2013 Graduate Medical Exit Survey Report Indiana University School of...

2013 Graduate Medical Exit Survey ReportIndiana University School of Medicine

Produced by:

Bowen Research Center, Department of Family MedicineIndiana University School of Medicine

In collaboration with:

Office of Graduate Medical EducationIndiana University School of Medicine

July 2014

Authors:Komal Kochhar, MBBS, MHABryce Buente, BAPeter Nalin, MD, FAAFPMichelle Howenstine, MDSharmin Bruen, MSM

2013 Graduate Medical Exit Survey Report

Indiana University School of Medicine

July 2014

Produced by:

Bowen Research Center

Department of Family Medicine

Indiana University School of Medicine

Komal Kochhar, MBBS, MHA

Bryce Buente, BA

Office of Graduate Medical Education

Peter Nalin, MD, FAAFP

Michelle Howenstine, MD

Sharmin Bruen, MSM

Copyright 2014 The Trustees of Indiana University.

ACKNOWLEDGEMENTS

At Indiana University School of Medicine (IUSM), many dedicated individuals provided

valuable participation to make this annual survey project and its report a success. We would like

to thank the IUSM Office of Graduate Medical Education (GME) for its insightful guidance and

support for this project.

In addition, we would like to thank the program directors and program coordinators for

their leadership assistance and participation. We would also like to thank the residents and

fellows who completed this exit survey as they were concluding their residency and fellowship

training at Indiana University.

Lastly, we would like to extend our sincere thanks to all those who support Graduate

Medical Education throughout our many affiliated institutions, whose dedication, quality and

commitment contribute to the program successes presented in this report.

Bowen Research Center

Komal Kochhar, MBBS, MHA

Bryce Buente, BA

Office of Graduate Medical Education

Peter Nalin, MD, FAAFP

Michelle Howenstine, MD

Sharmin Bruen, MSM

Copyright 2014 The Trustees of Indiana University. 2 | P a g e

TABLE OF CONTENTS

Acknowledgements 2

Table of Contents 3

Executive Summary 4

Chapter 1: Introduction 8

Chapter 2: Methods 9

Chapter 3: All Respondents 10

Chapter 4: Primary Care and Non-Primary Care Respondents 28

Chapter 5: Resident and Fellow Respondents 49

Chapter 6: Those Intending to Stay within Indiana or Go Out of State to Practice 70

Chapter 7: Male and Female Respondents 91

Chapter 8: Trending Patterns, 2008-2013 112

Chapter 9: Distribution of Graduates’ Practice Location using GIS Maps 122

Appendix 1: 2013 IUSM GME Exit Survey 124


EXECUTIVE SUMMARY

Background To plan effective healthcare workforce development initiatives, it is important to

understand the reasons why the Indiana University School of Medicine residency and fellowship graduates choose to practice in specific locations. This study documented the proportion of residency and fellowship graduates in 2013 that were planning to practice in areas of need in Indiana. The 2013 Graduate Medical Education Exit Survey identified factors affecting graduates’ choice of practice location and gathered feedback on their self-rated level of competency training to serve the rural and underserved populations; assessment of their training program and the six Accreditation Council for Graduate Medical Education (ACGME) competency areas. Methods

A cross-sectional survey of individuals completing graduate medical education programs at IUSM was conducted in 2013. The survey used a group-administered questionnaire, as well as an electronic questionnaire to obtain respondents’ demographic characteristics, reactions to their residency training, and their plans after graduation, including where they intended to practice and why they chose that location. A total of 417 graduates were invited to participate on the survey, of which 300 responded, yielding a 71.9% response rate.

Of those who responded to the survey, 155 indicated they planned to go into “patient care or clinical practice” after graduation. Of those 155 graduates, 32 were in a primary care specialty, 123 were in a non-primary care specialty, 98 were completing a residency training program, 57 were completing a fellowship training program, 72 were intending to stay within Indiana to practice, 67 were intending to practice out-of-state, 87 were male, and 68 were female. Results

Over three-fourths of the respondents were between the ages of 30 and 39 years. Nearly two-fifths of the respondents were female. Over three-fourths of the respondents were white, followed by over one-tenth that indicated they were Asian. Less than one-tenth of the respondents were of Hispanic or Latino ethnicity. Over four-fifths of the respondents indicated they were from the United States; of whom over one-half indicated that Indiana was not their home state prior to their current training program. And, less than one-fifth indicated that they were from another country. Over one-third of the respondents indicated having a hometown in Indiana. And, one-third reported that they graduated from a high school, college, or medical school in Indiana.

Over four-fifths of the respondents “strongly agree” or “agree” that the residency or fellowship training program was helpful in preparing them for their board exam. Nearly all of the respondents felt “fully” competent in patient care, interpersonal and communication skills, and professionalism. Over four-fifths felt “fully” competent in medical knowledge, practiced-based learning and improvement, and systems-based practice. Over one-half of the respondents indicated they had received training to serve the rural populations. A majority of the respondents


indicated they had received training to serve the underserved populations. Three-fourths of the respondents indicated they felt “fully” competent in providing care to rural populations. Nearly all indicated they felt “fully” competent in providing care to underserved populations.

Nearly all respondents indicated that they were part of a multidisciplinary inter-professional team and able to utilize electronic health records to provide care to patients. About three-fourths of the respondents participated in quality improvement projects to improve health outcome, while over one-half of the respondents participated in patient safety projects. Over four-fifths of the respondents indicated the quality of their training program was “excellent” or “above average.” Over four-fifths of the respondents “strongly agree” or “agree” that faculty and other residents or fellows in their training program exceeded their expectations.

Over one-half of the respondents planned to be clinical practitioners, over one-fourth planned to continue their training, and nearly one-fifth planned to work in an academic setting (teaching and/or research). Nearly all of the respondents indicated they will be working full-time. Over one-fifth of the respondents indicated having no educational debt (individual or a total household). Over three-fifths of the respondents had an educational debt load of $100,000 or more, while nearly two-fifths had an educational debt of $200,000 or more.

Nearly three-fifths of the respondents reported entering a group practice. Over one-fourth intended to practice in a hospital setting (inpatient, ambulatory care, or emergency department). Nearly all of the respondents indicated that they will be working full-time in direct patient-care activities. Of those intending to work full-time, nearly one-fourth of the respondents expected to earn between $200,000 and $249,999 and two-fifths expected to earn $250,000 or more. Almost one-half of the respondents planned to practice outside Indiana. Over one-half of the respondents indicated receiving three or more offers for employment. Of those intending to practice in Indiana, over one-fourth of the respondents indicated receiving three or more offers for employment. Almost three-fourths of the respondents indicated there were “many” or “some” job opportunities available within their specialties in Indiana.

The top three reasons given by respondents for choosing to practice at this location were: “liked the people,” “met my personal needs or preferences,” and “met my professional needs or preferences.” Of those intending to practice in Indiana, the top three reasons given for choosing to practice in Indiana were: “cost of practicing reasonable in Indiana,” “salary or compensation,”, and “proximity to my spouse’s family.” Of those intending to practice outside Indiana, the top three reasons given for choosing not to practice in Indiana were: “proximity to my family,” “proximity to my spouse’s family,” and “lack of job opportunities in Indiana.” Of those going into clinical care with no visa obligation, over one-half (52.9%) of the respondents indicated that they will either be located in a designated MUA/HPSA or expect to serve a substantial proportion (greater than 50%) of patients from underserved populations in their new practice. Primary Care versus Non-Primary Care The chi-square test of association between the two groups was statistically significant: Non-primary care respondents were more likely to be between ages of 30 to 39 years. Primary care respondents were more likely to be female.


Primary care respondents were more likely to report participating in a quality improvement project.

Primary care respondents were more likely to report participating in a patient safety project. Primary care respondents were more likely to agree that faculty in their program had

exceeded their expectations. Non-primary care respondents expected to earn more during the first year of practice. Non-primary care respondents were more likely to move outside Indiana to practice. Non-primary care respondents were more likely to practice at this location due to proximity

to family. Residents versus Fellows The chi-square test of association between the two groups was statistically significant: Fellows were more likely to be between 30 and 39 years of age. Residents were more likely to have received training to serve the underserved population. Fellows were more likely to report participating in a quality improvement project. Fellows were more likely to accept an academic position (teaching or research) after

completing their training. Residents were more likely to have an educational debt of $200,000 or more. Fellows were more likely to work part-time in patient-care activities. Fellows were more likely to practice out-of-state. Residents were more likely to report that “many” jobs were available within their specialty in

Indiana. Residents were more likely to practice at this location due to proximity to family. Residents were more likely to practice in Indiana due to cost of practicing being reasonable

and proximity to their families; while fellows were more likely to practice in Indiana due to the climate.

Residents were more likely to practice outside Indiana due to proximity to their families; while fellows were more likely to practice outside Indiana due to lack of jobs and other reasons.

Those Staying Within Indiana to Practice versus Those Going Out-Of-State The chi-square test of association between the two groups was statistically significant: Out-of-state respondents were more likely to be male. Out-of-state respondents were more likely to be Asian; while those intending to practice

within Indiana were more likely to be white. Out-of-state respondents were more likely to be from outside Indiana or another country. In-state respondents were more likely to indicate they had received training to serve the

underserved populations. Out-of-state respondents were more likely to work part-time in patient care activities. In-state respondents were more likely to report there were “many” or “some” job

opportunities available in Indiana.


Out-of-state respondents were more likely to practice at this location due to proximity to recreation and climate.

Male versus Female The chi-square test of association between the two groups was statistically significant: Male respondents were more likely to participate in a patient safety project. Male respondents were more likely to report they expect to earn $200,000 or more during

their first year of practice. Male respondents were more likely to practice in another state. Female respondents were more likely to report they had “some jobs” available. Male respondents were more likely to practice at this location due to salary or compensation,

proximity to recreation, and climate. Male respondents were more likely to practice outside Indiana because of lack of jobs in the

state, while female respondents were more likely to practice outside Indiana due to “other” reasons.

Trends Data has been compared from 2008 to 2013 to determine any trends or shifts: An increasing trend is noted in: International students graduating from the IUSM residency and fellowship programs “Fully” competent in self-rated ACGME competency areas Those going into an “academic” position (teaching and/or research) Those with an education debt of $250,000 or more Those who expect to earn between $200,000 and $299,999 during their first year of practice Those who expect to earn $400,000 or more during their first year of practice Those who indicated receiving 1 to 2 job offers all together Those who indicated receiving 1 to 2 job offers in Indiana Those reporting “no jobs” within their specialty in Indiana A declining trend is noted in: Those planning to go into “patient care or clinical practice” after completing their training Those indicating there were “many jobs” available Maps

The distribution of clinical care respondents’ practice location was mapped using Arc GIS software, v10.2: The clinical care respondents were dispersed over 27 states. Of whom, over one-half

practiced in Indiana. The clinical care respondents were dispersed over 18 counties in Indiana. Of whom, one-half

intended to practice in Marion county.


CHAPTER 1: INTRODUCTION

Indiana University School of Medicine regularly collects information regarding medical

students’ plans after graduation. However, due to the shortage and mal-distribution of

physicians in Indiana, understanding where the IUSM residents and fellows go after completing

their training, and understanding the factors that affect those decisions has become very

important. For the past six years, Bowen Research Center has been preparing reports for IUSM

to help track this information to have a better understanding of the trends. This report will be a

valuable contribution to help policymakers improve efforts to recruit and retain physicians in

areas of need in Indiana.

The 2013 Graduate Medical Education Exit survey marks the sixth consecutive year of

determining what physicians are planning to do after graduation, and more specially, for those

primarily planning to provide clinical care, where they were planning to practice. An additional

objective was to assess their opinions of job availabilities in Indiana, why they chose specific

locations to work, and for those leaving Indiana, why they decided not to practice in the state. A

final objective was to obtain feedback on their training and curricula, specifically suggestions

and ideas for improvement.

In addition, this report provides an assessment of performance based on the six

competency areas (namely, patient care, medical knowledge, practice based learning and

improvement, interpersonal and communication skills, professionalism, and systems-based

practice) in order to address the Accreditation Council for Graduate Medical Education’s

Outcome Project that has been designed to support programs in the implementation of

competencies in their curricula.

The next chapter describes the methodology used for this study. Chapters 3 to 7

summarize results of the 2013 IUSM Graduate Medical Education Exit Survey. Chapter 8

describes the trends over the past six years when the survey was administered. Lastly, Chapter 9

shows the distribution of practice locations of the clinical care respondents throughout the United

States and within Indiana using a GIS mapping software.


CHAPTER 2: METHODS

For the purpose of this project, a survey instrument was designed and a protocol was

developed by the Indiana University Bowen Research Center (BRC) in collaboration with IUSM

Office of Graduate Medical Education (GME). The survey instrument measured the

respondents’ (both residents and fellows) plans after graduation, where they intended to practice

and why they chose that location, the number of employment offers received, practice

opportunities within the state, and assessment of their training program. A copy of the survey

instrument is included in Appendix 1.

An exempt approval was obtained from the IUPUI Institutional Review Board in

December 2012 and the survey was conducted between January 1 and December 31, 2013.

Paper survey instruments were provided for each department within IUSM to be administered in

group settings. In addition, an electronic survey tool, Survey Monkey®, was used to collect

responses from individuals who did not respond to the paper instrument. The staff of the GME

office facilitated the paper and electronic survey administration, while the BRC team performed

the scanning, verification of completed questionnaires, data analysis, and generation of this

report. All data files were kept in a secure and protected database.

Survey instruments were distributed to all accredited graduate medical education

programs to be administered to 417 residents and fellows graduating from IUSM in the 2013

calendar year. A total of 300 graduates completed the survey, yielding a 71.9% response rate.

Out of a total of 300 graduates who responded to the survey, 155 (51.7%) responded they

planned to go into “patient care or clinical practice” after graduation. Responses from those

going into patient care or clinical practice were further analyzed based on: a] type of specialty-

primary care (n=32) or non-primary care (n=123); b] type of program- residents (n=98) or

fellows (n=57); c] those intending to move out-of-state (n=67) or stay within Indiana to practice

(n=72); and, d] gender– male (n=87) or female (n=68). Chi-square tests were used to compare

the responses between groups. P-values less than 0.05 were considered statistically significant.

SPSS Version 20 was used to perform all of the statistical analyses. A mapping software,

ArcGIS v10.2, was used to show the graduates’ choice of practice location within Indiana and

the United States.


CHAPTER 3: ALL RESPONDENTS

The data shown in tables 3.1 to 3.14 and figures 3.1 to 3.3 are based on responses from

all 300 graduates participating in this survey. The remaining tables and figures show responses

from only those graduates who indicated that they planned to work in “patient care or clinical

practice” after graduation (n=155).

All Respondents (n=300)

Age Table 3.1 All Respondents (n=300)

Age Number Percent 25-29 51 17.0 30-34 190 63.3 35-39 39 13.0 40-44 13 4.3 45-49 4 1.3 >50 3 1.0 Total 300 100.0 Missing 0

Table 3.1 shows the age distribution of all graduates who responded to the survey. Over

three-fourths (76.3%) of the respondents were between the ages of 30 and 39 years.

Gender

Table 3.2 All Respondents (n=300) Gender Number Percent Male 185 61.7 Female 115 38.3 Total 300 100.0 Missing 0

Table 3.2 shows the gender distribution of all graduates who responded to the survey.

Nearly two-fifths (38.3%) of the respondents were female.


Race Table 3.3 All Respondents (n=300)

Race Number Percent American Indiana/ Native Alaskan 0 0.0 Asian 43 15.0 Black/African American 11 3.8 Native Hawaiian/ Pacific Islander 1 0.3 White 216 75.5 Other 15 5.2 Total 286 100.0 Missing 14

Table 3.3 shows the racial distribution of all graduates who responded to the survey.

Over three-fourths (75.5%) of the respondents were white, followed by over one-tenth (15.0%)

that indicated they were Asian.

Ethnicity

Table 3.4 All Respondents (n=300) Ethnicity Number Percent Hispanic or Latino 14 5.0 Not Hispanic or Latino 266 95.0 Total 280 100.0 Missing 20

Table 3.4 shows the ethnicity of all graduates who responded to the survey. Less than

one-tenth (5.0%) of the respondents were of Hispanic or Latino ethnicity.

