Inadequate Access & health disparities

Dr. Andy Agwunobi

March 2, 2005

Exceptional Care. Remarkable Services. Extraordinary Grady.

Population at risk for inadequate access

Of 285 Million Americans

33 Million (12%) are underinsured 44 Million (15%) are uninsured

Minorities Living Without Health Insurance

20% of African Americans 33% of Hispanic/Latino Americans

Exceptional Care. Remarkable Services. Extraordinary Grady.

Georgia’s uninsured population is higher than the national average

14.2% 14.3% 14.6%

16.6%15.2%

16.1%

0.0%

5.0%

10.0%

15.0%

20.0%

2000 2001 2002

Total U.S. Georgia

Source: U.S. Census Bureau

Exceptional Care. Remarkable Services. Extraordinary Grady.

The number of the unemployed in Atlanta increased over 80% from 2000-2002

2.9

3.5

5.3

3.74.0

5.1

4.0

4.7

5.8

-0.5

2.0

4.5

7.0

Atlanta MSA Georgia Total U.S.

2000 2001 2002

Source: Georgia Department of Labor - Unemployment Rate %

Exceptional Care. Remarkable Services. Extraordinary Grady.

Health Disparities: Target areas for improvement

Nutrition Exercise Medical Home

Exceptional Care. Remarkable Services. Extraordinary Grady.

Access to a Medical Home

PCP

Subspecialty care

Emergency Care

Inpatient Care

Wellness care

Birth Death

Exceptional Care. Remarkable Services. Extraordinary Grady.

Distribution – Primary Care

Distribution of Pediatricians and OB/GYNs problematic60% of state poorly covered by Pediatricians, 40% for

OB/GYNLarge regions of state poorly covered by either, with the

eastern region of state sharing deficitsStrong implications for health care in early stages of life

Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Randolph Randolph Randolph Randolph Randolph Randolph Randolph Randolph Randolph

Stewart Stewart Stewart Stewart Stewart Stewart Stewart Stewart Stewart Webster Webster Webster Webster Webster Webster Webster Webster Webster

Schley Schley Schley Schley Schley Schley Schley Schley Schley

Sumter Sumter Sumter Sumter Sumter Sumter Sumter Sumter Sumter Crisp Crisp Crisp Crisp Crisp Crisp Crisp Crisp Crisp

Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox

Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Houston Houston Houston Houston Houston Houston Houston Houston Houston

Candler Candler Candler Candler Candler Candler Candler Candler Candler

Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins

Burke Burke Burke Burke Burke Burke Burke Burke Burke Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin

Monroe Monroe Monroe Monroe Monroe Monroe Monroe Monroe Monroe Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Troup Troup Troup Troup Troup Troup Troup Troup Troup

Coweta Coweta Coweta Coweta Coweta Coweta Coweta Coweta Coweta

Fayette Fayette Fayette Fayette Fayette Fayette Fayette Fayette Fayette Henry Henry Henry Henry Henry Henry Henry Henry Henry

Butts Butts Butts Butts Butts Butts Butts Butts Butts

Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Clayton Clayton Clayton Clayton Clayton Clayton Clayton Clayton Clayton Newton Newton Newton Newton Newton Newton Newton Newton Newton

Putnam Putnam Putnam Putnam Putnam Putnam Putnam Putnam Putnam

Greene Greene Greene Greene Greene Greene Greene Greene Greene

Hancock Hancock Hancock Hancock Hancock Hancock Hancock Hancock Hancock

Elbert Elbert Elbert Elbert Elbert Elbert Elbert Elbert Elbert

Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb

Walton Walton Walton Walton Walton Walton Walton Walton Walton Fulton Fulton Fulton Fulton Fulton Fulton Fulton Fulton Fulton

Paulding Paulding Paulding Paulding Paulding Paulding Paulding Paulding Paulding

Douglas Douglas Douglas Douglas Douglas Douglas Douglas Douglas Douglas

Cobb Cobb Cobb Cobb Cobb Cobb Cobb Cobb Cobb

Carroll Carroll Carroll Carroll Carroll Carroll Carroll Carroll Carroll

Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Marion Marion Marion Marion Marion Marion Marion Marion Marion

Liberty Liberty Liberty Liberty Liberty Liberty Liberty Liberty Liberty

Bryan Bryan Bryan Bryan Bryan Bryan Bryan Bryan Bryan Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall

Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Johnson Johnson Johnson Johnson Johnson Johnson Johnson Johnson Johnson

Dodge Dodge Dodge Dodge Dodge Dodge Dodge Dodge Dodge Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski

Peach Peach Peach Peach Peach Peach Peach Peach Peach Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee

Upson Upson Upson Upson Upson Upson Upson Upson Upson

Glascock Glascock Glascock Glascock Glascock Glascock Glascock Glascock Glascock Jasper Jasper Jasper Jasper Jasper Jasper Jasper Jasper Jasper

Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe

Oconee Oconee Oconee Oconee Oconee Oconee Oconee Oconee Oconee Clarke Clarke Clarke Clarke Clarke Clarke Clarke Clarke Clarke

Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery

McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie Warren Warren Warren Warren Warren Warren Warren Warren Warren

Columbia Columbia Columbia Columbia Columbia Columbia Columbia Columbia Columbia

Long Long Long Long Long Long Long Long Long

Floyd Floyd Floyd Floyd Floyd Floyd Floyd Floyd Floyd

Charlton Charlton Charlton Charlton Charlton Charlton Charlton Charlton Charlton Camden Camden Camden Camden Camden Camden Camden Camden Camden

Ware Ware Ware Ware Ware Ware Ware Ware Ware Brantley Brantley Brantley Brantley Brantley Brantley Brantley Brantley Brantley Glynn Glynn Glynn Glynn Glynn Glynn Glynn Glynn Glynn

Bacon Bacon Bacon Bacon Bacon Bacon Bacon Bacon Bacon Irwin Irwin Irwin Irwin Irwin Irwin Irwin Irwin Irwin Early Early Early Early Early Early Early Early Early

Clay Clay Clay Clay Clay Clay Clay Clay Clay

Hart Hart Hart Hart Hart Hart Hart Hart Hart Franklin Franklin Franklin Franklin Franklin Franklin Franklin Franklin Franklin Dawson Dawson Dawson Dawson Dawson Dawson Dawson Dawson Dawson

Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Hall Hall Hall Hall Hall Hall Hall Hall Hall

Worth Worth Worth Worth Worth Worth Worth Worth Worth

Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell

Stephens Stephens Stephens Stephens Stephens Stephens Stephens Stephens Stephens Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin

