. 

Looking ahead to 2026, UGA’s School of Medicine, the state’s second public medical school after the Medical College of Georgia, will mark another important step in retaining Georgia’s physicians: the number of physicians practicing in the same state as their medical school location increases from 38% to 46% when examining only public medical school graduates. 

Importantly, how does Georgia stack up with its neighboring states – and its competitors in economic development – when it comes to producing physicians? 

	Medical Schools	Teaching Facilities**	2023 Residents***
Georgia	5*	32	3,343
Florida	10	62	8,525
North Carolina	6	20	4,264
Tennessee	5	12	2,785

When reviewing those numbers, Georgia seems relatively middle of the pack. However, Georgia’s true lag behind its neighbors becomes clearer when considering population: North Carolina produces 39.87 residents per 100,000 people (18th in the nation) followed by Tennessee at 39.51 (19th). Florida is just behind at 38.32 (21st). 

Georgia produced 30.63 residents per 100,000 people, which was 36th in the nation for the same time period. 

To put that into perspective, the state and its teaching facilities would need to invest in roughly 1,000 more residency slots to produce physicians at the same rate as North Carolina and Tennessee. Clearly, Georgia has some work to do to catch up to our neighbors if we want to train our physician workforce of the future to keep pace with our growing population. 

Of course, investing in residency training requires money, and while graduate medical education primarily takes place in a hospital setting, it is almost completely funded by two government programs. 

Medicare, the federal insurer for seniors, spends $18 billion annually to fund residency training across the country. However, states such as Georgia that have experienced high growth in recent decades are a net loser per capita in this arrangement; the spending levels are still based on 1996 population levels as set by the Balanced Budget Act of 1997. 

Medicaid, the state and federally funded program for the aged, blind, disabled and low-income populations, accounts for roughly $8 billion in residency training nationally. Every dollar spent by Georgia on Medicaid is matched by two federal dollars. This represents the best avenue for maximizing residency funding, especially given the limitations for the state when it comes to Medicare funded training. 

Currently, lawmakers are considering ways to invest in additional residency slots here in Georgia. In the amended budget, the House proposed $12.5 million for 270 new residency slots at one health system, while the Senate proposed over $20 million for new GME programs at hospitals south of State Route 540, the “Fall Line Freeway” that runs from Columbus to Augusta. 

This investment will take years to bear fruit. That is why the Georgia Public Policy Foundation also champions policies adopted by other states to bring more providers online in the short-term, such as allowing Assistant Physicians and Internationally Licensed Physicians to practice in Georgia. 

If 1,000 new residency slots is Georgia’s benchmark, then it will take a strong commitment from the state and its teaching facilities to get there.