Home state prior to training

Table 3.5 All Respondents (n=300) What do you consider to be your home state? Number Percent Outside USA 47 15.8 Within USA 250 84.2 Outside Indiana 137 54.8 Within Indiana 113 45.2 Total 297 100.0 Missing 3

Table 3.5 shows what the graduates’ considered their home-state prior to their current

training program. Three graduates did not respond to this question. Of the remaining 297

graduates who responded, over four-fifths (84.2%) of the respondents indicated they were from


the United States; of whom over one-half (54.8%) indicated that Indiana was not their home state

prior to their current training program. And, less than one-fifth (15.8%) indicated that they were

from another country.

Respondents from Indiana

Table 3.6 All Respondents (n=300) Respondents who have an Indiana… Number Percent Hometown 113 38.0 High School 96 33.2 College 97 33.9 Medical School 96 33.1

Table 3.6 shows the graduates’ who reported having an Indiana hometown or graduated

from a high school, college, or medical school in Indiana. Over one-third (38.0%) of the

respondents indicated having a hometown in Indiana. And, one-third reported that they

graduated from a high school (33.2%), college (33.9%), or medical school (33.1%) in Indiana.

Training program

Table 3.7 All Respondents (n=300) The residency or fellowship training program was helpful in the preparation for my board exams. Number Percent Strongly Agree 93 34.2 Agree 145 53.3 Neutral 27 9.9 Disagree 4 1.5 Strongly Disagree 3 1.1 Total 272 100.0 Missing/Board exam in my field does not exist 28

Table 3.7 shows the graduates’ assessment of how helpful the residency or fellowship

training program was in preparing them for their board exam. Over four-fifths (87.5%) of the

respondents “strongly agree” or “agree” that the residency or fellowship training program was

helpful in preparing them for their board exam.


ACGME competency areas Table 3.8 All Respondents (n=300)

How competent do you feel in the following ACGME competencies?

Fully Partially Not at all Number Percent Number Percent Number Percent

Patient Care 277 97.2 6 2.1 2 0.7 Medical Knowledge 249 88.9 28 10.0 3 1.1 Practice-based learning and improvement 265 91.7 21 7.3 3 1.0 Interpersonal and Communication skills 277 97.5 4 1.4 3 1.1 Professionalism 275 96.8 6 2.1 3 1.1 Systems-based practice 251 91.3 19 6.9 5 1.8

Table 3.8 shows the graduates’ self-rated competency level in the Accredited Council for

Graduate Medical Education (ACGME) competency areas. Nearly all of the respondents felt

“fully” competent in patient care (97.2%), interpersonal and communication skills (97.5%), and

professionalism (96.8%). Over four-fifths felt “fully” competent in medical knowledge (88.9%),

practiced-based learning and improvement (91.7%), and systems-based practice (91.3%).

Rural and underserved training

Table 3.9a All Respondents (n=300)

In your residency or fellowship program, did you receive training to serve the:

Yes No

Number Percent Number Percent Rural population 155 53.8 133 46.2 Underserved population 257 90.5 27 9.5

Table 3.9a shows whether the graduates’ received training to serve the rural and

underserved populations during their training program. Over one-half (53.8%) of the

respondents indicated they had received training to serve the rural populations. A majority

(90.5%) of the respondents indicated they had received training to serve the underserved

populations.

Competency in providing care to the rural and underserved populations

Table 3.9b All Respondents (n=300) How competent do you feel providing care to the:

Fully Partially Not at all Number Percent Number Percent Number Percent

Rural population 215 75.4 61 21.4 9 3.2 Underserved population 267 95.4 11 3.9 2 0.7


Table 3.9b shows the graduates’ self-rated competency levels in providing care to the

rural and underserved populations. Three-fourths (75.4%) of the respondents indicated they felt

“fully” competent in providing care to rural populations. Nearly all (95.4%) indicated they felt

“fully” competent in providing care to underserved populations.

Program opportunities Table 3.10 All Respondents (n=300)

In the current academic year, did you:

Yes No

Number Percent Number Percent Have an opportunity to be part of a multidisciplinary inter-professional team to provide care 275 95.8 12 4.2 Participate in a quality improvement project to improve health outcome 215 74.1 75 25.9

Participate in patient safety project 154 53.8 132 46.2 Utilize electronic health records, including order entry and progress notes, in the direct care of patients 276 98.6 4 1.4

Table 3.10 shows if there were any opportunities available for the graduates’ to

participate in the current academic year. Nearly all respondents indicated that they were part of a

multidisciplinary inter-professional team (95.8%) and able to utilize electronic health records

(98.6%) to provide care to their patients. About three-fourths (74.1%) of the respondents

participated in quality improvement projects to improve health outcome. Over one-half of the

respondents (53.8%) participated in patient safety projects.

Quality of program Table 3.11 All Respondents (n=300)

I would rate the overall quality of my residency or fellowship program as: Number Percent Excellent 163 56.4 Above Average 84 29.1 Average 23 8.0 Below Average 8 2.8 Extremely Poor 11 3.8 Total 289 100.0 Missing 11


Table 3.11 shows the graduates’ overall rating of the quality of their residency or

fellowship training program. Over four-fifths (85.5%) of the respondents indicated the quality of

their training program was “excellent” or “above average.” Less than one-tenth (6.6%) of the

respondents indicated that the quality of their program was “extremely poor” or “below

average.”

Faculty assessment

Table 3.12 All Respondents (n=300) I would rate the overall performance of the other faculty in my residency or fellowship program to have exceeded my expectations. Number Percent Strongly Agree 131 45.3 Agree 113 39.1 Neutral 37 12.8 Disagree 7 2.4 Strongly Disagree 1 0.3 Total 289 100.0 Missing 11

Table 3.12 shows the graduates’ overall performance rating of faculty in their training

program. Over four-fifths (84.4%) of the respondents “strongly agree” or “agree” that faculty in

their training program exceeded their expectations. Over one-tenth (12.8%) of the respondents

remained “neutral.”

Other trainees’ assessment

Table 3.13 All Respondents (n=300) I would you rate the overall performance of the other residents/fellows in my residency or fellowship program to have exceeded my expectations. Number Percent Strongly Agree 98 34.6 Agree 148 52.3 Neutral 32 11.3 Disagree 5 1.8 Strongly Disagree 0 0.0 Total 283 100.0 Missing 17

Table 3.13 shows the graduates’ overall performance rating of other residents or fellows

in their training program. Over four-fifths (86.9%) of the respondents “strongly agree” or

“agree” that the other residents or fellows exceeded their expectations. Over one-tenth (11.3%)

of the respondents remained “neutral.”


Plans after graduation Table 3.14a All Respondents (n=300)

What do you expect to be doing after completion of your current training program? Number Percent Patient care or clinical practice (in Non-training position) 155 51.7 Fellowship or Additional Subspecialty Training 83 27.7 Academic position (Teaching and/or research) 51 17.0 Temporarily out of medicine 0 0.0 Military 1 0.3 Industry 0 0.0 Other 6 2.0 Undecided or don't know yet 4 1.3 Total 300 100.0 Missing 0

Table 3.14a shows what the graduates’ expect to do after completing their current

training program. Over one-half of the respondents (51.7%) planned to be clinical practitioners,

over one-fourth (27.7%) planned to continue their training, and nearly one-fifth (17.0%) planned

to work in an academic setting (teaching and/or research).

Work status

Table 3.14b All Respondents (n=300) After your current graduation, do you expect to be working full-time or part-time? Number Percent Full-time 276 94.8 Part-time 15 5.2 Total 291 100.0 Missing 9

Table 3.14b shows how much time graduates plan to be working after completion of their

current program. Nearly all (94.8%) of the respondents indicated they will be working full-time.

Of those working part-time five indicated they would be working 30 hours per week and eight

planned to be working less than 30 hours per week. Two respondents did not indicate their part

time hours.


Current educational debt

Figure 3.1 presents the current level of educational debt among the graduates who

responded to the survey. Over one-fifth (23.4%) of the respondents indicated having no

educational debt. Over three-fifths (63.2%) of the respondents had an educational debt load of

$100,000 or more. Nearly two-fifths (39.5%) of the respondents had an educational debt of

$200,000 or more.

23.4

5.5 7.9

10.0 13.7

21.3 18.2

0

5

10

15

20

25

30

35

40

45

50

Perc

ent o

f Res

pond

ents

(%)

Figure 3.1: Current Educational Debt



Current total household educational debt

Figure 3.2 presents the current level of total household educational debt among the

graduates who responded to the survey. One-fifth (19.9%) of the respondents indicated having

no educational debt in their household. Two-thirds (66.7%) of the respondents had a total

household educational debt load of $100,000 or more. Nearly one-half (48.8%) of the

respondents had a total household educational debt of $200,000 or more.

19.9

6.5 6.9 9.3 8.6

21.0

27.8

0

5

10

15

20

25

30

35

40

45

50

Perc

ent o

f Res

pond

ents

(%)

Figure 3.2: Current Total Household Educational Debt



Respondents Planning to Primarily Provide Patient or Clinical Care (n=155)

Type of practice

Table 3.15 Clinical Care Respondents (n=155) Which best describes the principal type of Patient Care Practice you will be entering? Number Percent Solo practice 5 3.8 Partnership (2 person) 6 4.5 Group Practice 77 57.9 Hospital‐inpatient 15 11.3 Hospital‐ambulatory care 13 9.8 Hospital‐emergency department 11 8.3 Free‐standing health center or clinic 4 3.0 Nursing Home 0 0.0 Other (specify) 2 1.5 Total 133 100.0 Missing 22

Table 3.15 shows the principal type of practice setting the graduate will be entering after

completing their training. Nearly three-fifths (57.9%) of the respondents reported entering a

group practice. Over one-fourth (29.4%) intended to practice in a hospital setting (inpatient,

ambulatory care, or emergency department).

Amount of direct patient-care activities Table 3.16 Clinical Care Respondents (n=155)

In your upcoming position, what amount of direct patient-care activities will you do? Number Percent No patient-care activities 1 0.7 Part-time patient-care activities 13 8.6 Full-time patient-care activities 137 90.7 Total 151 100.0 Missing 4

Table 3.16 shows the graduates’ expected amount of time spent in direct patient-care

activities. Nearly all (90.7%) of the respondents indicated that they will be working full-time in

direct patient-care activities.


Expected gross income

*Reflects responses from only those respondents who indicated intending to work full-time in patient care activities

Figure 3.3 presents the gross income that graduates expect to earn during their first year

of practice. Only those respondents who reported they intended to work full-time in direct

patient-care activities were included in this analysis.

Of those intending to work full-time, nearly one-fourth of the respondents (24.8%)

expected to earn between $200,000 and $249,999. Over four-fifths of the respondents (89.4%)

expected to earn $150,000 or more. Two-fifths of the respondents (41.6%) expected to earn

$250,000 or more.

0.0 2.7

8.0

23.0 24.8

14.2

7.1 8.8

5.3 2.7 3.5

0

5

10

15

20

25

30

35

40

45

50

Perc

ent o

f Res

pond

ents

(%)

Figure 3.3: Expected Gross Income*

Clinical Care Respondents (n=137)


Primary practice location

Table 3.17 Clinical Care Respondents

(n=155) Where is the location of your primary activity after completing your current training program? Number Percent Same city or county as current training 41 29.5 Same region in Indiana, but different city or county 12 8.6 Other area in Indiana 19 13.7 Other U.S. state (not Indiana) 67 48.2 Outside of U.S. 0 0.0 Total 139 100.0 Missing 16

Table 3.17 shows the location of the graduates’ primary activity after completion of their

training program. Almost one-half of the respondents planned to practice outside Indiana

(48.2%) as well as within Indiana (51.8%).

Job offers all together


(n=155) How many offers for employment/practice positions did you receive all together? Number Percent 0 1 0.8 1 27 21.1 2 34 26.6 3 34 26.6 4 13 10.2 5 or more 19 14.8 Total 128 100.0

Missing/ Did not seek employment positions at the time 27

Table 3.18 shows the total number of job offers the graduates’ received for employment

or practice positions. Over one-half of the respondents (51.6%) indicated receiving three or

more offers for employment.


Job offers in Indiana


(n=72)* How many offers for employment/practice positions did you receive in Indiana? Number Percent 0 1 1.6 1 20 31.3 2 24 37.5 3 15 23.4 4 3 4.7 5 1 1.6 Total 64 100.0 Missing/ Did not seek an employment position at the time 8

*Reflects responses from only those respondents who indicated their primary practice location was in Indiana

Table 3.19 shows the number of job offers the graduates’ received for employment or

practice positions in Indiana. Only those respondents who indicated their primary practice

location was in Indiana were included in the analysis.

Of those intending to practice in Indiana, over one-fourth of the respondents (29.7%)

indicated receiving three or more offers for employment.


Opportunities in Indiana

Figure 3.4 presents the overall assessment of practice opportunities for graduates within

their specialty in Indiana. Almost three-fourths (73.5%) of the respondents indicated there were

“many” or “some” job opportunities available within their specialties in Indiana. Over one-fifth

(23.5%) reported there were “few” or “very few jobs” available within their specialties in

Indiana.

29.7

43.8

14.1

9.4

3.1

0

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30

35

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45

50

Perc

ent o

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(%)

Figure 3.4: Overall Assessment of Practice Opportunities in Specialty in Indiana

Clinical Care Respondents (n=155)


Main reasons to practice at this location

Figure 3.5 shows the main reasons influencing graduates’ choice of practice location.

The top three reasons given by respondents for choosing to practice at this location were: “liked

the people” (61.9%), “met my personal needs or preferences” (56.8%), and “met my professional

needs or preferences” (51.6%).

1.9

5.8

9.7

13.5

16.1

26.5

38.7

43.2

51.6

56.8

61.9

0 10 20 30 40 50 60 70 80 90 100

Satisfy loan or scholarship requirement

Other

Climate

Proximity to recreation

Opportunity for my spouse

Proximity to my spouse's family

Proximity to family

Salary or compensation

Met my professional needs or preferences

Met my personal needs or preferences

Liked the people

Percent of Clinical Care Respondents (%)

Figure 3.5 Main Reasons to Practice at this Location (n=155)


Main reasons to practice in Indiana


Figure 3.6 presents the main reasons influencing graduates’ choice of practice location in

Indiana. Only those respondents who indicated their primary practice location was in Indiana

were included in this analysis.

Of those intending to practice in Indiana, the top three reasons given for choosing to

practice in Indiana were: “cost of practicing reasonable in Indiana” (47.2%), “salary or

compensation” (44.4%), and “proximity to my spouse’s family” (30.6%).

4.2

6.9

8.3

16.7

20.8

20.8

25.0

29.2

30.6

44.4

47.2

0 10 20 30 40 50 60 70 80 90 100


Climate

Relationship with my mentor

Rotation experience

Other

More job opportunities in IN

Always intended to practice in IN




Cost of practicing is reasonable in IN


Figure 3.6 Main Reasons to Practice in Indiana (n=72)*


Main reasons not to practice in Indiana

*Reflects responses from only those respondents who indicated their primary practice location was outside Indiana

Figure 3.7 presents the main reasons influencing graduates’ choice of practice location

outside Indiana. Only those respondents who indicated their primary practice location was

outside of Indiana were included in this analysis.

Of those intending to practice outside Indiana, the top three reasons given for choosing

not to practice in Indiana were: “proximity to my family” (43.3%), “proximity to my spouse’s

family” (34.3%), and “lack of job opportunities in Indiana” (29.9%).

1.5

3.0

7.5

13.4

19.4

25.4

25.4

29.9

34.3

43.3

0 5 10 15 20 25 30 35 40 45 50

Cost of practicing too high in IN

No opportunity for my spouse

Inadequate salary or compensation

Other


Climate

Never intended to practice in IN

Lack of jobs or practice opportunities in IN


Proximity to my family


Figure 3.7: Main Reasons Not to Practice in Indiana (n=67)*


Medically Underserved Area (MUA)/ Health Professions Shortage Area (HPSA) or Expected to Serve the Underserved Population

*Reflects responses from only those respondents who indicated they had no visa obligation

Figure 3.8 presents the graduates’ response for going to practice in the MUA/HPAS or

those expecting to serve the underserved population in their new practice. Only those clinical

care respondents who had no visa obligation were included in this analysis.

Of those going into clinical care with no visa obligation, over one-half (52.9%) of the

respondents indicated that they will either be located in a designated MUA/HPSA or expect to

serve a substantial proportion (greater than 50%) of patients from underserved populations in

their new practice.