White White White White White White White White White

Gordon Gordon Gordon Gordon Gordon Gordon Gordon Gordon Gordon Pickens Pickens Pickens Pickens Pickens Pickens Pickens Pickens Pickens

Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Habersham Habersham Habersham Habersham Habersham Habersham Habersham Habersham Habersham

Berrien Berrien Berrien Berrien Berrien Berrien Berrien Berrien Berrien Baker Baker Baker Baker Baker Baker Baker Baker Baker

Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga

Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Cook Cook Cook Cook Cook Cook Cook Cook Cook

Seminole Seminole Seminole Seminole Seminole Seminole Seminole Seminole Seminole Decatur Decatur Decatur Decatur Decatur Decatur Decatur Decatur Decatur

Rabun Rabun Rabun Rabun Rabun Rabun Rabun Rabun Rabun Towns Towns Towns Towns Towns Towns Towns Towns Towns

Fannin Fannin Fannin Fannin Fannin Fannin Fannin Fannin Fannin Murray Murray Murray Murray Murray Murray Murray Murray Murray Union Union Union Union Union Union Union Union Union

Clinch Clinch Clinch Clinch Clinch Clinch Clinch Clinch Clinch

Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Brooks Brooks Brooks Brooks Brooks Brooks Brooks Brooks Brooks Thomas Thomas Thomas Thomas Thomas Thomas Thomas Thomas Thomas

Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield

Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa

Walker Walker Walker Walker Walker Walker Walker Walker Walker

Dade Dade Dade Dade Dade Dade Dade Dade Dade

Echols Echols Echols Echols Echols Echols Echols Echols Echols

Appling Appling Appling Appling Appling Appling Appling Appling Appling

Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson

Banks Banks Banks Banks Banks Banks Banks Banks Banks

Barrow Barrow Barrow Barrow Barrow Barrow Barrow Barrow Barrow

Bartow Bartow Bartow Bartow Bartow Bartow Bartow Bartow Bartow

Bibb Bibb Bibb Bibb Bibb Bibb Bibb Bibb Bibb

Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch

Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun

Chatham Chatham Chatham Chatham Chatham Chatham Chatham Chatham Chatham

Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee

Coffee Coffee Coffee Coffee Coffee Coffee Coffee Coffee Coffee

Crawford Crawford Crawford Crawford Crawford Crawford Crawford Crawford Crawford

Dooly Dooly Dooly Dooly Dooly Dooly Dooly Dooly Dooly

Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty

Effingham Effingham Effingham Effingham Effingham Effingham Effingham Effingham Effingham

Evans Evans Evans Evans Evans Evans Evans Evans Evans

Grady Grady Grady Grady Grady Grady Grady Grady Grady

Haralson Haralson Haralson Haralson Haralson Haralson Haralson Haralson Haralson

Harris Harris Harris Harris Harris Harris Harris Harris Harris

Heard Heard Heard Heard Heard Heard Heard Heard Heard

Jackson Jackson Jackson Jackson Jackson Jackson Jackson Jackson Jackson

Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jones Jones Jones Jones Jones Jones Jones Jones Jones Lamar Lamar Lamar Lamar Lamar Lamar Lamar Lamar Lamar

Lanier Lanier Lanier Lanier Lanier Lanier Lanier Lanier Lanier

Laurens Laurens Laurens Laurens Laurens Laurens Laurens Laurens Laurens

Lee Lee Lee Lee Lee Lee Lee Lee Lee

Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln

McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh

Macon Macon Macon Macon Macon Macon Macon Macon Macon

Madison Madison Madison Madison Madison Madison Madison Madison Madison

Miller Miller Miller Miller Miller Miller Miller Miller Miller

Morgan Morgan Morgan Morgan Morgan Morgan Morgan Morgan Morgan

Pierce Pierce Pierce Pierce Pierce Pierce Pierce Pierce Pierce

Pike Pike Pike Pike Pike Pike Pike Pike Pike

Polk Polk Polk Polk Polk Polk Polk Polk Polk

Quitman Quitman Quitman Quitman Quitman Quitman Quitman Quitman Quitman

Richmond Richmond Richmond Richmond Richmond Richmond Richmond Richmond Richmond

Screven Screven Screven Screven Screven Screven Screven Screven Screven

Spalding Spalding Spalding Spalding Spalding Spalding Spalding Spalding Spalding

Talbot Talbot Talbot Talbot Talbot Talbot Talbot Talbot Talbot

Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro

Taylor Taylor Taylor Taylor Taylor Taylor Taylor Taylor Taylor

Telfair Telfair Telfair Telfair Telfair Telfair Telfair Telfair Telfair

Terrell Terrell Terrell Terrell Terrell Terrell Terrell Terrell Terrell

Tift Tift Tift Tift Tift Tift Tift Tift Tift

Toombs Toombs Toombs Toombs Toombs Toombs Toombs Toombs Toombs

Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen

Turner Turner Turner Turner Turner Turner Turner Turner Turner

Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs

Washington Washington Washington Washington Washington Washington Washington Washington Washington

Wayne Wayne Wayne Wayne Wayne Wayne Wayne Wayne Wayne

Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler

Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson

OBSTETRICS & GYNECOLOGY OBSTETRICS & GYNECOLOGY OBSTETRICS & GYNECOLOGY OBSTETRICS & GYNECOLOGY OBSTETRICS & GYNECOLOGY OBSTETRICS & GYNECOLOGY OBSTETRICS & GYNECOLOGY OBSTETRICS & GYNECOLOGY OBSTETRICS & GYNECOLOGY

Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002

Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs*

Deficit Deficit Deficit Deficit Deficit Deficit Deficit Deficit Deficit

Adequate Adequate Adequate Adequate Adequate Adequate Adequate Adequate Adequate

Surplus Surplus Surplus Surplus Surplus Surplus Surplus Surplus Surplus

Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center 4/04 4/04 4/04 4/04 4/04 4/04 4/04 4/04

*A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/ - 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/ - 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/ - 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/ - 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/ - 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/ - 1 standard deviation of the physician rate per 100,000 in 2002.