51.5

25.2

52.9

0

10

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30

40

50

60

70

80

90

100

MUA/HPSA Expect to serve underservedpopulation

MUA/HPSA or servingunderserved population

Perc

ent o

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espo

nden

ts (%

)

Clinical Care Respondents w/ no Visa obligation (n=132)

Figure 3.8: MUA/HPSA or Expecting to Serve the Underserved Population*


CHAPTER 4: PRIMARY CARE AND NON-PRIMARY CARE RESPONDENTS

The survey respondents’ names were matched with their specialty and then classified into

two categories, primary care and non-primary. Primary care specialties included family

medicine, general internal medicine, general pediatrics, and medicine/pediatrics.

Of the 300 graduates who completed the survey, 56 were in primary care and 244 were in

a non-primary care specialty, as shown in tables 4.1 to 4.14 and figures 4.1 and 4.2. The

remaining tables and figures show responses from only those graduates who indicated that they

planned to work in ‘patient care or clinical practice’ after graduation: primary care (32) and non-

primary care (123).

To maintain chart clarity, percentage values have not been shown on the graphs. For this

report, the level of significance was set at α=0.05. All p-values less than or equal to 0.05 were

considered “statistically significant,” and are denoted with a symbol (ǂ).


Age

Table 4.1 Primary Care

(n=56) Non-Primary Care

(n=244) Age Number Percent Number Percent 25-29 24 42.9 27 11.1 30-34 27 48.2 163 66.8 35-39 3 5.4 36 14.8 40-44 1 1.8 12 4.9 45-49 1 1.8 3 1.2 >50 0 0.0 3 1.2 Total 56 100.0 244 100.0 Missing 0 0 Chi-square p-value =0.000ǂ

Table 4.1 shows the age distribution of primary and non-primary care graduates who

responded to the survey. Over one-half of the primary care (53.6%) and over four-fifths of the

non-primary care (81.6%) respondents were between the ages of 30 and 39 years. The chi-

square test of association between the two groups was statistically significant. Non-primary care

respondents were more likely to be between ages of 30 to 39 years.


Gender



(n=244) Gender Number Percent Number Percent Male 25 44.6 160 65.6 Female 31 55.4 84 34.4 Total 56 100.0 244 100.0 Missing 0 0 Chi-square p-value =0.004ǂ

Table 4.2 shows the gender distribution of primary care and non-primary care graduates

who responded to the survey. Over one-half (55.4%) of primary care and over one-third (34.4%)

of non-primary care respondents were female. The chi-square test of association between the

two groups was statistically significant. Primary care respondents were more likely to be female.

Race



(n=244) Race Number Percent Number Percent American Indiana/ Native Alaskan 0 0.0 0 0.0 Asian 6 11.1 37 15.9 Black/African American 3 5.6 8 3.4 Native Hawaiian/ Pacific Islander 0 0.0 1 0.4 White 40 74.1 176 75.9 Other 5 9.3 10 4.3 Total 54 100.0 232 100.0 Missing 2 12 Chi-square p-value =0.593

Table 4.3 shows the racial distribution of primary and non-primary care graduates who

responded to the survey. Almost three-fourths of the primary care (74.1%) and non-primary care

(75.9%) respondents were white. Over one-tenth of primary care (11.1%) and non-primary care

(15.9%) respondents were Asian. There was no statistically significant difference between

groups.


Ethnicity



(n=244) Ethnicity Number Percent Number Percent Hispanic or Latino 5 9.1 9 4.0 Not Hispanic or Latino 50 90.9 216 96.0 Total 55 100 225 100.0 Missing 1 19 Chi-square p-value =0.076

Table 4.4 shows the ethnicity of primary and non-primary care graduates who responded

to the survey. Less than one-tenth of primary care (9.1%) and non-primary care (4.0%)

respondents indicated having a Hispanic ethnicity. There was no statistically significant

difference between groups.




(n=244) What do you consider to be your home state prior to your current training program? Number Percent Number Percent Outside USA 14 25.0 33 13.7 Within USA 42 75.0 208 86.3 Outside Indiana 23 41.1 114 47.3 Within Indiana 19 33.9 94 39.0 Total 56 100.0 241 100.0 Missing 0 3 Chi-square p-value = 0.113

Table 4.5 shows what the primary care and non-primary care respondents considered

their home-state prior to their current training program. One-fourth (25.0%) of the primary care

and over one-tenth of the non-primary care (13.7%) respondents were from another country. Of

the respondents who were from the United States, over two-fifths of primary care (41.1%) and

non-primary care (47.3%) respondents were from outside Indiana. There was no statistically

significant difference between groups.





(n=244) Respondents who have an Indiana… Number Percent Number Percent Hometown 19 33.9 94 39.0 High School 19 34.5 77 32.9 College 18 32.7 79 34.2 Medical School 18 33.3 78 33.1

Table 4.6 shows the primary care and non-primary care respondents who reported having

an Indiana hometown, or who graduated from high school, college, or medical school in Indiana.

Over one-third of primary care (33.9%) and non-primary care (39.0%) respondents indicated

having a hometown in Indiana. About one-third of the primary care respondents reported

graduating from a high school (34.5%), college (32.7%), or medical school (33.3%) in Indiana;

which was similar to the non-primary care respondents who indicated they graduated from a high

school (32.9%), college (34.2%), or medical school (33.1%) in Indiana.

Training program



(n=244) The residency or fellowship training program was helpful in the preparation for my board exam? Number Percent Number Percent Strongly Agree 14 25.0 79 36.6 Agree 36 64.3 109 50.5 Neutral 5 8.9 22 10.2 Disagree 1 1.8 3 1.4 Strongly Disagree 0 0.0 3 1.4 Total 56 100.0 216 100.0 Missing/ Board Exam in my field does not exist 0 28 Chi-square p-value=0.189

Table 4.7 shows the primary care and non-primary care respondents’ assessment of how

helpful their training was in preparing them for the board exams. Over four-fifths of the primary

care (89.3%) and non-primary care (87.1%) respondents “strongly agree” or “agree” that their

training was helpful in preparing them for their board exams. There was no statistically



ACGME competency areas Table 4.8

How competent do you feel in the following competencies?

Primary Care (n=56)

Non-Primary Care (n=244)

Patient care Percent Percent p-value Fully 98.2 96.9

0.767 Partially 1.8 2.2 Not at all 0.0 0.9

Medical knowledge Percent Percent p-value Fully 81.5 90.7


Practice-based learning and improvement Percent Percent p-value Fully 87.5 92.7


Interpersonal and communication skills Percent Percent p-value Fully 100.0 96.9


Professionalism Percent Percent p-value Fully 98.2 96.5


System based practice Percent Percent p-value Fully 94.3 90.5


Table 4.8 shows the primary care and non-primary care respondents’ self-rated

competency level in the ACGME competency areas. Nearly all primary care and non-primary

care respondents felt “fully” competent in the areas of patient care (98.2%, 96.9%), interpersonal

and communication skills (100.0%, 96.9%), and professionalism (98.2%, 96.5%), respectively.

There was no statistically significant difference between groups.


Rural and Underserved Training Table 4.9a


Primary Care (n=56)


Rural Population Percent Percent p-value Yes 46.4 55.6

0.216 No 53.6 44.4 Underserved Population Percent Percent p-value Yes 96.4 89.1

0.098 No 3.6 10.9

Table 4.9a shows whether the primary care and non-primary care respondents’ received

training to serve the rural and underserved populations. Over two-fifths (46.4%) of the primary

care respondents indicated they had received training to serve rural populations, compared to

over one-half (55.6%) of their counterparts in non-primary care. There was no statistically


Almost all of the primary-care (96.4%) and non-primary care (89.1%) respondents

reported they had received training to serve underserved populations. There was no statistically


Competency in Providing Care to the Rural and Underserved Populations

Table 4.9b

How competent do you feel providing care to the:

Primary Care (n=56)


Rural Population Percent Percent p-value Fully 63.6 78.3

0.068 Partially 32.7 18.7 Not at all 3.6 3.0 Underserved Population Percent Percent p-value Fully 92.6 96.0


Table 4.9b shows the primary care and non-primary care respondents’ self-rated

competency levels in providing care to rural and underserved populations. Over three-fifths

(63.6%) of primary care respondents indicated feeling “fully” competent in providing care to the


rural population compared to over three-fourths (78.3%) of the non-primary care respondents.


Nearly all of the primary care (92.6%) and non-primary care (96.0%) respondents

indicated feeling “fully” competent in providing care to underserved populations. There was no

statistically significant difference between groups.

Program opportunities

Table 4.10

In the current academic year did you: Primary Care (n=56)


Have an opportunity to be part of a multidisciplinary inter-professional team Percent Percent p-value Yes 100.0 94.8

0.081 No 0.0 5.2

Participate in a quality improvement project to improve health outcome Percent Percent p-value Yes 85.7 71.4

0.028ǂ No 14.3 28.6

Participate in a patient safety project Percent Percent p-value Yes 66.0 51.1

0.049ǂ No 34.0 48.9

Use electronic health records, including order entry and progress notes Percent Percent p-value Yes 100.0 98.2

0.325 No 0.0 1.8

Table 4.10 shows if there were any opportunities available for the primary care and non-

primary care respondents to participate in the current academic year. Nearly all of the primary

care and non-primary care respondents had the opportunity to be part of a multidisciplinary inter-

professional team (100.0%, 94.8%), and use electronic health records (100.0%, 98.2%),

respectively. There was no statistically significant difference between groups.

Over four-fifths (85.7%) of the primary care respondents reported participating in a

quality improvement project compared to over two-thirds (71.4%) of non-primary care

respondents. The chi-square test of association between the two groups was statistically


significant. Primary care respondents were more likely to report participating in a quality

improvement project.

Two-thirds (66.0%) of primary care respondents indicated participating in a patient safety

project compared to one-half (51.1%) of non-primary care respondents. The chi-square test of

association between the two groups was statistically significant. Primary care respondents were

more likely to report participating in a patient safety project.

Quality of program



(n=244) I would rate the overall quality of my residency or fellowship program as: Number Percent Number Percent Excellent 28 50.0 135 57.9 Above Average 24 42.9 60 25.8 Average 2 3.6 21 9.0 Below Average 1 1.8 7 3.0 Extremely Poor 1 1.8 10 4.3 Total 56 100.0 233 100.0 Missing 0 11 Chi-square p-value = 0.103

Table 4.11 shows the primary care and non-primary care respondents’ overall rating of

the quality of their residency or fellowship training program. Over four-fifths of the primary

care (92.9%) and non-primary care (83.7%) respondents indicated the quality of their training

program was “excellent” or “above average.” There was no statistically significant difference

between groups.

Faculty assessment



(n=244) I would rate the overall performance of the faculty in my residency or fellowship program to have exceeded my expectations? Number Percent Number Percent Strongly Agree 23 41.1 108 46.4 Agree 32 57.1 81 34.8 Neutral 0 0.0 37 15.9 Disagree 1 1.8 6 2.6 Strongly Disagree 0 0.0 1 0.4 Total 56 100.0 233 100.0 Missing 0 11 Chi-square p-value = 0.004ǂ


Table 4.12 shows the primary care and non-primary care respondents’ overall

performance rating of the faculty in their training program. Nearly all (98.2%) of the primary

care respondents indicated they “strongly agree” or “agree” that the faculty in their program have

exceeded their expectations, compared to over four-fifths (81.2%) of the non-primary care


significant. Primary care respondents were more likely to agree that faculty in their program had

exceeded their expectations.




(n=244)

I would rate the overall performance of the other residents/fellows in my residency or fellowship program to have exceeded my expectations? Number Percent Number Percent Strongly Agree 13 24.1 85 37.1 Agree 35 64.8 113 49.3 Neutral 4 7.4 28 12.2 Disagree 2 3.7 3 1.3 Strongly Disagree 0 0.0 0 0.0 Total 54 100.0 229 100.0 Missing 2 15 Chi-square p-value = 0.910

Table 4.13 shows the primary care and non-primary care respondents’ overall

performance rating of other residents or fellows in their training program. Over four-fifths of the

primary care (88.9%) and non-primary care (86.4%) respondents indicated they “strongly agree”

or “agree” that other residents or fellows in their program had exceeded their expectations.



Plans after graduation

Table 4.14a Primary Care


(n=244) What do you expect to be doing after completion of your current residency or fellowship program? Number Percent Number Percent Patient care or clinical practice (in Non-training position) 32 57.1 123 50.4 Fellowship or Additional Subspecialty Training 17 30.4 66 27.0 Academic position (Teaching and/or research) 6 10.7 45 18.4 Temporarily out of medicine 0 0.0 0 0.0 Military 0 0.0 1 0.4 Industry 0 0.0 0 0.0 Other 1 1.8 5 2.0 Undecided or don't know yet 0 0.0 4 1.6 Total 56 100.0 244 100.0 Missing 0 0 Chi-square p-value= 0.647

Table 4.14a shows what the primary care and non-primary care respondents expect to do

after completing their current training program. Over one-half of primary care (57.1%) and non-

primary care (50.4%) respondents planned to go into patient care or clinical practice after

completing their training. Over one-fourth of primary care (30.4%) and non-primary care

(27.0%) respondents planned to continue with additional training. There was no statistically


Work status

Table 4.14b Primary Care


(n=244) After your current graduation, do you expect to be working full-time or part-time? Number Percent Number Percent

Full-time 53 96.4 223 94.5 Part-time 2 3.6 13 5.5 Total 55 100.0 236 100.0 Missing 1 8 Chi-square p-value= 0.572

Table 4.14b shows how much time the primary care and non-primary care respondents

plan to be working after completion of their current program. Nearly all of the primary care

(96.4%) and non-primary care (94.5%) respondents indicated working full-time. Of those

intending to work part-time, two of the primary care and three of the non-primary care

respondents intended to work 30 hours per week; and ten of the non-primary care respondents

intended to work less than 30 hours per week. There was no statistically significant difference

between groups.



Chi-square p-value= 0.124

Figure 4.1 presents the current level of educational debt among the primary care and non-

primary care respondents. To maintain chart clarity, percentage values have not been shown on

the graph.

Nearly one-third (32.1%) of primary care and over one-fifth (21.3%) of non-primary care

respondents had no educational debt. Over one-half of primary care (53.6%) and over three-

fifths of non-primary care (65.5%) respondents had an educational debt of $100,000 or more.

Over one-third of primary care (35.7%) and two-fifths of non-primary care (40.4%) respondents

had an educational debt of $200,000 or more. There was no statistically significant difference

between groups.

0

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20

25

30

35

40

45

50

Perc

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Primary Care (n=56) Non-Primary Care (n=244)





primary care and non-primary care respondents. To maintain chart clarity, percentage values

have not been shown on the graph.

Over one-fourth (26.8%) of primary care and over one-tenth (18.3%) of non-primary care

respondents had no educational debt. Over three-fifths of primary care (62.5%) and non-primary

care (67.7%) respondents had an educational debt of $100,000 or more. Over two-fifths of

primary care (44.6%) and non-primary care (49.8%) respondents had an educational debt of

$200,000 or more. There was no statistically significant difference between groups.

0

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35

40

45

50

Perc

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Figure 4.2 Current Total Household Education Debt




Type of Practice

Table 4.15

Clinical Care Respondents Primary Care


(n=123) Which best describes the principal type of Patient Care Practice you will be entering? Number Percent Number Percent Solo practice 0 0.0 5 4.7 Partnership (2 person) 0 0.0 6 5.7 Group Practice 15 55.6 62 58.5 Hospital‐inpatient 6 22.2 9 8.5 Hospital‐ambulatory care 3 11.1 10 9.4 Hospital‐emergency department 2 7.4 9 8.5 Free‐standing health center or clinic 1 3.7 3 2.8 Nursing Home 0 0.0 0 0.0 Other (specify) 0 0.0 2 1.9 Total 27 100.0 106 100.0 Missing 5 17 Chi-square p-value= 0.529

Table 4.15 shows the principal type of patient care practice setting the primary care and

non-primary care respondents will be entering after completing their training. Over one-half of

the primary care (55.6%) and non-primary care (58.5%) respondents intended to work in a

“group practice” setting. Two-fifths of the primary care (40.7%) and over one-fourth of non-

primary care (26.4%) respondents planned to practice in a hospital setting. There was no


Amount of direct patient-care activities

Table 4.16



(n=123) In your upcoming position, what amount of direct patient-care activities will you do? Number Percent Number Percent No patient-care activities 0 0.0 1 0.8 Part-time patient-care activities 1 3.2 12 10.0 Full-time patient-care activities 30 96.8 107 89.2 Total 31 100.0 120 100.0 Missing 1 3 Chi-square p-value=0.421

Table 4.16 shows the primary care and non-primary care respondents’ expected amount

of time spent in direct patient-care activities. A majority of primary care (96.8%) and non-

primary care (89.2%) respondents intended to work full-time in patient-care activities. There

was no statistically significant difference between groups.




Chi-square p-value= 0.001ǂ

Figure 4.3 presents the gross income that primary care and non-primary care respondents’

expect to earn during their first year of practice. Only those respondents who indicated working

full-time in direct patient-care activities were included in this analysis. To maintain chart clarity,

percentage values have not been shown on the graph.

Of those intending to work full-time, over one-fourth (26.9%) of primary care

respondents expect to earn $200,000 or more during their first year of practice, compared to over

three-fourths (78.2%) of non-primary care respondents. The chi-square test of association

between the two groups was statistically significant. Non-primary care respondents expected to

earn more during the first year of practice.

0

10

20

30

40

50

60

Perc

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of C

linic

al C

are

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ents

(%)





Table 4.17



(n=123) Where is the location of your primary activity after completing your current training program? Number Percent Number Percent Same city or county as current training 16 51.6 25 21.0 Same region in Indiana, but different city or county 2 6.5 10 8.4 Other area in Indiana 5 16.1 14 11.8 Other U.S. state (not Indiana) 7 22.6 60 50.4 Outside of U.S. 0 0.0 0 0.0 Undecided 1 3.2 10 8.4 Total 31 100.0 119 100.0 Missing 1 4 Chi-square p-value= 0.007ǂ

Table 4.17 shows the location of primary activity for primary care and non-primary care

respondents’ after completion of their training program. Nearly three-fourths of primary care

(74.2%) and over two-fifths of non-primary care graduates (41.2%) planned to practice within

Indiana. One-fifth of the primary care respondents (22.6%) planned to practice in another state,

compared to one-half (50.4%) of non-primary care respondents. The chi-square test of

association between the two groups was statistically significant. Non-primary care respondents

were more likely to move outside Indiana to practice.


Table 4.18



(n=123) How many offers for employment/practice positions did you receive all together Number Percent Number Percent 0 0 0.0 1 1.0 1 10 35.7 17 17.0 2 9 32.1 25 25.0 3 4 14.3 30 30.0 4 1 3.6 12 12.0 5 4 14.3 15 15.0 Total 28 100.0 100 100.0 Missing/ Did not seem an employment position at the time 4 23 Chi-square p-value= 0.227


Table 4.18 shows the total number of offers the primary care and non-primary care

respondents received for employment or practice positions. Nearly one-third (32.2%) of primary

care and over one-half (57.0%) of non-primary care respondents reported being offered three or

more employment positions. There was no statistically significant difference between groups.


Table 4.19

Clinical Care Respondents* Primary Care


(n=49) How many offers for employment/practice positions did you receive in Indiana? Number Percent Number Percent 0 0 0.0 1 2.4 1 9 40.9 11 26.2 2 9 40.9 15 35.7 3 4 18.2 11 26.2 4 0 0.0 3 7.1 5 0 0.0 1 2.4 Total 22 100.0 42 100.0 Missing/ Did not seek employment positions at this time 1 7 *Of those respondents who indicated their primary practice location was in Indiana


Table 4.19 shows the number of offers the primary care and non-primary care

respondents received for employment or practice positions in Indiana. Only those respondents

who indicated their primary practice location was in Indiana were included in the analysis.

Of those intending to practice in Indiana, over one-tenth (18.2%) of primary care and

over one-third (35.7%) of non-primary care respondents were offered three or more employment

or practice positions. There was no statistically significant difference between groups.




Figure 4.4 presents the overall assessment of practice opportunities for primary care and

non-primary care respondents within their specialty. To maintain chart clarity, percentage values


Over one-third (35.7%) of primary care respondents reported that “many jobs” were

available within their specialty in Indiana, compared to over one-fourth (28.0%) of non-primary

care respondents. Less than one-tenth (7.1%) of primary care and over one-fourth (32.0%) of

non-primary care respondents reported there were “few”, “very few” or “no jobs” available

within their specialty in Indiana. There was no statistically significant difference between

groups.

0

10

20

30

40

50

60

70

80

90

100

Perc

ent o

f Clin

ical

Car

e R

espo

nden

ts (%

) Figure 4.4: Overall Assessment of Practice





Figure 4.5 presents the main reasons influencing the primary care and non-primary care

respondents’ choice of practice location. To maintain chart clarity, percentage values have not

been shown on the graph.

The top three reasons given by primary care respondents to practice at this location were:

“met my personal needs or preferences (65.6%), “liked the people” (62.5%), and “met my

professional needs or preferences” (53.1%). The top-three responses given by non-primary care

respondents for choosing to practice at this location were: “liked the people” (61.8%), “met my

personal needs or preferences” (54.5%), and “met my professional needs or preferences”

(51.2%). There was no statistically significant difference between groups.

0 10 20 30 40 50 60 70 80 90 100

Satisfy loan requirement

Other

Climate





Salary

Met my professional needs

Liked the people

Met my personal needs


Figure 4.5: Main Reasons to Practice at This Location





Figure 4.6 presents the main reasons influencing primary care and non-primary care

respondents’ choice of practice location in Indiana. Only those respondents who indicated their

primary practice location was in Indiana were included in this analysis. To maintain chart

clarity, percentage values have not been shown on the graph.

Of those intending to practice in Indiana, the top reasons given by primary care

respondents for choosing to practice in Indiana were: “cost of practicing is reasonable in

Indiana” (30.4%), and “more job opportunities in Indiana” (30.4%). The top-three responses

given by non-primary care respondents for choosing to practice in Indiana were: “proximity to

my family” (57.1%), “cost of practicing is reasonable in Indiana” (51.0%), and “proximity to my

spouse’s family” (34.7%). The chi-square test of association between the two groups was

statistically significant for proximity to my family. Non-primary care respondents were more

likely to practice at this location due to proximity to family.

0 10 20 30 40 50 60 70 80 90 100


Climate


Always intended to practice in Indiana

Rotation experience



Other


Proximity to my familyǂ

More jobs or practice opportunities in IN



Figure 4.6: Main Reasons to Practice in Indiana





Figure 4.7 presents the main reasons influencing primary care and non-primary care

respondents’ choice of practice location outside Indiana. Only those who indicated their primary

practice location was outside Indiana were included in this analysis. To maintain chart clarity,


Of those intending to practice outside Indiana, the top reasons given by primary care

respondents for choosing not to practice in Indiana were: “proximity to my family” (42.9%),

“proximity to my spouse’s family” (42.9%) and “never intended to practice in Indiana” (42.9%).

The top three reasons given by non-primary care respondents for choosing not to practice in

Indiana were: “proximity to my family” (43.3%), “proximity to my spouse’s family” (33.3%),

and “lack of jobs in Indiana” (33.3%). There was no statistically significant difference between

groups.

0 10 20 30 40 50 60 70 80 90 100

Lack of job in IN

Inadequate salary or compensation


Cost of practicing too high in IN


Other

Climate





Figure 4.7: Main Reasons Not to Practice in Indiana



Medically Underserved Area (MUA) / Health Professions Shortage Area (HPSA) or Expected to Serve the Underserved Population


Figure 4.8 presents the primary care and non-primary care respondents’ response for

going to practice in the MUA/HPSA or those expecting to serve the underserved population in

their new practice. Only those clinical care respondents who had no visa obligation were

included in the analysis for this graph. To maintain chart clarity, percentage values have not


Of those going into clinical care with no visa obligation, over one-half (57.9%) of

primary care and non-primary care (52.0%) respondents indicated that they will either be located

in a designated MUA/HPSA or expect to serve a substantial proportion (greater than 50%) of

patients from underserved populations in their new practice.

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CHAPTER 5: RESIDENT AND FELLOW RESPONDENTS

The survey respondents’ names were matched with their specialty and then classified into

a residency or fellowship training program.

Of the 300 graduates who completed the survey, 166 were in a residency program and

134 were in a fellowship program, as shown in tables 5.1 to 5.14 and figures 5.1 and 5.2. The

remaining tables and figures show responses from only those graduates who indicated that they

planned to work in ‘patient care or clinical practice’ after graduation: residents (98) and fellows

(57).





Age

Table 5.1 Residents (n=166)

Fellows (n=134)

Age Number Percent Number Percent 25-29 44 26.5 7 5.2 30-34 98 59.0 92 68.7 35-39 12 7.2 27 20.1 40-44 9 5.4 4 3.0 45-49 2 1.2 2 1.5 >50 1 0.6 2 1.5 Total 166 100.0 134 100.0 Missing 0 0 Chi-square p-value= 0.000ǂ

Table 5.1 shows the age distribution of residency and fellowship graduates who

responded to the survey. Over three-fifths of the resident (66.2%) and four-fifths of the fellow

(88.8%) respondents were between the ages of 30 and 39 years. The chi-square test of

association between the two groups was statistically significant. Fellows were more likely to be

between 30 and 39 years of age.


Gender


Fellows (n=134)

Gender Number Percent Number Percent Male 96 57.8 89 66.4 Female 70 42.2 45 33.6 Total 166 100.0 134 100.0 Missing 0 0 Chi-square p-value= 0.128

Table 5.2 shows the gender distribution of residency and fellowship graduates who

responded to the survey. Over two-fifths (42.2%) of residents and one-third (33.6%) of fellow

respondents were male. There was no statistically significant difference between groups.

Race


Fellows (n=134)

Race Number Percent Number Percent American Indiana/ Native Alaskan 0 0.0 0 0.0 Asian 23 14.2 20 12.3 Black/African American 6 3.7 5 3.1 Native Hawaiian/ Pacific Islander 1 0.6 0 0.0 White 121 74.7 95 58.6 Other 11 6.8 4 2.5 Total 162 100.0 124 76.5 Missing 4 10 Chi-square p-value= 0.226

Table 5.3 shows the racial distribution of residency and fellowship graduates who

responded to the survey. Almost three-fourths (74.7%) of the residents and over one-half

(58.6%) of fellow respondents were white. Over one-tenth of the residents (14.2%) and fellow

(12.3%) respondents were Asian. There was no statistically significant difference between

groups.

Ethnicity


Fellows (n=134)

Ethnicity Number Percent Number Percent Hispanic or Latino 10 6.5 4 3.2 Not Hispanic or Latino 145 93.5 121 96.8 Total 155 100 125 100.0 Missing 11 9 Chi-square p-value= 0.463


Table 5.4 shows the ethnicity of residency and fellowship graduates who responded to the

survey. Less than one-tenth of residents (6.5%) and fellow (3.2%) respondents indicated having

a Hispanic ethnicity. There was no statistically significant difference between groups.



Fellows (n=134)

What do you consider to be your home state prior to your current training program? Number Percent Number Percent Outside USA 23 13.9 24 18.3 Within USA 143 86.1 107 81.7 Outside Indiana 71 42.8 66 50.4 Within Indiana 72 43.4 41 31.3 Total 166 100.0 131 100.0 Missing 0 3 Chi-square p-value = 0.098

Table 5.5 shows what the residency and fellowship respondents’ considered their home-

state prior to their current training program. Over-one tenth (13.9%) of residents and fellows

(18.3%) were from another country. Of the respondents who were from the United States, over

two-fifths (42.8%) of residents and over one-half (50.4%) of fellow respondents were from

outside Indiana. There was no statistically significant difference between groups.



Fellows (n=134)

Respondents who have an Indiana… Number Percent Number Percent Hometown 77 46.4 41 31.3 High School 65 39.9 31 24.6 College 72 44.2 25 20.3 Medical School 70 43.2 26 20.3

Table 5.6 shows the residency and fellowship respondents who reported having an

Indiana hometown, or who graduated from high school, college, or medical school in Indiana.

Over two-fifths (46.4%) of residents and almost one-third (31.3%) of fellow respondents

indicated having a hometown in Indiana. About two-fifths of residents reported graduating from

a high school (39.9%), college (44.2%), or medical school (43.2%) in Indiana. Over one-fifth of

fellow respondents indicated they graduated from a high school (24.6%), college (20.3%), or

medical school (20.3%) in Indiana.


Training program


Fellows (n=134)

The residency or fellowship training program was helpful in the preparation for my board exam? Number Percent Number Percent Strongly Agree 55 35.5 38 32.5

Agree 85 54.8 60 51.3

Neutral 10 6.5 17 14.5

Disagree 3 1.9 1 0.9

Strongly Disagree 2 1.3 1 0.9

Total 155 100.0 117 100.0 Missing/ Board Exam in my field does not exist 11 17


Table 5.7 shows the residency and fellowship respondents’ assessment of how helpful

their training was in preparing them for the board exams. Over four-fifths of the residents

(90.3%) and fellow (83.8%) respondents “strongly agree” or “agree” that their training was

helpful in preparing them for their board exams. There was no statistically significant difference

between groups.




Residents (n=166)

Fellows (n=134)













Table 5.8 shows the residency and fellowship respondents’ self-rated competency level in

the ACGME competency areas. Nearly all resident and fellow respondents felt “fully”

competent in the areas of patient care (97.5%, 96.8%), interpersonal and communication skills

(97.5%, 96.8%), and professionalism (97.5%, 96.0%). There was no statistically significant





Residents (n=166)

Fellows (n=134)

Rural Population Percent Percent p-value Yes 54.0 53.5

0.933 No 46.0 46.5

Underserved Population Percent Percent p-value Yes 93.6 86.7

0.050ǂ Not 6.4 13.3

Table 5.9a shows whether the residency and fellowship respondents’ received training to

serve the rural and underserved populations. Over one-half of the residents (54.0%) and fellow

(53.5%) respondents indicated they had received training to serve rural populations. There was

no statistically significant difference between groups.

Almost all (93.6%) residents reported they had received training to serve the underserved

populations, compared to over fourth-fifths (86.7%) of the fellowship respondents. The chi-

square test of association between the two groups was statistically significant. Residents were

more likely to have received training to serve the underserved population.


Table 5.9b


Residents (n=166)

Fellows (n=134)



Underserved Population Percent Percent p-value Fully 94.9 96.0


Table 5.9b shows the residency and fellowship respondents’ self-rated competency levels

in providing care to rural and underserved populations. Almost three-fourths of the residents

(71.7%) and four-fifths of the fellow respondents (80.2%) indicated feeling “fully” competent in


providing care to rural populations. There was no statistically significant difference between

groups.

Almost all resident (94.9%) and fellow (96.0%) respondents indicated feeling “fully”

competent in providing care to underserved populations. There was no statistically significant


Program Opportunities

Table 5.10

In the current academic year did you: Residents (n=166)

Fellows (n=134)

Have an opportunity to be part of a multidisciplinary inter-professional team Percent Percent p-value Yes 96.3 95.3

0.642 No 3.8 4.7

Participate in a quality improvement project to improve health outcome Percent Percent p-value Yes 69.6 79.8

0.047ǂ No 30.4 20.2

Participate in a patient safety project Percent Percent p-value Yes 54.7 52.8

0.741 No 45.3 47.2

Use electronic health records, including order entry and progress notes Percent Percent p-value Yes 98.1 99.2

0.434 No 1.9 0.8

Table 5.10 shows if there were any opportunities available for the residents and fellow

respondents to participate in the current academic year. Nearly all residents and fellow

respondents had the opportunity to be part of a multidisciplinary inter-professional team (96.3%,

95.3%) and use electronic health records (98.1%, 99.2%), respectively. There was no


Over two-thirds (69.6%) of the residents reported participating in a quality improvement

project compared to almost four-fifths (79.8%) of fellow respondents. The chi-square test of

association between the two groups was statistically significant. Fellows were more likely to

report participating in a quality improvement project.


Over one-half of residents (54.7%) and fellow (52.8%) respondents indicated

participating in a patient safety project. There was no statistically significant difference between

groups.

Quality of Program


Fellows (n=134)

I would rate the overall quality of my residency or fellowship program as: Number Percent Number Percent Excellent 84 52.8 79 60.8 Above Average 52 32.7 32 24.6 Average 12 7.5 11 8.5 Below Average 5 3.1 3 2.3 Extremely Poor 6 3.8 5 3.8 Total 159 100.0 130 100.0 Missing 7 4 Chi-square p-value = 0.615

Table 5.11 shows the residency and fellowship respondents’ overall rating of the quality

of their residency or fellowship training program. Over four-fifths of the residents (85.5%) and

fellow (85.4%) respondents indicated the quality of their training program was “excellent” or

“above average.” There was no statistically significant difference between groups.