1 1 1 1 1 1 1 1 1

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50 50 50 50 50 50 50 50 50

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64 64 64 64 64 64 64 64 64

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67 67 67 67 67 67 67 67 67

68 68 68 68 68 68 68 68 68 69 69 69 69 69 69 69 69 69

70 70 70 70 70 70 70 70 70

71 71 71 71 71 71 71 71 71

72 72 72 72 72 72 72 72 72 73 73 73 73 73 73 73 73 73 74 74 74 74 74 74 74 74 74 75 75 75 75 75 75 75 75 75

76 76 76 76 76 76 76 76 76

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80 80 80 80 80 80 80 80 80

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85 85 85 85 85 85 85 85 85

86 86 86 86 86 86 86 86 86

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90 90 90 90 90 90 90 90 90

91 91 91 91 91 91 91 91 91

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93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94

95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96

Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Randolph Randolph Randolph Randolph Randolph Randolph Randolph Randolph Randolph

Stewart Stewart Stewart Stewart Stewart Stewart Stewart Stewart Stewart Webster Webster Webster Webster Webster Webster Webster Webster Webster

Schley Schley Schley Schley Schley Schley Schley Schley Schley

Sumter Sumter Sumter Sumter Sumter Sumter Sumter Sumter Sumter Crisp Crisp Crisp Crisp Crisp Crisp Crisp Crisp Crisp

Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox

Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Houston Houston Houston Houston Houston Houston Houston Houston Houston

Candler Candler Candler Candler Candler Candler Candler Candler Candler

Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins

Burke Burke Burke Burke Burke Burke Burke Burke Burke Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin

Monroe Monroe Monroe Monroe Monroe Monroe Monroe Monroe Monroe Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Troup Troup Troup Troup Troup Troup Troup Troup Troup

Coweta Coweta Coweta Coweta Coweta Coweta Coweta Coweta Coweta

Fayette Fayette Fayette Fayette Fayette Fayette Fayette Fayette Fayette Henry Henry Henry Henry Henry Henry Henry Henry Henry

Butts Butts Butts Butts Butts Butts Butts Butts Butts

Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Clayton Clayton Clayton Clayton Clayton Clayton Clayton Clayton Clayton Newton Newton Newton Newton Newton Newton Newton Newton Newton

Putnam Putnam Putnam Putnam Putnam Putnam Putnam Putnam Putnam

Greene Greene Greene Greene Greene Greene Greene Greene Greene

Hancock Hancock Hancock Hancock Hancock Hancock Hancock Hancock Hancock

Elbert Elbert Elbert Elbert Elbert Elbert Elbert Elbert Elbert

Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb

Walton Walton Walton Walton Walton Walton Walton Walton Walton Fulton Fulton Fulton Fulton Fulton Fulton Fulton Fulton Fulton

Paulding Paulding Paulding Paulding Paulding Paulding Paulding Paulding Paulding

Douglas Douglas Douglas Douglas Douglas Douglas Douglas Douglas Douglas

Cobb Cobb Cobb Cobb Cobb Cobb Cobb Cobb Cobb

Carroll Carroll Carroll Carroll Carroll Carroll Carroll Carroll Carroll

Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Marion Marion Marion Marion Marion Marion Marion Marion Marion

Liberty Liberty Liberty Liberty Liberty Liberty Liberty Liberty Liberty

Bryan Bryan Bryan Bryan Bryan Bryan Bryan Bryan Bryan Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall

Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Johnson Johnson Johnson Johnson Johnson Johnson Johnson Johnson Johnson

Dodge Dodge Dodge Dodge Dodge Dodge Dodge Dodge Dodge Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski

Peach Peach Peach Peach Peach Peach Peach Peach Peach Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee

Upson Upson Upson Upson Upson Upson Upson Upson Upson

Glascock Glascock Glascock Glascock Glascock Glascock Glascock Glascock Glascock Jasper Jasper Jasper Jasper Jasper Jasper Jasper Jasper Jasper

Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe

Oconee Oconee Oconee Oconee Oconee Oconee Oconee Oconee Oconee Clarke Clarke Clarke Clarke Clarke Clarke Clarke Clarke Clarke

Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery

McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie Warren Warren Warren Warren Warren Warren Warren Warren Warren

Columbia Columbia Columbia Columbia Columbia Columbia Columbia Columbia Columbia

Long Long Long Long Long Long Long Long Long

Floyd Floyd Floyd Floyd Floyd Floyd Floyd Floyd Floyd

Charlton Charlton Charlton Charlton Charlton Charlton Charlton Charlton Charlton Camden Camden Camden Camden Camden Camden Camden Camden Camden

Ware Ware Ware Ware Ware Ware Ware Ware Ware Brantley Brantley Brantley Brantley Brantley Brantley Brantley Brantley Brantley Glynn Glynn Glynn Glynn Glynn Glynn Glynn Glynn Glynn

Bacon Bacon Bacon Bacon Bacon Bacon Bacon Bacon Bacon Irwin Irwin Irwin Irwin Irwin Irwin Irwin Irwin Irwin Early Early Early Early Early Early Early Early Early

Clay Clay Clay Clay Clay Clay Clay Clay Clay

Hart Hart Hart Hart Hart Hart Hart Hart Hart Franklin Franklin Franklin Franklin Franklin Franklin Franklin Franklin Franklin Dawson Dawson Dawson Dawson Dawson Dawson Dawson Dawson Dawson

Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Hall Hall Hall Hall Hall Hall Hall Hall Hall

Worth Worth Worth Worth Worth Worth Worth Worth Worth

Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell

Stephens Stephens Stephens Stephens Stephens Stephens Stephens Stephens Stephens Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin

White White White White White White White White White

Gordon Gordon Gordon Gordon Gordon Gordon Gordon Gordon Gordon Pickens Pickens Pickens Pickens Pickens Pickens Pickens Pickens Pickens

Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Habersham Habersham Habersham Habersham Habersham Habersham Habersham Habersham Habersham

Berrien Berrien Berrien Berrien Berrien Berrien Berrien Berrien Berrien Baker Baker Baker Baker Baker Baker Baker Baker Baker

Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga

Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Cook Cook Cook Cook Cook Cook Cook Cook Cook

Seminole Seminole Seminole Seminole Seminole Seminole Seminole Seminole Seminole Decatur Decatur Decatur Decatur Decatur Decatur Decatur Decatur Decatur

Rabun Rabun Rabun Rabun Rabun Rabun Rabun Rabun Rabun Towns Towns Towns Towns Towns Towns Towns Towns Towns

Fannin Fannin Fannin Fannin Fannin Fannin Fannin Fannin Fannin Murray Murray Murray Murray Murray Murray Murray Murray Murray Union Union Union Union Union Union Union Union Union

Clinch Clinch Clinch Clinch Clinch Clinch Clinch Clinch Clinch

Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Brooks Brooks Brooks Brooks Brooks Brooks Brooks Brooks Brooks Thomas Thomas Thomas Thomas Thomas Thomas Thomas Thomas Thomas

Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield

Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa

Walker Walker Walker Walker Walker Walker Walker Walker Walker

Dade Dade Dade Dade Dade Dade Dade Dade Dade

Echols Echols Echols Echols Echols Echols Echols Echols Echols

Appling Appling Appling Appling Appling Appling Appling Appling Appling

Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson

Banks Banks Banks Banks Banks Banks Banks Banks Banks

Barrow Barrow Barrow Barrow Barrow Barrow Barrow Barrow Barrow

Bartow Bartow Bartow Bartow Bartow Bartow Bartow Bartow Bartow

Bibb Bibb Bibb Bibb Bibb Bibb Bibb Bibb Bibb

Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch

Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun

Chatham Chatham Chatham Chatham Chatham Chatham Chatham Chatham Chatham

Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee

Coffee Coffee Coffee Coffee Coffee Coffee Coffee Coffee Coffee

Crawford Crawford Crawford Crawford Crawford Crawford Crawford Crawford Crawford

Dooly Dooly Dooly Dooly Dooly Dooly Dooly Dooly Dooly

Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty

Effingham Effingham Effingham Effingham Effingham Effingham Effingham Effingham Effingham

Evans Evans Evans Evans Evans Evans Evans Evans Evans

Grady Grady Grady Grady Grady Grady Grady Grady Grady

Haralson Haralson Haralson Haralson Haralson Haralson Haralson Haralson Haralson

Harris Harris Harris Harris Harris Harris Harris Harris Harris

Heard Heard Heard Heard Heard Heard Heard Heard Heard

Jackson Jackson Jackson Jackson Jackson Jackson Jackson Jackson Jackson

Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jones Jones Jones Jones Jones Jones Jones Jones Jones Lamar Lamar Lamar Lamar Lamar Lamar Lamar Lamar Lamar

Lanier Lanier Lanier Lanier Lanier Lanier Lanier Lanier Lanier

Laurens Laurens Laurens Laurens Laurens Laurens Laurens Laurens Laurens

Lee Lee Lee Lee Lee Lee Lee Lee Lee

Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln

McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh

Macon Macon Macon Macon Macon Macon Macon Macon Macon

Madison Madison Madison Madison Madison Madison Madison Madison Madison

Miller Miller Miller Miller Miller Miller Miller Miller Miller

Morgan Morgan Morgan Morgan Morgan Morgan Morgan Morgan Morgan

Pierce Pierce Pierce Pierce Pierce Pierce Pierce Pierce Pierce

Pike Pike Pike Pike Pike Pike Pike Pike Pike

Polk Polk Polk Polk Polk Polk Polk Polk Polk

Quitman Quitman Quitman Quitman Quitman Quitman Quitman Quitman Quitman

Richmond Richmond Richmond Richmond Richmond Richmond Richmond Richmond Richmond

Screven Screven Screven Screven Screven Screven Screven Screven Screven

Spalding Spalding Spalding Spalding Spalding Spalding Spalding Spalding Spalding

Talbot Talbot Talbot Talbot Talbot Talbot Talbot Talbot Talbot

Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro

Taylor Taylor Taylor Taylor Taylor Taylor Taylor Taylor Taylor

Telfair Telfair Telfair Telfair Telfair Telfair Telfair Telfair Telfair

Terrell Terrell Terrell Terrell Terrell Terrell Terrell Terrell Terrell

Tift Tift Tift Tift Tift Tift Tift Tift Tift

Toombs Toombs Toombs Toombs Toombs Toombs Toombs Toombs Toombs

Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen

Turner Turner Turner Turner Turner Turner Turner Turner Turner

Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs

Washington Washington Washington Washington Washington Washington Washington Washington Washington

Wayne Wayne Wayne Wayne Wayne Wayne Wayne Wayne Wayne

Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler

Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson

PEDIATRICS PEDIATRICS PEDIATRICS PEDIATRICS PEDIATRICS PEDIATRICS PEDIATRICS PEDIATRICS PEDIATRICS

Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002 Physician Distribution - 2002

Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs*

Deficit Deficit Deficit Deficit Deficit Deficit Deficit Deficit Deficit

Adequate Adequate Adequate Adequate Adequate Adequate Adequate Adequate Adequate

Surplus Surplus Surplus Surplus Surplus Surplus Surplus Surplus Surplus

Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center Prepared by: Mercer University Health Sciences Center 4/04 4/04 4/04 4/04 4/04 4/04 4/04 4/04

*A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/ - 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/ - 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/ - 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/ - 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/ - 1 standard deviation of the physician rate per 100,000 in 2002. *A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/ - 1 standard deviation of the physician rate per 100,000 in 2002.

1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7

8 8 8 8 8 8 8 8 8

10 10 10 10 10 10 10 10 10

9 9 9 9 9 9 9 9 9 11 11 11 11 11 11 11 11 11

12 12 12 12 12 12 12 12 12

13 13 13 13 13 13 13 13 13

14 14 14 14 14 14 14 14 14

15 15 15 15 15 15 15 15 15

16 16 16 16 16 16 16 16 16

17 17 17 17 17 17 17 17 17

18 18 18 18 18 18 18 18 18

19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 20

21 21 21 21 21 21 21 21 21

22 22 22 22 22 22 22 22 22 23 23 23 23 23 23 23 23 23 24 24 24 24 24 24 24 24 24

25 25 25 25 25 25 25 25 25

26 26 26 26 26 26 26 26 26

27 27 27 27 27 27 27 27 27

28 28 28 28 28 28 28 28 28

29 29 29 29 29 29 29 29 29

30 30 30 30 30 30 30 30 30 31 31 31 31 31 31 31 31 31

32 32 32 32 32 32 32 32 32 33 33 33 33 33 33 33 33 33

34 34 34 34 34 34 34 34 34

35 35 35 35 35 35 35 35 35 36 36 36 36 36 36 36 36 36

37 37 37 37 37 37 37 37 37

38 38 38 38 38 38 38 38 38 39 39 39 39 39 39 39 39 39

40 40 40 40 40 40 40 40 40 41 41 41 41 41 41 41 41 41

42 42 42 42 42 42 42 42 42

43 43 43 43 43 43 43 43 43

44 44 44 44 44 44 44 44 44 45 45 45 45 45 45 45 45 45

46 46 46 46 46 46 46 46 46

47 47 47 47 47 47 47 47 47

48 48 48 48 48 48 48 48 48 49 49 49 49 49 49 49 49 49

50 50 50 50 50 50 50 50 50

51 51 51 51 51 51 51 51 51

52 52 52 52 52 52 52 52 52

53 53 53 53 53 53 53 53 53

54 54 54 54 54 54 54 54 54

55 55 55 55 55 55 55 55 55

56 56 56 56 56 56 56 56 56

57 57 57 57 57 57 57 57 57

58 58 58 58 58 58 58 58 58 59 59 59 59 59 59 59 59 59

61 61 61 61 61 61 61 61 61

60 60 60 60 60 60 60 60 60 62 62 62 62 62 62 62 62 62

63 63 63 63 63 63 63 63 63

64 64 64 64 64 64 64 64 64

65 65 65 65 65 65 65 65 65

66 66 66 66 66 66 66 66 66

67 67 67 67 67 67 67 67 67

68 68 68 68 68 68 68 68 68 69 69 69 69 69 69 69 69 69

70 70 70 70 70 70 70 70 70

71 71 71 71 71 71 71 71 71

72 72 72 72 72 72 72 72 72 73 73 73 73 73 73 73 73 73 74 74 74 74 74 74 74 74 74 75 75 75 75 75 75 75 75 75