Faculty assessment


Fellows (n=134)

I would rate the overall performance of the faculty in my residency or fellowship program to have exceeded my expectations? Number Percent Number Percent Strongly Agree 64 39.8 67 52.3 Agree 74 46.0 39 30.5 Neutral 19 11.8 18 14.1 Disagree 4 2.5 3 2.3 Strongly Disagree 0 0.0 1 0.8 Total 161 100.0 128 100.0 Missing 5 6 Chi-square p-value = 0.077

Table 5.12 shows the residency and fellowship respondents’ overall performance rating

of the faculty in their training program. Over four-fifths of the residents (85.8%) and fellows

(82.8%) indicated they “strongly agree” or “agree” that the faculty in their program had

exceeded their expectations. There was no statistically significant difference between groups.



Fellows (n=134)


Table 5.13 shows the residency and fellowship respondents’ overall performance rating

of other residents or fellows in their training program. Over four-fifths of the residents (89.9%)

and fellow (83.2%) respondents indicated they “strongly agree” or “agree” that other residents or

fellows in their program had exceeded their expectations. There was no statistically significant




Table 5.14a Residents (n=166)

Fellows (n=134)

What do you expect to be doing after completion of your current residency or fellowship program? Number Percent Number Percent Patient care or clinical practice (in Non-training position) 98 59.0 57 42.5 Fellowship or Additional Subspecialty Training 41 24.7 42 31.3 Academic position (Teaching and/or research) 21 12.7 30 22.4 Temporarily out of medicine 0 0.0 0 0.0 Military 1 0.6 0 0.0 Industry 0 0.0 0 0.0 Other 4 2.4 2 1.5 Undecided or don't know yet 1 0.6 3 2.2 Total 166 100.0 134 100.0 Missing 0 0 Chi-square p-value = 0.037ǂ

Table 5.14a shows what the residency and fellowship respondents expected to do after

completing their current training program. Over one-half (59.0%) of the residents and over two-

fifths (42.5%) of the fellow respondents indicated they planned to go into patient care or clinical

practice after completing their training. One-fourth of the residents (24.7%) and fellow (31.3%)

respondents planned to continue with additional training. The chi-square test of association

between the two groups was statistically significant. Fellows were more likely to accept an

academic position (teaching or research) after completing their training.

Work status

Table 5.14b Residents (n=166)

Fellows (n=134)

After your current graduation, do you expect to be working full-time or part-time? Number Percent Number Percent


Table 5.14b shows how much time residency and fellowship graduates plan to be working

after completion of their current program. Nearly all residents (94.4%) and fellow (95.3%)

respondents intended working full-time. Of the residents intending to work part-time, four

planned to work 30 hours per week; four less than 30 hours per week; and one did not indicate

the hours. Of the fellow respondents intending to work part-time, one planned to work 30 hours

per week; four less than 30 hours per week; and one did not indicate the hours. There was no




Chi-square p-value = 0.030ǂ

Figure 5.1 presents the current level of educational debt among the residency and

fellowship respondents. To maintain chart clarity, percentage values have not been shown on the

graph.

Nearly one-fifth (18.6%) of residents and over one-fourth (29.2%) of fellow respondents

had no educational debt. Over two-fifths (45.3%) of residents and one-third (32.3%) of fellows

had an educational debt of $200,000 or more. The chi-square test of association between the two

groups was statistically significant. Residents were more likely to have an educational debt of

$200,000 or more.

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Residents (n=166) Fellows (n=134)



Chi-square p-value = 0.318


residency and fellowship graduates. To maintain chart clarity, percentage values have not been

shown on the graph.

Over one-tenth (15.4%) of resident and one-fourth (25.6%) of fellow respondents had no

educational debt. Over one-half (51.2%) of residents compared to over two-fifths (45.7%) of

fellow respondents had an educational debt of $200,000 or more. There was no statistically


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Figure 5.2: Current Total Household Debt




Type of Practice

Table 5.15

Clinical Care Respondents Residents

(n=98) Fellows (n=57)

Which best describes the principal type of Patient Care Practice you will be entering? Number Percent Number Percent Solo practice 3 3.6 2 4.0 Partnership (2 person) 4 4.8 2 4.0 Group Practice 45 54.2 32 64.0 Hospital‐inpatient 10 12.0 5 10.0 Hospital‐ambulatory care 6 7.2 7 14.0 Hospital‐emergency department 10 12.0 1 2.0 Free‐standing health center or clinic 4 4.8 0 0.0 Nursing Home 0 0.0 0 0.0 Other (specify) 1 1.2 1 2.0 Total 83 100.0 50 100.0 Missing 15 7 Chi-square p-value= 0.355

Table 5.15 shows the principal type of patient care practice the residency and fellowship

graduates will be entering after completing their training. Over one-half of the residents (54.2%)

and three-fifths of the fellow respondents (64.0%) intended to work in a “group practice” setting.

Over one-third (36.1%) of the resident and one-fourth of fellow respondents (26.0%) planned to

practice in a hospital setting. There was no statistically significant difference between groups.


Table 5.16



In your upcoming position, what amount of direct patient-care activities will you do? Number Percent Number Percent No patient-care activities 0 0.0 1 1.8 Part-time patient-care activities 3 3.2 10 17.9 Full-time patient-care activities 92 96.8 45 80.4 Total 95 100.0 56 100.0 Missing 3 1 Chi-square p-value=0.003ǂ

Table 5.16 shows the residency and fellowship respondents’ expected amount of time

spent in direct patient-care activities in their upcoming position. Nearly all residents (96.8%)

and four-fifths of the fellow respondents (80.4%) intended to work full-time in patient-care

activities. The chi-square test of association between the two groups was statistically significant.

Fellows were more likely to work part-time in patient-care activities.





Figure 5.3 presents the gross income that residency and fellowship respondents’ expect to

earn during their first year of practice. Only those respondents who indicated working full-time

in direct patient-care activities were included in this analysis. To maintain chart clarity,


Of those intending to work full-time, over three-fifths (65.3%) of the residents and fellow

respondents (68.4%) expect to earn $200,000 or more during their first year of practice. There


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Table 5.17



Where is the location of your primary activity after completing your current training program? Number Percent Number Percent Same city or county as current training 32 34.0 9 16.1 Same region in Indiana, but different city or county 11 11.7 1 1.8 Other area in Indiana 10 10.6 9 16.1 Other U.S. state (not Indiana) 33 35.1 34 60.7 Outside of U.S. 0 0.0 0 0.0 Undecided 8 8.5 3 5.4 Total 94 100.0 56 100.0 Missing 4 1 Chi-square p-value= 0.005ǂ

Table 5.17 shows the location of primary activity for the residency and fellowship

respondents after completion of their training program. Over one-half (56.3%) of the residents

and one-third of fellow respondents (34.0%) planned to practice within Indiana. Over one-third

(35.1%) of the residents three-fifths (60.7%) of the fellowship respondents planned to practice in

another state. The chi-square test of association between the two groups was statistically

significant. Fellows were more likely to practice out-of-state.


Table 5.18



How many offers for employment/practice positions did you receive all together Number Percent Number Percent 0 0 0.0 1 2.1 1 15 18.8 12 25.0 2 22 27.5 12 25.0 3 21 26.3 13 27.1 4 8 10.0 5 10.4 5 14 17.5 5 10.4 Total 80 100.0 48 100.0 Missing/ Did not seem an employment position at the time 18 9 Chi-square p-value= 0.834

Table 5.18 shows the total number of offers the residency and fellowship respondents

received for employment or practice positions. Over one-half (53.8%) of residents and over two-

fifths (47.9%) of fellow respondents reported being offered three or more employment positions.




Table 5.19

Clinical Care Respondents* Residents


How many offers for employment/practice positions did you receive in Indiana? Number Percent Number Percent 0 0 0.0 1 6.3 1 14 29.2 6 37.5 2 20 41.7 4 25.0 3 11 22.9 4 25.0 4 3 6.3 0 0.0 5 0 0.0 1 6.3 Total 48 100.0 16 100.0 Missing/ Did not seek employment positions at this time 5 3 *Of those respondents who indicated their primary practice location was in Indiana


Table 5.19 shows the number of offers the residency and fellowship respondents received

for employment or practice positions in Indiana. Only those respondents who indicated their

primary practice location was in Indiana were included in the analysis.

Of those intending to practice in Indiana, almost one-third of residents (29.2%) and

fellow respondents (31.3%) were offered three or more employment or practice positions. There





Figure 5.4 presents the overall assessment of practice opportunities within the specialty

among the residency and fellowship respondents. To maintain chart clarity, percentage values


Over four-fifths (87.2%) of residents reported that “many jobs” or “some jobs” were

available within their specialty in Indiana, compared to over one-half (52.0%) of fellow


significant. Residents were more likely to report that “many” jobs were available within their

specialty in Indiana.

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Figure 5.4: Overall Assessment of Practice Opportunities in Indiana




Figure 5.5 presents the main reasons influencing the residency and fellowship

respondent’s choice of practice location. To maintain chart clarity, percentage values have not


The top three reasons given by the residents for choosing to practice at this location were:

“liked the people” (63.3%), “met my personal needs or preferences” (58.2%), and “met my

professional needs or preferences” (49.0%). The top three reasons given by the fellow

respondents for choosing to practice at this location were: “liked the people” (59.6%) “met my

professional needs or preferences” (56.1%), and “met my personal needs or preferences”

(54.4%). The chi-square test of association between the two groups was statistically significant

for “proximity to my family” category. Residents were more likely to practice at this location

due to proximity to family.

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Other

Climate





Salary



Liked the people







Figure 5.6 presents the main reasons influencing residency and fellowship respondent’s

choice of practice location in Indiana. Only those respondents who indicated their primary

practice location was in Indiana were included in this analysis. To maintain chart clarity,


Of those intending to practice in Indiana, the top three reasons given by residents for

choosing to practice in Indiana were: “cost of practicing is reasonable in Indiana” (52.8%),

“proximity to my family” (49.1%), and “proximity to my spouse’s family” (35.8%). The top

responses given by fellow respondents for choosing to practice in Indiana were: “proximity to

my family” (42.1%) and “opportunity for my spouse” (42.1%). The chi-square test of

association between the two groups was statistically significant for the following categories:

opportunity for my spouse, cost of practicing in Indiana, proximity to my spouse’s family, and

climate. Residents were more likely to practice in Indiana due to cost of practicing being

reasonable and proximity to their families; while fellows were more likely to practice in Indiana

due to the climate.

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Climateǂ Proximity to recreation

Relationship with my mentorRotation experience

OtherOpportunity for my spouse ǂ

More jobs or practice opportunities in INAlways intended to practice in IN

Salary or compensationProximity to my spouse's familyǂ

Proximity to my familyCost of practicing is reasonable in INǂ


Figure 5.6: Main Reasons to Practice in Indiana*




*Reflects responses from only those respondents who indicated their primary practice location was outside Indiana Figure 5.7 presents the main reasons influencing residency and fellowship respondent’s

choice of practice location outside Indiana. Only those who indicated their primary practice

location was outside Indiana were included in this analysis. To maintain chart clarity, percentage

values have not been shown on the graph.

Of those intending to practice outside Indiana, the top three reasons given by residents for

choosing not to practice in Indiana were: “proximity to my family” (63.6%), “proximity to

spouse’s family” (51.5%) and “never intended to practice in Indiana” (33.3%). The top three

reasons given by fellow respondents for choosing not to practice in Indiana were: “lack of jobs in

Indiana” (44.1%), “proximity to my family” (23.5%), and “other” (23.5%). The chi-square test

of association between the two groups was statistically significant for the following categories:

proximity to my family, proximity to my spouse’s family, lack of jobs in Indiana and other

reasons. Residents were more likely to practice outside Indiana due to proximity to their

families; while fellows were more likely to practice outside Indiana due to lack of jobs and other

reasons.

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Cost of Practicing too high


Otherǂ

Inadequate salary

Lack of jobs in INǂ


Climate


Proximity to my spouse's familyǂ



Figure 5.7: Main Reasons to Not to Practice in Indiana





Figure 5.8 presents the residency and fellowship respondents’ response for going to

practice in the MUA/HPSA or those expecting to serve the underserved population in their new

practice. Only those clinical care respondents who had no visa obligation were included in the

analysis for this graph. To maintain chart clarity, percentage values have not been shown on the

graph.

Of those going into clinical care with no visa obligation, over one-half of the residents

(54.1%) and fellow respondents (51.1%) indicated that they will either be located in a designated

MUA/HPSA or expect to serve a substantial proportion (greater than 50%) of patients from

underserved populations in their new practice.

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CHAPTER 6: THOSE INTENDING TO STAY WITHIN INDIANA OR GO OUT-OF-STATE TO PRACTICE

Based on the response to a question (Q11) on the 2013 Graduate Medical Education Exit

Survey regarding location of primary practice activity after completion of training program,

graduates were stratified into: those intending to practice in Indiana and those planning to

practice out-of-state.

Of the 300 graduates who completed the survey, 28 did not indicate their practice

locations and were thus excluded from the analysis in this chapter. Of the remaining 272

respondents, 141 indicated they planned to practice in Indiana and 131 intended to practice out-

of-state, as shown in tables 6.1 to 6.13 and figures 6.1 and 6.2. The remaining tables and figures

show responses from only those graduates who indicated that they planned to work in ‘patient

care or clinical practice’ after graduation: in-state (72) and out-of-state (68).





Age

Table 6.1 In-state (n=141)

Out-of-state (n=131)

Age Number Percent Number Percent 25-29 30 21.3 17 13.0 30-34 87 61.7 87 66.4 35-39 17 12.1 18 13.7 40-44 5 3.5 5 3.8 45-49 0 0.0 3 2.3 >50 2 1.4 1 0.8 Total 141 100.0 131 100.0 Missing 0 0 Chi-square p-value= 0.252

Table 6.1 shows the age distribution between respondents intending to practice within

Indiana and those going out-of-state. Almost three-fourths (73.8%) of the respondents intending

to practice within Indiana and four-fifths (80.1%) of those going out-of-state (80.1%) were


between the ages of 30 and 39 years. There was no statistically significant difference between

groups.

Gender



Gender Number Percent Number Percent Male 80 56.7 92 70.2 Female 61 43.3 39 29.8 Total 141 100.0 131 100.0 Missing 0 0 Chi-square p-value= 0.021ǂ

Table 6.2 shows the gender distribution between respondents intending to practice within

Indiana and those going out-of-state. Over two-fifths (43.3%) of the respondents intending to

practice within Indiana were female, compared to over one-fourth (29.8%) of those going out-of-

state. The chi-square test of association between the two groups was statistically significant.

Out-of-state respondents were more likely to be male.

Race



Race Number Percent Number Percent American Indiana/ Native Alaskan 0 0.0 0 0.0 Asian 9 6.7 25 18.5 Black/African American 7 5.2 2 1.5 Native Hawaiian/ Pacific Islander 0 0.0 0 0.0 White 108 80.0 97 71.9 Other 11 8.1 2 1.5 Total 135 100.0 126 93.3 Missing 6 5 Chi-square p-value= 0.002ǂ

Table 6.3 shows the racial distribution of respondents intending to practice within Indiana

and those going out-of-state. Less than one-tenth of the respondents intending to practice in

Indiana (6.7%) were Asian, compared to about one-fifth (18.5) of those intending to go out-of-

state. The chi-square test of association between the two groups was statistically significant.

Out-of-state respondents were more likely to be Asian; while those intending to practice within

Indiana were more likely to be white.


Ethnicity



Ethnicity Number Percent Number Percent Hispanic or Latino 7 5.5 7 5.5 Not Hispanic or Latino 120 94.5 121 94.5 Total 127 100 128 100.0 Missing 14 3 Chi-square p-value= 0.988

Table 6.4 shows the ethnicity of respondents intending to practice within Indiana and

those going out-of-state. Less than one-tenth of the respondents intending to practice within

Indiana (5.5%) and those going out-of-state (5.5%) indicated having a Hispanic ethnicity. There





What do you consider to be your home state prior to your current training program? Number Percent Number Percent Outside USA 13 9.4 25 19.2 Within USA 126 90.6 105 80.8 Outside Indiana 51 36.7 77 59.2 Within Indiana 75 54.0 28 21.5 Total 139 100.0 130 100.0 Missing 2 1 Chi-square p-value =0.000ǂ

Table 6.5 shows what the respondents considered being their hometown prior to their

current training program. Less than one-tenth (9.4%) of the respondents intending to practice

within Indiana were from another country, compared to about one-fifth (19.2%) of those going

out-of-state. Of the respondents who were from the United States, over one-half (54.0%) of

those intending to practice within Indiana and one-fifth (21.5%) of those going out-of-state were

from Indiana. The chi-square test of association between the two groups was statistically

significant. Out-of-state respondents were more likely to be from outside Indiana or another

country.