76 76 76 76 76 76 76 76 76

77 77 77 77 77 77 77 77 77

78 78 78 78 78 78 78 78 78

79 79 79 79 79 79 79 79 79

80 80 80 80 80 80 80 80 80

81 81 81 81 81 81 81 81 81 82 82 82 82 82 82 82 82 82

83 83 83 83 83 83 83 83 83 84 84 84 84 84 84 84 84 84

85 85 85 85 85 85 85 85 85

86 86 86 86 86 86 86 86 86

87 87 87 87 87 87 87 87 87

88 88 88 88 88 88 88 88 88

89 89 89 89 89 89 89 89 89

90 90 90 90 90 90 90 90 90

91 91 91 91 91 91 91 91 91

92 92 92 92 92 92 92 92 92

93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94

95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96

Exceptional Care. Remarkable Services. Extraordinary Grady.

Distribution – Primary Care

Problems seen in General Surgery30 out of 96 PCSAs

undersupplied in General Surgeons

This distribution is likely getting worse as effective number of General Surgeons is currently dropping

Jeff DavisJeff DavisJeff DavisJeff DavisJeff DavisJeff DavisJeff DavisJeff DavisJeff DavisBen HillBen HillBen HillBen HillBen HillBen HillBen HillBen HillBen HillRandolphRandolphRandolphRandolphRandolphRandolphRandolphRandolphRandolph

StewartStewartStewartStewartStewartStewartStewartStewartStewartWebsterWebsterWebsterWebsterWebsterWebsterWebsterWebsterWebster

SchleySchleySchleySchleySchleySchleySchleySchleySchley

SumterSumterSumterSumterSumterSumterSumterSumterSumter

CrispCrispCrispCrispCrispCrispCrispCrispCrisp

WilcoxWilcoxWilcoxWilcoxWilcoxWilcoxWilcoxWilcoxWilcox

BleckleyBleckleyBleckleyBleckleyBleckleyBleckleyBleckleyBleckleyBleckleyHoustonHoustonHoustonHoustonHoustonHoustonHoustonHoustonHouston

CandlerCandlerCandlerCandlerCandlerCandlerCandlerCandlerCandler

JenkinsJenkinsJenkinsJenkinsJenkinsJenkinsJenkinsJenkinsJenkins

BurkeBurkeBurkeBurkeBurkeBurkeBurkeBurkeBurke

BaldwinBaldwinBaldwinBaldwinBaldwinBaldwinBaldwinBaldwinBaldwinMonroeMonroeMonroeMonroeMonroeMonroeMonroeMonroeMonroeMeriwetherMeriwetherMeriwetherMeriwetherMeriwetherMeriwetherMeriwetherMeriwetherMeriwetherTroupTroupTroupTroupTroupTroupTroupTroupTroup

CowetaCowetaCowetaCowetaCowetaCowetaCowetaCowetaCoweta

FayetteFayetteFayetteFayetteFayetteFayetteFayetteFayetteFayetteHenryHenryHenryHenryHenryHenryHenryHenryHenry

ButtsButtsButtsButtsButtsButtsButtsButtsButts

RockdaleRockdaleRockdaleRockdaleRockdaleRockdaleRockdaleRockdaleRockdaleClaytonClaytonClaytonClaytonClaytonClaytonClaytonClaytonClaytonNewtonNewtonNewtonNewtonNewtonNewtonNewtonNewtonNewton

PutnamPutnamPutnamPutnamPutnamPutnamPutnamPutnamPutnam

GreeneGreeneGreeneGreeneGreeneGreeneGreeneGreeneGreene

HancockHancockHancockHancockHancockHancockHancockHancockHancock

ElbertElbertElbertElbertElbertElbertElbertElbertElbert

GwinnettGwinnettGwinnettGwinnettGwinnettGwinnettGwinnettGwinnettGwinnett

DeKalbDeKalbDeKalbDeKalbDeKalbDeKalbDeKalbDeKalbDeKalb

WaltonWaltonWaltonWaltonWaltonWaltonWaltonWaltonWaltonFultonFultonFultonFultonFultonFultonFultonFultonFulton

PauldingPauldingPauldingPauldingPauldingPauldingPauldingPauldingPaulding

DouglasDouglasDouglasDouglasDouglasDouglasDouglasDouglasDouglas

CobbCobbCobbCobbCobbCobbCobbCobbCobb

CarrollCarrollCarrollCarrollCarrollCarrollCarrollCarrollCarroll

ChattahoocheeChattahoocheeChattahoocheeChattahoocheeChattahoocheeChattahoocheeChattahoocheeChattahoocheeChattahoochee

MarionMarionMarionMarionMarionMarionMarionMarionMarion

LibertyLibertyLibertyLibertyLibertyLibertyLibertyLibertyLiberty

BryanBryanBryanBryanBryanBryanBryanBryanBryanTattnallTattnallTattnallTattnallTattnallTattnallTattnallTattnallTattnall

EmanuelEmanuelEmanuelEmanuelEmanuelEmanuelEmanuelEmanuelEmanuel

JohnsonJohnsonJohnsonJohnsonJohnsonJohnsonJohnsonJohnsonJohnson

DodgeDodgeDodgeDodgeDodgeDodgeDodgeDodgeDodge

PulaskiPulaskiPulaskiPulaskiPulaskiPulaskiPulaskiPulaskiPulaski

PeachPeachPeachPeachPeachPeachPeachPeachPeachMuscogeeMuscogeeMuscogeeMuscogeeMuscogeeMuscogeeMuscogeeMuscogeeMuscogee

UpsonUpsonUpsonUpsonUpsonUpsonUpsonUpsonUpson

GlascockGlascockGlascockGlascockGlascockGlascockGlascockGlascockGlascockJasperJasperJasperJasperJasperJasperJasperJasperJasper

WilkesWilkesWilkesWilkesWilkesWilkesWilkesWilkesWilkes

OglethorpeOglethorpeOglethorpeOglethorpeOglethorpeOglethorpeOglethorpeOglethorpeOglethorpeOconeeOconeeOconeeOconeeOconeeOconeeOconeeOconeeOconee

ClarkeClarkeClarkeClarkeClarkeClarkeClarkeClarkeClarke

MontgomeryMontgomeryMontgomeryMontgomeryMontgomeryMontgomeryMontgomeryMontgomeryMontgomery

McDuffieMcDuffieMcDuffieMcDuffieMcDuffieMcDuffieMcDuffieMcDuffieMcDuffie

WarrenWarrenWarrenWarrenWarrenWarrenWarrenWarrenWarren

ColumbiaColumbiaColumbiaColumbiaColumbiaColumbiaColumbiaColumbiaColumbia

LongLongLongLongLongLongLongLongLong

FloydFloydFloydFloydFloydFloydFloydFloydFloyd

CharltonCharltonCharltonCharltonCharltonCharltonCharltonCharltonCharltonCamdenCamdenCamdenCamdenCamdenCamdenCamdenCamdenCamden

WareWareWareWareWareWareWareWareWare

BrantleyBrantleyBrantleyBrantleyBrantleyBrantleyBrantleyBrantleyBrantley GlynnGlynnGlynnGlynnGlynnGlynnGlynnGlynnGlynn

BaconBaconBaconBaconBaconBaconBaconBaconBaconIrwinIrwinIrwinIrwinIrwinIrwinIrwinIrwinIrwin

EarlyEarlyEarlyEarlyEarlyEarlyEarlyEarlyEarly

ClayClayClayClayClayClayClayClayClay

HartHartHartHartHartHartHartHartHart

FranklinFranklinFranklinFranklinFranklinFranklinFranklinFranklinFranklinDawsonDawsonDawsonDawsonDawsonDawsonDawsonDawsonDawson

ForsythForsythForsythForsythForsythForsythForsythForsythForsyth HallHallHallHallHallHallHallHallHall

WorthWorthWorthWorthWorthWorthWorthWorthWorth

MitchellMitchellMitchellMitchellMitchellMitchellMitchellMitchellMitchell

StephensStephensStephensStephensStephensStephensStephensStephensStephensLumpkinLumpkinLumpkinLumpkinLumpkinLumpkinLumpkinLumpkinLumpkin

WhiteWhiteWhiteWhiteWhiteWhiteWhiteWhiteWhite

GordonGordonGordonGordonGordonGordonGordonGordonGordonPickensPickensPickensPickensPickensPickensPickensPickensPickens

GilmerGilmerGilmerGilmerGilmerGilmerGilmerGilmerGilmerHabershamHabershamHabershamHabershamHabershamHabershamHabershamHabershamHabersham

BerrienBerrienBerrienBerrienBerrienBerrienBerrienBerrienBerrienBakerBakerBakerBakerBakerBakerBakerBakerBaker

ChattoogaChattoogaChattoogaChattoogaChattoogaChattoogaChattoogaChattoogaChattooga

ColquittColquittColquittColquittColquittColquittColquittColquittColquitt CookCookCookCookCookCookCookCookCook

SeminoleSeminoleSeminoleSeminoleSeminoleSeminoleSeminoleSeminoleSeminole DecaturDecaturDecaturDecaturDecaturDecaturDecaturDecaturDecatur

RabunRabunRabunRabunRabunRabunRabunRabunRabunTownsTownsTownsTownsTownsTownsTownsTownsTowns

FanninFanninFanninFanninFanninFanninFanninFanninFannin

MurrayMurrayMurrayMurrayMurrayMurrayMurrayMurrayMurray UnionUnionUnionUnionUnionUnionUnionUnionUnion

ClinchClinchClinchClinchClinchClinchClinchClinchClinch

LowndesLowndesLowndesLowndesLowndesLowndesLowndesLowndesLowndes

BrooksBrooksBrooksBrooksBrooksBrooksBrooksBrooksBrooksThomasThomasThomasThomasThomasThomasThomasThomasThomas

WhitfieldWhitfieldWhitfieldWhitfieldWhitfieldWhitfieldWhitfieldWhitfieldWhitfield

CatoosaCatoosaCatoosaCatoosaCatoosaCatoosaCatoosaCatoosaCatoosa

WalkerWalkerWalkerWalkerWalkerWalkerWalkerWalkerWalker

DadeDadeDadeDadeDadeDadeDadeDadeDade

EcholsEcholsEcholsEcholsEcholsEcholsEcholsEcholsEchols

ApplingApplingApplingApplingApplingApplingApplingApplingAppling

AtkinsonAtkinsonAtkinsonAtkinsonAtkinsonAtkinsonAtkinsonAtkinsonAtkinson

BanksBanksBanksBanksBanksBanksBanksBanksBanks

BarrowBarrowBarrowBarrowBarrowBarrowBarrowBarrowBarrow

BartowBartowBartowBartowBartowBartowBartowBartowBartow

BibbBibbBibbBibbBibbBibbBibbBibbBibb

BullochBullochBullochBullochBullochBullochBullochBullochBulloch

CalhounCalhounCalhounCalhounCalhounCalhounCalhounCalhounCalhoun

ChathamChathamChathamChathamChathamChathamChathamChathamChatham

CherokeeCherokeeCherokeeCherokeeCherokeeCherokeeCherokeeCherokeeCherokee

CoffeeCoffeeCoffeeCoffeeCoffeeCoffeeCoffeeCoffeeCoffee

CrawfordCrawfordCrawfordCrawfordCrawfordCrawfordCrawfordCrawfordCrawford

DoolyDoolyDoolyDoolyDoolyDoolyDoolyDoolyDooly

DoughertyDoughertyDoughertyDoughertyDoughertyDoughertyDoughertyDoughertyDougherty

EffinghamEffinghamEffinghamEffinghamEffinghamEffinghamEffinghamEffinghamEffingham

EvansEvansEvansEvansEvansEvansEvansEvansEvans

GradyGradyGradyGradyGradyGradyGradyGradyGrady

HaralsonHaralsonHaralsonHaralsonHaralsonHaralsonHaralsonHaralsonHaralson

HarrisHarrisHarrisHarrisHarrisHarrisHarrisHarrisHarris

HeardHeardHeardHeardHeardHeardHeardHeardHeard

JacksonJacksonJacksonJacksonJacksonJacksonJacksonJacksonJackson

JeffersonJeffersonJeffersonJeffersonJeffersonJeffersonJeffersonJeffersonJeffersonJonesJonesJonesJonesJonesJonesJonesJonesJonesLamarLamarLamarLamarLamarLamarLamarLamarLamar