Table 6.6 shows the respondents who reported having an Indiana hometown, or who

graduated from high school, college, or medical school in Indiana. Over one-half of those

intending to practice within Indiana indicated having a hometown (54.0%) in Indiana, compared

to one-fifth (21.5%) of those intending to go-out-of-state. Of those intending to practice in

Indiana, over two-fifths graduated from a high school (47.1%), college (46.7%), or a medical

school (47.1%) in Indiana. Of those intending to go out-of-state to practice, about one-fifth

graduated from a high school (19.2%), college (21.0%), or a medical school (15.5%) in Indiana.

Training program



The residency or fellowship training program was helpful in the preparation for my board exam? Number Percent Number Percent Strongly Agree 43 32.8 43 35.2 Agree 71 54.2 66 54.1 Neutral 12 9.2 11 9.0 Disagree 4 3.1 0 0.0 Strongly Disagree 1 0.8 2 1.6 Total 131 100.0 122 100.0 Missing/ Board Exam in my field does not exist 10 9


Table 6.7 shows the respondents’ assessment of how helpful their training was in

preparing them for their board exams. Over three-fourths of the respondents intending to

practice within Indiana (87.0%) and those intending to go out-of-state (89.3%) “Strongly agree”

or “agree” that their training was helpful in preparing them for their board exams. There was no





In-state (n=141)














Table 6.8 shows the self-rated competency level in the ACGME competency areas.

Nearly all respondents intending to practice within Indiana and those going out-of-state felt

“fully” competent in the areas of patient care (97.1%, 97.6%), interpersonal and communication

skills (97.8%, 97.7%), and professionalism (97.0%, 96.8%), respectively. There was no





In-state (n=141)


Rural Population Percent Percent p-value Yes 56.1 53.5 0.666 No 43.9 46.5

Underserved Population Percent Percent p-value Yes 97.1 85.0 0.001ǂ Not 2.9 15.0

Table 6.9a shows the respondents’ assessment of receiving training to serve rural and

underserved populations. Over one-half of the respondents intending to practice within Indiana

(56.1%) and those going out-of-state (53.5%) indicated they had received training to serve rural

populations. There was no statistically significant difference between groups.

Nearly all (97.1%) of the respondents intending to practice within Indiana and over four-

fifths (85.0%) of those going out-of-state indicated they had received training to serve

underserved populations. The chi-square test of association between the two groups was

statistically significant. In-state respondents were more likely to indicate they had received

training to serve the underserved populations.


Table 6.9b


In-state (n=141)







Table 6.9b shows the respondents’ self-rated competency levels in providing care to rural

and underserved populations. Three-fourths of the respondents intending to practice within

Indiana (75.0%) and those going out-of-state (77.0%) indicated feeling “fully” competent in

providing care to the rural population. There was no statistically significant difference between

groups.

A majority of the respondents intending to practice within Indiana (97.1%) and those

going out-of-state (94.3%) indicated feeling “fully” competent in providing care to the

underserved population. There was no statistically significant difference between groups.

Program Opportunities Table 6.10

In the current academic year did you: In-state (n=141)


Have an opportunity to be part of a multidisciplinary inter-professional team Percent Percent p-value Yes 95.7 96.9 0.609 No 4.3 3.1

Participate in a quality improvement project to improve health outcome Percent Percent p-value Yes 76.1 75.0 0.837 No 23.9 25.0

Participate in a patient safety project Percent Percent p-value Yes 57.7 52.8 0.423 No 42.3 47.2

Use electronic health records, including order entry and progress notes Percent Percent p-value Yes 98.5 99.2 0.603 No 1.5 0.8

Table 6.10 shows if there were any opportunities available for the respondents to

participate in the current academic year. Nearly all of the respondents intending to practice in

Indiana and those going out-of-state had the opportunity to be part of a multidisciplinary inter-

professional team (95.7%, 96.9%) and use electronic health records (98.5%, 99.2%),

respectively. There was no statistically significant difference between groups.


About three-fourth of the respondents intending to practice in Indiana (76.1%) and those

going out-of-state (75.0%) reported participating in a quality improvement project. There was


Over one-half of the respondents intending to practice in Indiana (57.7%) and those going

out-of-state (52.8%) indicated participating in a patient safety project. There was no statistically


Quality of Program



I would rate the overall quality of my residency or fellowship program as: Number Percent Number Percent Excellent 85 61.2 68 53.1 Above Average 36 25.9 42 32.8 Average 10 7.2 9 7.0 Below Average 2 1.4 5 3.9 Extremely Poor 6 4.3 4 3.1 Total 139 100.0 128 100.0 Missing 2 3 Chi-square p-value= 0.457

Table 6.11 shows the overall quality rating of the respondents’ residency or fellowship

training program. Over four-fifths of those intending to practice within Indiana (87.1%) and

those going out-of-state (85.9%) indicated the quality of their training program was “excellent”

or “above average.” There was no statistically significant difference between groups.

Faculty assessment



I would rate the overall performance of the faculty in my residency or fellowship program to have exceeded my expectations? Number Percent Number Percent Strongly Agree 66 47.5 55 43.0 Agree 54 38.8 52 40.6 Neutral 16 11.5 16 12.5 Disagree 3 2.2 4 3.1 Strongly Disagree 0 0.0 1 0.8 Total 139 100.0 128 100.0 Missing 2 3 Chi-square p-value= 0.785


Table 6.12 shows the respondents’ overall performance rating of the faculty in their

training program. Over four-fifths of the respondents intending to practice within Indiana

(86.3%) and those going out-of-state (83.6%) indicated they “strongly agree” or “agree” that the

faculty in their program have exceeded their expectations. There was no statistically significant





I would rate the overall performance of the other residents/fellows in my residency or fellowship program to have exceeded my expectations? Number Percent Number Percent Strongly Agree 51 38.3 37 29.4 Agree 69 51.9 70 55.6 Neutral 12 9.0 15 11.9 Disagree 1 0.8 4 3.2 Strongly Disagree 0 0.0 0 0.0 Total 133 100.0 126 100.0 Missing 8 5 Chi-square p-value= 0.243

Table 6.13 shows respondents’ overall performance rating of other residents or fellows in

their training program. Over four-fifths of the respondents intending to practice within Indiana

(90.2%) and those going out-of-state (85.0%) indicated they “strongly agree” or “agree” that

other residents or fellows have exceeded their expectations. There was no statistically significant



Table 6.14a In-state (n=141)


What do you expect to be doing after completion of your current residency or fellowship program? Number Percent Number Percent Patient care or clinical practice (in Non-training position) 72 51.1 67 51.5 Fellowship or Additional Subspecialty Training 35 24.8 42 32.3 Academic position (Teaching and/or research) 31 22.0 18 13.8 Temporarily out of medicine 0 0.0 0 0.0 Military 0 0.0 1 0.8 Industry 0 0.0 0 0.0 Other 3 2.1 2 1.5 Undecided or don't know yet 0 0.0 0 0.0 Total 141 100.0 130 100.0 Missing 0 1 Chi-square p-value= 0.368


Table 6.14a shows what the respondents expect to do after completing their current

training program. Over one-half of the respondents intending to practice within Indiana (51.1%)

and those going out-of-state (51.5%) planned to go into patient care or clinical practice after

completing their training. Nearly one-fourth (24.8%) of those intending to practice within

Indiana planned to continue with additional training, compared to over one-fourth (32.3%) of

those going to practice out-of-state. There was no statistically significant difference between

groups.

Work status

Table 6.14b In-state (n=141)

Out-state (n=131)




current program. Nearly all of the respondents intending to practice within Indiana (95.0%) and

those going out-of-state (96.9%) respondents indicated working full-time. Of those intending to

practice in Indiana, three intended to work 30 hours per week; three less than 30 hours per week;

and one did not indicate the hours. Of those intending to practice out-of-state, one intended to

work 30 hours per week and three less than 30 hours per week. There was no statistically





Figure 6.1 presents the current level of educational debt among the respondents. To

maintain chart clarity, percentage values have not been shown on the graph.

Over one-fifth of the respondents intending to practice within Indiana (21.9%) and those

going out-of-state (24.8%) had no education debt. Nearly one-half (47.4%) of those intending to

practice within Indiana and about one-third (31.8%) of those going out-state had an educational

debt of $200,000 or more. There was no statistically significant difference between groups.

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graduates who responded to the survey. To maintain chart clarity, percentage values have not


Over one-tenth (16.5%) of those intending to practice within Indiana and over one-fifth

(22.7%) of those going out-of-state to practice had no educational debt. Over three-fifths of

those intending to practice within Indiana (72.7%) and those going out-of-state to practice

(61.7%) had an educational debt of $100,000 or more. Over one-half of those intending to

practice within Indiana (55.4%) and over two-fifths those going out-of state to practice (42.2%)

had an educational debt of $200,000 or more. There was no statistically significant difference

between groups.

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Sixteen clinical care respondents did not indicate their practice locations and thus were excluded from

analysis in this chapter.

Type of Practice

Table 6.15

Clinical Care Respondents In-State (n=72)

Out-of-State (n=67)

Which best describes the principal type of Patient Care Practice you will be entering? Number Percent Number Percent Solo practice 1 1.5 4 6.5 Partnership (2 person) 3 4.5 3 4.8 Group Practice 37 55.2 37 59.7 Hospital‐inpatient 8 11.9 6 9.7 Hospital‐ambulatory care 9 13.4 4 6.5 Hospital‐emergency department 6 9.0 5 8.1 Free‐standing health center or clinic 3 4.5 1 1.6 Nursing Home 0 0.0 0 0.0 Other (specify) 0 0.0 2 3.2

Total 67 100.0 62 100.0

Missing 5 5 Chi-square p-value= 0.544

Table 6.15 shows the principal type of patient care practice the respondents will be

entering after completing their training. Over one-half (55.2%) of the respondents who intended

to practice within Indiana and three-fifths (59.7%) of those going out-of-state intended to work

in a “group practice” setting. Over one-third (34.3%) of those who intending to practice within

Indiana and over one-fifth (24.2%) of those going out-of-state planned to practice in a hospital

setting. There was no statistically significant difference between groups.



Table 6.16


Out-of-State (n=67)

In your upcoming position, what amount of direct patient-care activities will you do? Number Percent Number Percent No patient-care activities 0 0.0 1 1.5 Part-time patient-care activities 2 2.8 10 15.2 Full-time patient-care activities 69 97.2 55 83.3 Total 71 100.0 66 100.0 Missing 1 1 Chi-square p-value= 0.021ǂ

Table 6.16 shows the respondents’ expected amount of time spent in direct patient-care

activities in their upcoming position. Nearly all (97.2%) of the respondents intending to practice

within Indiana intended to work full-time in patient-care activities, compared to over four-fifths

(83.3%) of those going out-of-state. The chi-square test of association between the two groups

was statistically significant. Out-of-state respondents were more likely to work part-time in

patient care activities.





Figure 6.3 presents the gross income that respondents’ expect to earn during their first

year of practice. Only those respondents who indicated working full-time in direct patient-care

activities were included in this analysis. To maintain chart clarity, percentage values have not


Of those intending to work full-time, over one-half of the respondents intending to

practice within Indiana (55.7%) expect to earn $200,000 or more, compared to four-fifths of

those going out-of-state (80.0%). There was no statistically significant difference between

groups.

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In-State (n=69) Out-of-State (n=55)



Table 6.17


Out-of-State (n=67)


Table 6.17 shows the total number of offers the respondents received for employment or

practice positions. Over two-fifths (47.0%) of the respondents intending to practice within

Indiana and over one-half (58.4%) those going out-of-state reported being offered three or more

employment positions. There was no statistically significant difference between groups.


Table 6.18

Clinical Care Respondents* In-State (n=72)

How many offers for employment/practice positions did you receive in Indiana? Number Percent 0 1 1.6 1 20 31.3 2 24 37.5 3 15 23.4 4 3 4.7 5 1 1.6 Total 64 100.0 Missing/ Did not seek employment positions at this time 8

*Of those respondents who indicated their primary practice location was in Indiana

Table 6.18 shows the number of offers the respondents received for employment or

practice positions in Indiana. Only those respondents who indicated their primary practice

location was in Indiana were included in the analysis. Of those intending to practice in Indiana,

over one-fourth (29.7%) were offered 3 or more employment or practice positions.




Figure 6.4 presents the overall assessment of practice opportunities among the

respondents within their specialty. To maintain chart clarity, percentage values have not been

shown on the graph.

Over four-fifths (86.6%) of the respondents intending to practice within Indiana reported

there were “many jobs” or “some jobs” available within their specialty, compared to over one-

half (57.6%) of those going out-of-state. The chi-square test of association between the two

groups was statistically significant. In-state respondents were more likely to report there were

“many” or “some” job opportunities available in Indiana.

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Figure 6.5 present the main reasons influencing the respondent’s choice of practice

location. To maintain chart clarity, percentage values have not been shown on the graph.

The top three reasons given by the “in-state” respondents for choosing to practice at this

location were: “liked the people” (72.2%), “met my personal needs or preferences” (62.5%), and

“met my professional needs or preferences” (59.7%). The top reasons given by the “out-of-

state” respondents for choosing to practice at this location were: “liked the people” (61.2%),

“met my personal needs or preferences” (59.7%), and “met my professional needs or

preferences” (55.2%). The chi-square test of association between the two groups was

statistically significant for proximity to recreation and climate. Out-of-state respondents were

more likely to practice at this location due to proximity to recreation and climate.

0 10 20 30 40 50 60 70 80 90 100


Climateǂ

Proximity to recreationǂ

Other




Salary



Liked the people







Figure 6.6 presents the main reasons influencing respondent’s choice of practice

location in Indiana. Only those who indicated their primary practice location was in Indiana

were included in this analysis. To maintain chart clarity, percentage values have not been shown

on the graph.

Of those intending to practice in Indiana, the top three reasons given by the respondents

intending to practice in Indiana were: “proximity to my family” (47.2%), “cost of practicing is

reasonable in Indiana” (44.4%), and “salary or compensation” (30.6%). There was no


0 10 20 30 40 50


Climate


Rotation experience

Other

More jobs or practice opportunities in IN









In-State (n=72)


Main reasons to not practice in Indiana


Figure 6.7 presents the main reasons influencing respondent’s choice of practice

location outside Indiana. Only those who indicated their primary practice location was outside

Indiana were included in this analysis. To maintain chart clarity, percentage values have not


Of those intending to practice outside Indiana, the top three reasons given by the

respondents intending to practice outside Indiana were: “proximity to my family” (43.3%),

“proximity to my spouse’s family” (34.3%), and “lack of jobs in Indiana” (29.9%). There was


0 10 20 30 40 50 60 70 80 90 100

Cost of Practicing too high


Inadequate salary

Other



Climate

Lack of jobs in IN



Figure 6.7: Main Reasons Not to Practice in Indiana*

Out-of-State (n=67)




Figure 6.8 presents the respondents’ responses for going to practice in the MUA/HPSA or

those expecting to serve the underserved population in their new practice. Only those clinical

care respondents who had no visa obligation were included in the analysis for this graph. To

maintain chart clarity, percentage values have not been shown on the graph.

Of those going into clinical care with no visa obligation, about one-half of those

intending to practice within Indiana (49.1%) and those going to practice out-of-state (55.2%),

indicated that they will either be located in a designated MUA/HPSA or expecting to serve a

substantial proportion (greater than 50%) of patients from underserved populations in their new

practice.

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CHAPTER 7: MALE AND FEMALE RESPONDENTS

Based on the response to a question (Q3) on the 2013 Graduate Medical Education Exit

Survey, the respondents were stratified by gender: males and females.

Of the 300 graduates who completed the survey 185 were male and 115 were female, as

shown in tables 7.1 to 7.13 and figures 7.1 and 7.2. The remaining tables and figures show

responses from only those graduates who indicated that they planned to work in ‘patient care or

clinical practice’ after graduation: males (87) and females (68).

To maintain chart clarity, percentage values have not been show on the graphs. For this




Age

Table 7.1 Males

(n=185) Females (n=115)

Age Number Percent Number Percent 25-29 26 14.1 25 21.7 30-34 118 63.8 72 62.6 35-39 30 16.2 9 7.8 40-44 7 3.8 6 5.2 45-49 2 1.1 2 1.7 >50 2 1.1 1 0.9 Total 185 100.0 115 100.0 Missing 0 0 Chi-square p-value= 0.227

Table 7.1 shows the age distribution of male and female graduates who responded to the

survey. Four-fifths (80.0%) of the male respondents were between the ages of 30 and 39 years,

compared to 70.4% of the female respondents. There was no statistically significant difference

between groups.