LanierLanierLanierLanierLanierLanierLanierLanierLanier

LaurensLaurensLaurensLaurensLaurensLaurensLaurensLaurensLaurens

LeeLeeLeeLeeLeeLeeLeeLeeLee

LincolnLincolnLincolnLincolnLincolnLincolnLincolnLincolnLincoln

McIntoshMcIntoshMcIntoshMcIntoshMcIntoshMcIntoshMcIntoshMcIntoshMcIntosh

MaconMaconMaconMaconMaconMaconMaconMaconMacon

MadisonMadisonMadisonMadisonMadisonMadisonMadisonMadisonMadison

MillerMillerMillerMillerMillerMillerMillerMillerMiller

MorganMorganMorganMorganMorganMorganMorganMorganMorgan

PiercePiercePiercePiercePiercePiercePiercePiercePierce

PikePikePikePikePikePikePikePikePike

PolkPolkPolkPolkPolkPolkPolkPolkPolk

QuitmanQuitmanQuitmanQuitmanQuitmanQuitmanQuitmanQuitmanQuitman

RichmondRichmondRichmondRichmondRichmondRichmondRichmondRichmondRichmond

ScrevenScrevenScrevenScrevenScrevenScrevenScrevenScrevenScreven

SpaldingSpaldingSpaldingSpaldingSpaldingSpaldingSpaldingSpaldingSpalding

TalbotTalbotTalbotTalbotTalbotTalbotTalbotTalbotTalbot

TaliaferroTaliaferroTaliaferroTaliaferroTaliaferroTaliaferroTaliaferroTaliaferroTaliaferro

TaylorTaylorTaylorTaylorTaylorTaylorTaylorTaylorTaylor

TelfairTelfairTelfairTelfairTelfairTelfairTelfairTelfairTelfair

TerrellTerrellTerrellTerrellTerrellTerrellTerrellTerrellTerrell

TiftTiftTiftTiftTiftTiftTiftTiftTift

ToombsToombsToombsToombsToombsToombsToombsToombsToombs

TreutlenTreutlenTreutlenTreutlenTreutlenTreutlenTreutlenTreutlenTreutlen

TurnerTurnerTurnerTurnerTurnerTurnerTurnerTurnerTurner

TwiggsTwiggsTwiggsTwiggsTwiggsTwiggsTwiggsTwiggsTwiggs

WashingtonWashingtonWashingtonWashingtonWashingtonWashingtonWashingtonWashingtonWashington

WayneWayneWayneWayneWayneWayneWayneWayneWayne

WheelerWheelerWheelerWheelerWheelerWheelerWheelerWheelerWheeler

WilkinsonWilkinsonWilkinsonWilkinsonWilkinsonWilkinsonWilkinsonWilkinsonWilkinson

GENERAL SURGERYGENERAL SURGERYGENERAL SURGERYGENERAL SURGERYGENERAL SURGERYGENERAL SURGERYGENERAL SURGERYGENERAL SURGERYGENERAL SURGERYPhysician Distribution - 2002Physician Distribution - 2002Physician Distribution - 2002Physician Distribution - 2002Physician Distribution - 2002Physician Distribution - 2002Physician Distribution - 2002Physician Distribution - 2002Physician Distribution - 2002

Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs* Deficit, Adequate, and Surplus PCSAs*

DeficitDeficitDeficitDeficitDeficitDeficitDeficitDeficitDeficitAdequateAdequateAdequateAdequateAdequateAdequateAdequateAdequateAdequateSurplusSurplusSurplusSurplusSurplusSurplusSurplusSurplusSurplus

Prepared by: Mercer University Health Sciences CenterPrepared by: Mercer University Health Sciences CenterPrepared by: Mercer University Health Sciences CenterPrepared by: Mercer University Health Sciences CenterPrepared by: Mercer University Health Sciences CenterPrepared by: Mercer University Health Sciences CenterPrepared by: Mercer University Health Sciences CenterPrepared by: Mercer University Health Sciences CenterPrepared by: Mercer University Health Sciences Center 4/044/044/044/044/044/044/044/044/04

*A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002.*A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002.*A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002.*A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002.*A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002.*A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002.*A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002.*A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002.*A PCSA (Primary Care Service Area) is categorized as deficit, adequate, or surplus based on the +/- 1 standard deviation of the physician rate per 100,000 in 2002.

111111111222222222 333333333

444444444555555555 666666666 777777777

888888888101010101010101010

999999999111111111111111111

121212121212121212

131313131313131313

141414141414141414

151515151515151515

161616161616161616

171717171717171717

181818181818181818

191919191919191919 202020202020202020

212121212121212121

222222222222222222232323232323232323 242424242424242424

252525252525252525

262626262626262626

272727272727272727

282828282828282828

292929292929292929

303030303030303030 313131313131313131

323232323232323232333333333333333333

343434343434343434353535353535353535

363636363636363636

373737373737373737

383838383838383838393939393939393939

404040404040404040414141414141414141

424242424242424242

434343434343434343

444444444444444444454545454545454545

464646464646464646

474747474747474747

484848484848484848 494949494949494949505050505050505050

515151515151515151

525252525252525252

535353535353535353

545454545454545454

555555555555555555

565656565656565656

575757575757575757

585858585858585858595959595959595959616161616161616161

606060606060606060626262626262626262

636363636363636363

646464646464646464656565656565656565

666666666666666666

676767676767676767

686868686868686868696969696969696969

707070707070707070

717171717171717171

727272727272727272 737373737373737373 747474747474747474 757575757575757575

767676767676767676

777777777777777777

787878787878787878

797979797979797979

808080808080808080

818181818181818181828282828282828282

838383838383838383848484848484848484

858585858585858585

868686868686868686

878787878787878787

888888888888888888

898989898989898989

909090909090909090

919191919191919191929292929292929292

939393939393939393949494949494949494

959595959595959595 969696969696969696

Exceptional Care. Remarkable Services. Extraordinary Grady.

Contributing FactorsMedical Education System

Pursuit of medical careers facing challengesEducation debt of

students can be substantial – with 40% of GA students having debt of $80,000 or higher

This could disproportionately impact rural Georgia – debt service will remain the same yet incomes drop when physician practice in rural settings.

Amount of Debt Number of Respondents

Percentage of Respondents

None 135 35.81%

Educational Debt of Survey Respondents

Less than $20,000 7 1.86%$20,000-$39,999 21 5.57%$40,000-$59,999 25 6.63%$60,000-$79,999 30 7.96%$80,000-$99,999 32 8.49%$100,000-$124,999 47 12.47%$125,000-$149,999 14 3.71%$150,000-$199,999 35 9.28%Over $200,000 31 8.22%TOTAL Respondents 377 100%

Exceptional Care. Remarkable Services. Extraordinary Grady.

Contributing FactorsMedical Marketplace

Reductions in reimbursement from public payer systems have been substantialCombination of state and federal cuts have reduced payments

to physicians for their servicesMedicaid reimbursements do not cover physicians’ costsImpact in cuts in public programs disproportionately impacts

rural physicians

Exhibit 16Percent Accepting Medicaid

Georgia, 1992 - 2002

83.184.6

86.285.3 85.4

77.3

76788082848688

1992 1994 1996 1998 2000 2002

Exhibit 17Percent Accepting Medicare

Georgia, 1992 - 2002

76.5

80.9

84.2 84.685.4

78.3

76

78

80

82

84

86

88

1992 1994 1996 1998 2000 2002

Exceptional Care. Remarkable Services. Extraordinary Grady.

Grady Health System

Grady Memorial Hospital (953 beds)Hughes Spalding Children’s Hospital (84 beds)Crestview Nursing Facility (388 beds)9 Primary Care Health Centers1 Airport Health CenterGrady EMS (Ambulances)Infectious Disease Center (Ponce de Leon)

Exceptional Care. Remarkable Services. Extraordinary Grady.

Services:

Level 1 Trauma CenterBurn CenterEmergency Care CenterDiabetes detection and control centerGeorgia Poison Control CenterCancer CenterRegional Perinatal CenterRape Crisis CenterSickle Cell CenterRegional Neonatal ICUHospice

Exceptional Care. Remarkable Services. Extraordinary Grady.

Inadequate access

1. Lack of availability of any needed services

2. Financial Barriers to access

3. Poor quality of the care accessed

4. Lack of the knowledge necessary to access care

5. Poor coordination of the care being accessed

6. Other barriers to access

Exceptional Care. Remarkable Services. Extraordinary Grady.

Lack of availability

1. Self Pay

2. Losses on Medicare

3. Losses on Medicaid

Exceptional Care. Remarkable Services. Extraordinary Grady.

Sources of Revenue

44%

14%

17%

8%

2%

13%2%

MedicaidMedicareCountyInsuranceSelf PayGrantsOther

Exceptional Care. Remarkable Services. Extraordinary Grady.

Government Payments to Grady

Medicaid Payment for Inpatient & Outpatient Services Covers About 80% of Costs

Medicare payment is about 80% of costs for NAPH members (2002). This takes into account DSH and IME funds.

2 Counties pay between 35-60% of costs

Exceptional Care. Remarkable Services. Extraordinary Grady.

Medicaid Cuts FY 2006

The FY06 State budget contains targeted cuts of $130 million to the Medicaid program.

The impact to Grady health System is $8.18 million.

Managed Medicaid

1. Decreased facility fees for hospital-based freestanding clinics,

2. Decreased reimbursement for ambulatory surgery provided in hospital outpatient setting

3. Reduction reimbursement for costly outliers.

Exceptional Care. Remarkable Services. Extraordinary Grady.

Comparison of County Contributions to Total Operating Expenses($ millions)

25

.8

25

.1

23

.9

22

.5

22

.0

22

.0

22

.8

21

.5

22

.4

21

.4

21

.18

2.0 10

3.2

87

.9

82

.54

83

.12

76

.8

75

.7

75

.8

75

.3

73

.6

72

.8

78

.611

3.7

10

7.6

10

7.0

99

.3

97

.7

97

.8

98

.0

95

.0

95

.2

10

0.0

346.3375.7

389.1 396.9416.2

448.8474.0 470.0

520.2

589.7629.0

$0

$100

$200

$300

$400

$500

$600

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002$0

$100

$200

$300

$400

$500

$600

$700

DeKalb Fulton Total Contributions Expenses Indigent Cost

Exceptional Care. Remarkable Services. Extraordinary Grady.

Trauma.

Trauma total for 2002 (Grady) Disch LOS CHgs Cost Reimb Loss

Fulton 2,112 8.16 43.7M 29.7M 18.2M (11.5)Dekalb 727 8.01 14.8M 10M 6M (4M)Others 1,126 9.38 36.7M 25M 16.4M (8.5M)

Total 3,965 8.48 95M 64.6M 40.7M (24 M)

Exceptional Care. Remarkable Services. Extraordinary Grady.

Grady Health System Net Patient Service Revenue Payer Mix

Self-Pay45%

Medicare16%Insurance

4%

Medicaid27%

Medicaid Pending8%

2003 Net Revenue Payer Mix

Source: Audited financial statements for 2003, June 2004 GHS Finance

Exceptional Care. Remarkable Services. Extraordinary Grady.

The ICTF

0

50

100

150

200

250

300

Mil

lio

ns

SFY 2000 SFY 2001 SFY 2002 SFY 2003

Net DSH For GA Grady DSH Limit Grady Net DSH

Exceptional Care. Remarkable Services. Extraordinary Grady.

$30.6

($12.8)

($17.1)

$20.3

($19.6)

($6.4)

($33.4)

($21.0)

($7.0)

($40) ($30) ($20) ($10) $0 $10 $20 $30 $40

1996

1997

1998

1999

2000

2001

2002

2003E

2004E

Grady received $30.8Min unrestricted one-time DSH Funds in 1996

Negative Margin

Net Income/(Loss) by Fiscal Year ($ millions)

Source: Audited Financial Statements 1996-2001, 2002 audited Financial Statements

Grady received $39.6Min unrestricted one-time DSH Funds in 1999

Exceptional Care. Remarkable Services. Extraordinary Grady.

Lack of availability of services

Emergency Department as Medical Home

Exceptional Care. Remarkable Services. Extraordinary Grady.

Capital Needs

Some Examples:Children’s hospital Renovation ($30M)Nursing home Renovation Project ($22M) Information Systems Upgrade ($50-75 M) Pharmacy Renovation Project ($4M) Labor and Delivery Renovation Project ($2.5M)Burn Unit Endowment ($5M)

Exceptional Care. Remarkable Services. Extraordinary Grady.

Inadequate access

Quality

1. Cultural competence

2. Customer service

3. Poor coordination of the care

Exceptional Care. Remarkable Services. Extraordinary Grady.

Inadequate access

Other Barriers

1. Transport

2. Language Barriers

3. Education and literacy

Exceptional Care. Remarkable Services. Extraordinary Grady.

Thoughts

Goals

1. Quality

2. Efficiency

3. Stable funding

1. Safety Net Providers not Insurers

2. Collaborate

3. Focus on providing a quality service

4. Competition where necessary to grow revenues

5. Manage Care efficiently