Race

Table 7.2 Males

(n=185) Females (n=115)

Race Number Percent Number Percent American Indiana/ Native Alaskan 0 0.0 0 0.0 Asian 25 14.1 18 16.5 Black/African American 5 2.8 6 5.5 Native Hawaiian/ Pacific Islander 1 0.6 0 0.0 White 137 77.4 79 72.5 Other 9 5.1 6 5.5 Total 177 100.0 109 100.0 Missing 8 6 Chi-square p-value= 0.778

Table 7.2 shows the racial distribution between the male and female graduates who

responded to the survey. Almost three-fourths of the male (77.4%) and female (72.5%)

respondents were white. Over one-tenth of the male (14.1%) and female (16.5%) respondents

were Asian. There was no statistically significant difference between groups.

Ethnicity

Table 7.3 Males

(n=185) Females (n=115)

Ethnicity Number Percent Number Percent Hispanic or Latino 7 4.1 7 6.5 Not Hispanic or Latino 165 95.9 101 93.5 Total 172 100.0 108 100.0 Missing 13 7


Table 7.3 shows the ethnicity of male and female graduates who responded to the survey.

Less than one-tenth of the male (4.1%) and female (6.5%) respondents indicated having a

Hispanic ethnicity. There was no statistically significant difference between groups.



Table 7.4 Males

(n=185) Females (n=115)

What do you consider to be your home state prior to your current training program? Number Percent Number Percent Outside USA 25 13.7 22 19.3 Within USA 158 86.3 92 80.7 Outside Indiana 88 48.1 49 43.0 Within Indiana 70 38.3 43 37.7 Total 183 100.0 114 100.0 Missing 2 1


Table 7.4 shows what the male and female respondents considered their home state prior

to their current training program. Over one-tenth of male (13.7%) and female (19.3%)

respondents were from another country. Of the respondents who were from the United States,

over two-fifths of the male (48.1%) and female (43.0%) respondents were from outside Indiana.



Table 7.5 Males

(n=185) Females (n=115)


Table 7.5 shows the male and female respondents who reported having an Indiana

hometown, or who graduated from high school, college, or medical school in Indiana. Almost

two-fifths of the male (38.3%) and female (37.7%) respondents indicated having a hometown in

Indiana. Over one-fourth of the male respondents reported graduating from a high school

(30.7%), college (29.9%), or medical school (30.7%) in Indiana. Over one-third of the female

respondents indicated they graduated from a high school (37.2%), college (40.4%), or medical

school (36.9%) in Indiana.


Training program

Table 7.6 Males

(n=185) Females (n=115)

The residency or fellowship training program was helpful in the preparation for my board exam? Number Percent Number Percent Strongly Agree 62 37.6 31 29.0 Agree 87 52.7 58 54.2 Neutral 14 8.5 13 12.1 Disagree 1 0.6 3 2.8 Strongly Disagree 1 0.6 2 1.9 Total 165 100.0 107 100.0 Missing/ Board Exam in my field does not exist 20 8


Table 7.6 shows the male and female respondents’ assessment of how helpful their

training was in preparing them for the board exams. Over four-fifths of the male (90.3%) and

female (83.2%) respondents “strongly agree” or “agree” that their training was helpful in

preparing them for their board exams. There was no statistically significant difference between

groups.




Males (n=185)

Females (n=115)













Table 7.7 shows the male and female respondents’ self-rated competency level in the

ACGME competency areas. Nearly all male and female respondents felt “fully” competent in

the areas of patient care (96.6%, 98.2%), interpersonal and communication skills (97.2%,

98.1%), and professionalism (97.1%, 96.4%), respectively. There was no statistically significant





Males (n=185)

Females (n=115)

Rural Population Percent Percent p-value Yes 54.5 52.7 0.770 No 45.5 47.3

Underserved Population Percent Percent p-value Yes 90.2 90.9 0.849 Not 9.8 9.1

Table 7.8a shows whether the male and female respondents’ received training to serve the

rural and underserved populations. Over one-half of the male (54.5%) and female (52.7%)

respondents indicated they had received training to serve rural populations. There was no


A majority of the male (90.2%) and female (90.9%) respondents reported they had

received training to serve the underserved population. There was no statistically significant



Table 7.8b

How competent do you feel providing care to the: Males

(n=185) Females (n=115)





Table 7.8b shows the male and female respondents’ self-rated competency levels in

providing care to rural and underserved populations. Over two-thirds of male (79.4%) and

female (69.1%) respondents indicated feeling “fully” competent in providing care to the rural

population. There was no statistically significant difference between groups.


Nearly all male (96.0%) and female (94.4%) respondents indicated feeling “fully”

competent in providing care to the underserved populations. There was no statistically


Program Opportunities

Table 7.9

In the current academic year did you: Males (n=185)

Females (n=115)

Have an opportunity to be part of a multidisciplinary inter-professional team Percent Percent p-value Yes 96.0 95.5 0.848 No 4.0 4.5

Participate in a quality improvement project to improve health outcome Percent Percent p-value Yes 75.8 71.4 0.403 No 24.2 28.6

Participate in a patient safety project Percent Percent p-value Yes 58.8 45.9 0.034ǂ No 41.2 54.1

Use electronic health records, including order entry and progress notes Percent Percent p-value Yes 98.8 98.1 0.625 No 1.2 1.9

Table 7.10 shows if there were any opportunities available for the male and female

respondents to participate in the current academic year. Nearly all of the male and female

respondents had the opportunity to be part of a multidisciplinary inter-professional team (96.0%,

95.5%), and use electronic health records (98.8%, 98.1%), respectively. There was no


About three-fourths of the male (75.8%) and female (71.4%) respondents reported

participating in a quality improvement project. There was no statistically significant difference

between groups.

Over one-half (58.8%) of male respondents indicated participating in a patient safety

project, compared to two-fifths (45.9%) of the female respondents. The chi-square test of

association between the two groups was statistically significant. Male respondents were more

likely to participate in a patient safety project.


Quality of Program

Table 7.10 Males

(n=185) Females (n=115)

I would rate the overall quality of my residency or fellowship program as: Number Percent Number Percent Excellent 103 57.9 60 54.1 Above Average 46 25.8 38 34.2 Average 13 7.3 10 9.0 Below Average 7 3.9 1 0.9 Extremely Poor 9 5.1 2 1.8 Total 178 100.0 111 100.0 Missing 7 4 Chi-square p-value= 0.181

Table 7.10 shows the male and female respondents’ overall rating of quality of their

residency or fellowship training program. Over four-fifths of the male (83.7%) and female

(88.3%) respondents indicated that the quality of their training program was “excellent” or

“above average.” There was no statistically significant difference between groups.

Faculty assessment

Table 7.11 Males

(n=185) Females (n=115)

I would rate the overall performance of the faculty in my residency or fellowship program to have exceeded my expectations? Number Percent Number Percent Strongly Agree 84 47.5 47 42.0 Agree 68 38.4 45 40.2 Neutral 21 11.9 16 14.3 Disagree 3 1.7 4 3.6 Strongly Disagree 1 0.6 0 0.0 Total 177 100.0 112 100.0 Missing 8 3 Chi-square p-value= 0.653

Table 7.11 shows the male and female respondents’ overall performance rating of the

faculty in their training program. Over four-fifths of the male (85.9%) and female (82.2%)

respondents indicated they “strongly agree” or “agree” that the faculty in their program had

exceeded their expectations. There was no statistically significant difference between groups.



Table 7.12 Males

(n=185) Females (n=115)


Table 7.12 shows the male and female respondents’ overall performance rating of other

residents or fellows in their training program. Over four-fifths of the male (87.5%) and female

(87.5%) respondents indicated they “strongly agree” or “agree” that other residents or fellows in

their program had exceeded their expectations. There was no statistically significant difference

between groups.


Table 7.13a Males

(n=185) Females (n=115)

What do you expect to be doing after completion of your current residency or fellowship program? Number Percent Number Percent Patient care or clinical practice (in Non-training position) 87 47.0 68 59.1 Fellowship or Additional Subspecialty Training 53 28.6 30 26.1 Academic position (Teaching and/or research) 38 20.5 13 11.3 Temporarily out of medicine 0 0.0 0 0.0 Military 1 0.5 0 0.0 Industry 0 0.0 0 0.0 Other 3 1.6 3 2.6 Undecided or don't know yet 3 1.6 1 0.9 Total 185 100.0 115 100.0 Missing 0 0 Chi-square p-value= 0.220

Table 7.13a shows what the male and female respondents expect to do after completing

their current training program. Over two-fifths of the male (47.0%) respondents planned to go

into patient care or clinical practice after completing their training, compared to three-fifths

(59.1%) of the female respondents. Over one-fourth of the male (28.6%) and female (26.1%)

respondents planned to continue with additional training. There was no statistically significant



Work status

Table 7.13b Males

(n=185) Females (n=115)


Full-time 176 97.2 100 90.9 Part-time 5 2.8 10 9.1 Total 181 100.0 110 100.0 Missing 4 5



current program. Nearly all the male (97.2%) and female (90.9%) respondents indicated

working full-time. Of the male respondents intending to work part-time, two intended to work

30 hours per week; two less than 30 hours per week; and one did not indicate the hours. Of the

female respondents intending to work part-time, three planned to work 30 hours per week; six

less than 30 hours per week; and one did not indicate the hours. There was no statistically





Figure 7.1 presents the current level of educational debt among the male and female

respondents. To maintain chart clarity, percentage values have not been shown on the graph.

Over one-fifth (21.2%) of male and female (26.8%) respondents had no educational debt.

Nearly two-fifths of the male (39.7%) and female (39.3%) respondents had an educational debt

of $200,000 or more. There was no statistically significant difference between groups.

05

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Males (n=185) Females (n=115)




Figure 7.2 presents the current level of total household educational debt among male and

female graduates. To maintain chart clarity, percentage values have not been shown on the

graph.

Nearly one-fifth of the male (19.0%) and female (21.4%) respondents had no educational

debt. Two-thirds of male (67.0%) and female (66.1%) respondents had an educational debt of

$100,000 or more. One-half of the male (50.3%) and female (46.4%) respondents had an

educational debt of $200,000 or more. There was no statistically significant difference between

groups.

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Type of Practice

Table 7.14

Clinical Care Respondents Males (n=87)

Females (n=68)

Which best describes the principal type of Patient Care Practice you will be entering? Number Percent Number Percent Solo practice 4 5.1 1 1.9 Partnership (2 person) 4 5.1 2 3.7 Group Practice 45 57.0 32 59.3 Hospital‐inpatient 9 11.4 6 11.1 Hospital‐ambulatory care 6 7.6 7 13.0 Hospital‐emergency department 7 8.9 4 7.4 Free‐standing health center or clinic 3 3.8 1 1.9 Nursing Home 0 0.0 0 0.0 Other (specify) 1 1.3 1 1.9 Total 79 100.0 54 100.0 Missing 8 14

Chi-Square p-value= 0.584

Table 7.14 shows the principal type of patient care practice the male and female

respondents will be entering after completing their training. About three-fifths of the male

(57.0%) and female (59.3%) respondents intended to work in a “group practice” setting. Over

one-fourth of the male (27.9%) and female (31.5%) respondents planned to practice in a hospital

setting. There was no statistically significant difference between groups.


Table 7.15


Females (n=68)

In your upcoming position, what amount of direct patient-care activities will you do? Number Percent Number Percent No patient-care activities 0 0.0 1 1.5 Part-time patient-care activities 5 6.0 8 11.9 Full-time patient-care activities 79 94.0 58 86.6 Total 84 100.0 67 100.0 Missing 3 1

Chi-Square p-value= 0.219

Table 7.15 shows the male and female respondents’ expected amount of time spent in

direct patient-care activities in their upcoming position. Nearly all male (94.0%) and over four-

fifths of the female (86.6%) respondents indicated that they would be working full-time in

patient-care activities. There was no statistically significant difference between groups.



*Reflects responses from only those respondents who indicated intending to work full-time in patient care activities Chi-square p-value= 0.000ǂ

Figure 7.3 presents the gross income that male and female respondents’ expect to earn

during their first year of practice. Only those respondents who indicated working full-time in

direct patient-care activities were included in this analysis. To maintain chart clarity, percentage


Of those intending to work full-time, over four-fifths (84.1%) of the male respondents

expect to earn $200,000 or more during their first year of practice, compared to over one-third

(38.6%) of the female respondents. The chi-square test of association between the two groups

was statistically significant. Male respondents were more likely to report they expect to earn

$200,000 or more during their first year of practice.

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Table 7.16


Females (n=68)

Where is the location of your primary activity after completing your current training program? Number Percent Number Percent Same city or county as current training 18 21.7 23 34.3 Same region in Indiana, but different city or county 5 6.0 7 10.4 Other area in Indiana 10 12.0 9 13.4 Other U.S. state (not Indiana) 49 59.0 18 26.9 Outside of U.S. 0 0.0 0 0.0 Undecided 1 1.2 10 14.9 Total 83 100.0 67 100.0 Missing 4 1 Chi-square p-value= 0.000ǂ

Table 7.16 shows the location of primary activity for the male and female respondents

after completion of their training program. Two-fifths of the male (39.7%) and three-fifths of the

female (58.1%) respondents planned to practice within Indiana. The chi-square test of

association between the two groups was statistically significant. Male respondents were more

likely to practice in another state.


Table 7.17


Females (n=68)


Table 7.17 shows the total number of offers the male and female respondents received for

employment or practice positions. About one-half of the male (54.1%) and female (48.2%)

respondents reported being offered three or more employment or practice positions. There was




Table 7.18

Clinical Care Respondents* Males (n=33)

Females (n=39)

How many offers for employment/practice positions did you receive in Indiana? Number Percent Number Percent 0 0 0.0 1 2.8 1 10 35.7 10 27.8 2 12 42.9 12 33.3 3 5 17.9 10 27.8 4 1 3.6 2 5.6 5 0 0.0 1 2.8 Total 28 100.0 36 100.0 Missing/ Did not seek employment positions at this time 5 3 *Of those respondents who indicated their primary practice location was in Indiana


Table 7.18 shows the number of offers the male and female respondents received for

employment or practice positions in Indiana. Only those respondents who indicated their

primary practice location was in Indiana were included in the analysis.

Of those intending to practice in Indiana, over one-fifth (21.5%) of the male respondents

were offered three or more employment or practice positions, compared to over one-third

(36.2%) of the female respondents. There was no statistically significant difference between

groups.



Chi-square p-value= 0. 001ǂ

Figure 7.4 presents the overall assessment of practice opportunities for male and female

respondents within their specialty. To maintain chart clarity, percentage values have not been

shown on the graph.

Over two-thirds (68.8%) of male respondents reported there were “many jobs” or “some

jobs” available within their specialty in Indiana, compared to over four-fifths (80.4%) of female


significant. Female respondents were more likely to report they had “some jobs” available.

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Figure 7.5 present the main reasons influencing the male and female respondent’s choice

of practice location. To maintain chart clarity, percentage values have not been shown on the

graph.

The top three reasons given by the male respondents for choosing to practice at this

location were: “liked the people” (66.7%), “met my personal needs or preferences” (60.9%), and

“met my professional needs or preferences” (55.2%). The top three reasons given by the female

respondents for choosing to practice at this location were: “liked the people” (55.9%), “met my

personal needs or preferences” (51.5%), and “met my professional needs or preferences”

(47.1%). The chi-square test of association between the two groups was statistically significant

for salary, proximity to recreation, and climate. Male respondents were more likely to practice at

this location due to salary or compensation, proximity to recreation, and climate.

0 10 20 30 40 50 60 70 80 90 100


Other

Climateǂ


Proximity to recreationǂ



Salaryǂ



Liked the people







Figure 7.6 presents the main reasons influencing male and female respondents choice of

practice location in Indiana. Only those respondents who indicated their primary practice

location was in Indiana were included in this analysis. To maintain chart clarity, percentage


Of those intending to practice in Indiana, the top-three responses given by the male

respondents for choosing to practice in Indiana were: “cost of practicing is reasonable in

Indiana” (51.5%), “proximity to my family” (48.5%), and “salary or compensation” (33.3%).

The top three reasons given by the female respondents for choosing to practice in Indiana were:

“proximity to my family” (46.2%), “cost of practicing is reasonable in Indiana” (38.5%), and

“proximity to my spouse’s family” (33.3%). There was no statistically significant difference

between groups.

0 10 20 30 40 50 60 70 80 90 100

Climate



Rotation experience

Other


More job opportunities in IN












Figure 7.7 presents the main reasons influencing male and female respondents choice of

practice location outside Indiana. Only those who indicated their primary practice location was

outside Indiana were included in this analysis. To maintain chart clarity, percentage values have

not been shown on the graph.

Of those intending to practice outside Indiana, the top three reasons given by the male

respondents for choosing not to practice in Indiana were: “proximity to my family” (44.9%),

“proximity to my spouse’s family” (36.7%), and “lack of jobs in Indiana” (36.7%). The top

reasons given by the female respondents for choosing not to practice in Indiana were: “proximity

to my family” (38.9%) and “proximity to my spouse’s family” (27.8%). The chi-square test of

association between the two groups was statistically significant for never intended to practice in

Indiana and other reasons. Male respondents were more likely to practice outside Indiana

because of lack of jobs in the state, while female respondents were more likely to practice

outside Indiana due to other reasons.

0 10 20 30 40 50 60 70 80 90 100

No opportunity for my spouse ǂ

Cost is too high

Inadequate salary

Other



Climate

Lack of jobs in IN ǂ




Figure 7.7: Main Reasons to Not to Practice in Indiana*



Medically Underserved Area (MUA)/ Health Professions Shortage Area (HPSA) or Expected to

Serve the Underserved Population


Figure 7.8 presents the male and female respondents’ response for going to practice in the

MUA/HPSA or those expecting to serve the underserved population in their new practice. Only

those clinical care respondents who had no visa obligation were included in the analysis for this

graph. To maintain chart clarity, percentage values have not been shown on the graph.

Of those going into clinical care with no visa obligation, one-half of the male (50.0%)

and female (57.4%) respondents indicated that they will either be located in a designated

MUA/HPSA or expecting to serve a substantial proportion (greater than 50%) of patients from

underserved populations in their new practice.

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CHAPTER 8: TRENDING PATTERNS, 2008-2013

This chapter shows a comparison of responses to the Graduate Medical Education Exit

Survey from the time of its inception in 2008 through 2013. Figures 8.1 to 8.4 present responses

related to demographics, ACGME competency areas, plans after graduation, and education debt.

These include responses from all respondents (n=300). Figures 8.5 through 8.9 present

responses to questions related to practice characteristics namely, type of practice, principal

practice location, expected gross income, job offers all together and within Indiana, and

assessment of practice opportunities. These include responses from only those respondents who

were planning to go into “patient care or clinical care practice” after graduation (n=155).



*This question was not asked on the 2008 IUSM GME exit survey

Figure 8.1 shows trends for what the graduates’ considered to be their home state prior to

the current training program. This question was not asked on the 2008 exit survey. There is an

increasing trend in international students graduating from the IUSM residency and fellowship

programs from 6.5% in 2009 to 15.8% in 2013.

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100

2009 2010 2011 2012 2013

Figure 8.1: Home State Prior to Training

Outside USA Outside Indiana Within Indiana


ACGME competency areas

Figures 8.2a and 8.2b show trends among the graduates’ self-rated competency level in

each of the six ACGME competency areas. This question was not asked on the 2008 exit survey.


Figure 8.2a shows trends among the graduates’ self-rated competency level in ACGME

competency areas where they felt more than 90 percent “fully” competent (patient care,

interpersonal communication skills, and professionalism). This question was not asked on the

2008 exit survey. Since 2009, there is an increasing trend in the respondents’ self-rated ACGME

competency levels of being “fully” competent in each of those three areas; however, it plateaued

in 2012 and 2013.

90919293949596979899

100

2009 2010 2011 2012 2013

Figure 8.2a: ACGME Competencies >90% "Fully" Competent

Patient CareInterpersonal and Communication skillsProfessionalism



Figure 8.2b shows trends among the graduates’ self-rated competency level in the

ACGME competency areas where they felt less than 90 percent “fully” competent (medical

knowledge, practice-based learning and improvement, and systems-based practice). This

question was not asked on the 2008 exit survey. Since 2009, there is a steady increase in the

respondents’ self-rated ACGME competency levels of being “fully” competent in each of those

three areas.

7577798183858789919395

2009 2010 2011 2012 2013

Figure 8.2b: ACGME Competencies ≤90% "Fully" Competent

Medical KnowledgePractice-based learning and improvementSystems-based practice


Expected area of practice after graduation

Figure 8.3 shows the trend for what the graduates’ planned to do after completing their

current training program. There has been a steady decrease from 65.0% (in 2008) to 51.7% (in

2013) among those planning to go into “patient care or clinical practice” after completing their

training. However in 2012 and 2013, an increasing trend was noted among those going into an

“academic” position (teaching and/or research).

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100

2008 2009 2010 2011 2012 2013

Figure 8.3: Expected Area of Practice After Graduation

Patient care or clinical practice (in non-training position)Additional subspecialty training or fellowshipTeaching or research (in non-training position)



Figure 8.4 shows the trends in current level of education debt among all graduates who

responded to the survey. There is an increasing trend from 5.2% (in 2008) to 18.4% (in 2013)

among respondents who indicated having an education debt of $250,000 or more.

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2008 2009 2010 2011 2012 2013

Figure 8.4: Current Level of Educational Debt

<$100,000 $100,000-$249,999 ≥$250,000



Type of patient care practice

Figure 8.5 shows the trend among the principal type of practice setting the graduates’ will

be entering after completing their training program. Those going into “group practice” have

remained steady since 2008. However, there is an increasing trend noted among those going into

“hospital-inpatient” in 2010, but it has been steady since.

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2008 2009 2010 2011 2012 2013

Figure 8.5: Type of Patient Care Practice

Group practice Hospital‐inpatient Hospital‐ambulatory care Hospital‐emergency department



*This question had different response options on the 2008 IUSM GME exit survey

Figure 8.6 shows the trend for the gross income that graduates expect to earn during their

first year of practice. The response options were different on the 2008 survey and thus have not

been included in this figure. An increasing trend from 31.9% (in 2009) to 39.0% (in 2013) is

noted among respondents who expect to earn between $200,000 and $299,999 during their first

year of practice. In addition, an increase is noted among those who expect to earn $400,000 or

more during their first year of practice ranging from 4.2% in 2009 to 11.5% in 2013.

05

101520253035404550

2009 2010 2011 2012 2013

Figure 8.6: Expected Gross Income

<$100,000 $100,000-$199,999 $200,000-$299,999$300,000-$399,999 >$400,000



Figure 8.7 shows the trends in the total number of job offers the graduates’ received for

employment. There is a slight increase noted among those who indicated receiving 1 to 2 job

offers all together, from 2008 (35.7%) to 2013 (47.7%). Those who indicated receiving 3 to 4

job offers all together have remained steady over the years.

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2008 2009 2010 2011 2012 2013

Figure 8.7: Job Offers All Together

0 1-2 3-4 5 or more



*Of those respondents who indicated their primary practice location was in Indiana

Figure 8.8 shows trends in the number of job offers the graduates’ received for

employment positions in Indiana. Only those respondents who indicated they will be practicing

in Indiana were included in this figure. An increasing trend is noted among those who indicated

receiving 1 to 2 job offers in Indiana, ranging from 52.8% (in 2008) to 68.8% (in 2013).

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2008 2009 2010 2011 2012 2013

Figure 8.8: Job Offers in Indiana

0 1-2 3-4 5 or more


Practice opportunity assessment

Figure 8.9 shows the trends in the overall assessment of practice opportunities for

graduates within their specialty in Indiana. There is a 20 percent decline among those indicating

there were “many jobs” available from 2008 (49.6%) to 2013 (29.7%). In addition, there is a

slight increase in those reporting “no jobs” between 2008 (0.0%) and 2013 (3.1%).

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Figure 8.9: Practice Opportunity Assessment

Many jobs Some jobs Few jobs Very few jobs No jobs


CHAPTER 9: DISTRIBUTION OF GRADUATES’ PRACTICE LOCATION USING GIS MAPS

Map 9.1 displays the distribution of principal practice locations of the 2013 IUSM Graduate Medical Education Exit Survey

clinical care respondents. Their response to Q15 on the survey was used to determine the primary practice location address. Of the

155 clinical care survey respondents, 120 provided their practice location address. The respondents were dispersed over 27 states. Of

whom, over one-half (54.2%) practiced in Indiana. Map 9.1: Distribution of Principal Practice Location of 2013 IUSM Exit Survey Clinical Care Respondents

Nevada

Texas

Utah

Arizona California

Washington

Georgia

Tennessee

Kentucky

Ohio

Missouri

Illinois

Indiana

Michigan

Alabama

Louisiana

Wisconsin

Idaho

Florida

Pennsylvania

North Carolina

South Carolina

Oregon

Arkansas

Mississippi

Maine


Map 9.2 displays the distribution of principal practice locations of the 2013 IUSM

Graduate Medical Education Exit Survey respondents. Their response to Q15 on the survey was

used to determine the primary practice location address. All sixty five clinical care survey

respondents that intended to practice in Indiana provided their practice location address. The

respondents were dispersed over 18 counties. Of whom, one-half (50.7%) intended to practice in

Marion county.

Map 9.2: Distribution of Principal Practice Location of 2013 IUSM Exit Survey Respondents within Indiana


APPENDIX 1

Indiana University School of Medicine 2013 Graduate Medical Education Exit Survey

In an effort to improve our program and document where our graduates go after their residency or fellowship program, we would like you to please respond to the following questions. Your responses to these questions will be kept confidential. A summary report will be created by the staff of the IU Bowen Research Center and only aggregated results will be shared with the program director. Your responses are very important to us, but if you do not want to answer a question, you may leave it blank. Your decision to participate in this survey will not affect your graduation from the program. 1. First name: Middle initial: Last name: ______________ 2. Birth date: (mm/dd/yyyy) __ __ / __ __ / __ __ __ __ 3. Gender: Male ______ Female ______ 4. Which of the following describes your race? Please mark ALL that apply.

o American Indian/ Native Alaskan o Asian o Black/African American o Native Hawaiian/ Pacific Islander o White o Other (please specify): _________________

5. Do you consider yourself to be Hispanic or Latino?

o Yes, Hispanic/Latino o No, not Hispanic/Latino

6. What do you consider your hometown?

o City ________________ State _____ Zip code ___________ o Outside of US

7a. Where was the high school located from which you graduated?

o City _____________ State _____ o Outside of U.S.

7b. Where was the college located from which you graduated?

o City _____________ State _____ o Outside of U.S. o Not Applicable


7c. Where was the medical school located from which you graduated? o City _____________ State _____ o Outside of U.S.

8. What do you expect to be doing after completion of your current residency or fellowship program? Please mark only ONE option.

o Patient Care or Clinical Practice (in Non-Training position) o Fellowship or Additional Subspecialty Training (please specify) __________________ o Academic position (Teaching and/or Research) o Temporarily Out of Medicine o Military o Industry o Other (please specify): ________________________________________ o Undecided or Don't know yet

9a. After your current graduation, do you expect to be working full-time or part-time?

o Full-time o Part-time

9b. If part-time, how many hours per week do you plan to work? ____ ____ 10. In your upcoming position, what amount of direct patient-care activities will you do?

o No patient-care activities o Part-time patient-care activities o Full-time patient-care activities

11. Where is the location of your primary activity after completing your current residency or fellowship program?

o Same city or county as current training o Same region in Indiana, but different city or county o Other area in Indiana o Other U.S. state (not Indiana) o Outside of U.S. o Undecided

12. What is your current level of educational debt?

o None o Less than $50,000 o $50,000 - $99,999 o $100,000 - $149,999 o $150,000 - $199,999 o $200,000 - $249,999 o $250,000 and over

13. Considering others in your household, what is the current total level of educational debt? o None o Less than $50,000


o $50,000 - $99,999 o $100,000 - $149,999 o $150,000 - $199,999 o $200,000 - $249,999 o $250,000 and over

14. Do you have an obligation or visa requirement to work in a designated health professional shortage area or medically underserved area when you complete your training?

o Yes o No

15. What is the name and address of your principal work location after completing your current residency or fellowship program? Name of facility: _________________________________________________ Street address: ________________________________________________ City: ____________________ State: ________________ Zip code: ____________ If you have NOT accepted a position in patient care practice, SKIP to question 25. 16. Which best describes the principal type of Patient Care Practice you will be entering?

o Solo practice o Partnership (2 person) o Group practice o Hospital - inpatient o Hospital - ambulatory care o Hospital - emergency department o Free-standing health center or clinic o Nursing home o Other (specify): _________________________________________________

17. In your new practice, what percentage of the patients do you expect to see from underserved populations? (Medicaid or self-pay, educationally or economically disadvantaged)

o Less than 10 percent o 10- 24 percent o 25- 49 percent o 50- 74 percent o More than 75 percent

18. What are the main reasons you decided to practice at this location? Please mark ALL that apply.

o Salary or compensation o Liked the people


o Opportunity for my spouse or significant other there o Met my personal needs or preferences o Met my professional needs or preferences o Satisfy loan or scholarship requirement o Proximity to my family o Proximity to my spouse's or significant other's family o Proximity to recreation o Climate o Other (specify): ________________________________________

19. If you plan to practice in Indiana, please indicate the main reasons why? Please mark ALL that apply.

o More jobs or practice opportunities in Indiana o Salary or compensation o Opportunity for my spouse or significant other o Cost of practicing is reasonable in Indiana o Proximity to my family o Proximity to my spouse's or significant other's family o Proximity to recreation o Climate o Always intended to practice in Indiana o Relationship with my mentor o Rotation experience o Other (specify): ________________________________________

20. If you are not planning to practice in Indiana, please indicate the main reasons why. Please mark ALL that apply.

o Lack of jobs or practice opportunities in Indiana o Inadequate salary or compensation o No opportunity for my spouse or significant other o Cost of practicing too high in Indiana o Proximity to my family o Proximity to my spouse's or significant other's family o Proximity to recreation o Climate o Never intended to practice in Indiana o Other (specify): ________________________________________

21. Expected gross income (salary + incentives) during your first year of practice:

o Less than $50,000 o $50,000 - $99,999 o $100,000 - $149,999 o $150,000 - $199,999 o $200,000 - $249,999 o $250,000 - $299,999 o $300,000 - $349,999


o $350,000 - $399,999 o $400,000 - $449,999 o $450,000 - $499,999 o $500,000 or more

22. How many offers for employment/practice positions did you receive all together?

o Did not seek an employment position at the time o 0 o 1 o 2 o 3 o 4 o 5 or more

23. How many offers for employment/practice positions did you receive in Indiana?

o Did not seek employment positions in Indiana o 0 o 1 o 2 o 3 o 4 o 5 or more

24. What is your overall assessment of practice opportunities in your specialty in Indiana?

o Many jobs o Some jobs o Few jobs o Very few jobs o No jobs

25. The residency or fellowship training program was helpful in the preparation for my board exams?

o Strongly Agree o Agree o Neutral o Disagree o Strongly Disagree o Board exam in my field does not exist

26. How competent do you feel in the following ACGME competencies?

Fully Partially Not at all a. Patient Care b. Medical Knowledge c. Practice-based learning and improvement d. Interpersonal and Communication skills e. Professionalism


f. Systems-based practice 27a. In your residency or fellowship program, did you receive training to serve the:

i. Rural population Yes No ii. Underserved population Yes No

27b. How competent do you feel providing care to the:

Fully Partially Not at all i. Rural population

ii. Underserved population 28. In the current academic year, did you: a. Have an opportunity to be part of a multi-disciplinary inter-professional team to provide care?

Yes No b. Participate in a quality improvement project to improve health outcome?

Yes No c. Participate in a patient safety project?

Yes No d. Utilize electronic health records, including order entry and progress notes, in the direct care of patients?

Yes No 29. I would rate the overall quality of my residency or fellowship program as:

o Excellent o Above Average o Average o Below Average o Extremely Poor

30. I would rate the overall performance of the faculty in my residency or fellowship program to have exceeded my expectations?

o Strongly Agree o Agree o Neutral o Disagree o Strongly Disagree

31. I would rate the overall performance of the other residents/fellows in my residency or fellowship program to have exceeded my expectations?

o Strongly Agree o Agree o Neutral o Disagree o Strongly Disagree

32. Please add your suggestions for improving the residency or fellowship program.


33. Please list your ideas for new areas for the residency or fellowship curriculum. Q33 is the last question. Thank you for completing the 2013 Graduate Medical Education Exit Survey!


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