Update On Graduate Medical Education Positions

The Accreditation Council for Graduate Medical Education (ACGME) recently published its annual Data Resource Book (DRB). The ACGME DRB provides authoritative data on trends of interest to those involved in Graduate Medical Education (GME) and physician workforce policies.

The new Book documents a small but steady growth in “pipeline” programs—which lead to initial board certification—and a larger percentage growth in the number of “continuing” programs and positions in subspecialties. It also documents that a large number of foreign medical school graduates continue to enter GME each year.

Data On GME Trends

The ACGME is the accrediting body for US allopathic training, and all ACGME-accredited programs report basic data to the organization. The ACGME DRB summarizes data for the previous academic year (2014-2015 in this case) and trends for the last 10 years. The Book includes data on the residents and fellows entering and completing training, as well as geographic and other characteristics of GME programs, leadership, and faculty as reported for accreditation purposes. The strength of the data is its completeness and the consistency of the data collection process.

The ACGME reports 27,534 entrants into pipeline programs for 2014-15. This includes 2,930 doctors of osteopathic medicine (DOs) who entered ACGME-accredited programs during the academic year. However, as of 2014-15, residency programs approved solely by the American Osteopathic Association (AOA) were not accredited by the ACGME, and therefore the programs and their residents are not included in the Book. Since there were about 2,000 entrants into residency programs authorized solely by the AOA in 2014-15 (Note 1), the ACGME data is missing roughly 7 percent of those entering GME.

Osteopathic residents and fellows in ACGME-accredited programs are increasing in number and totaled 10,999 in 2014-15. The good news is that a merger of the ACGME and AOA accreditation systems is underway, so within the next few years a single comprehensive source of data on all GME should be available.

While many people use the data from the National Resident Matching Program (NRMP) to monitor the inflow of physicians into training, not all physicians go through the match, so caution is needed in interpreting the NRMP data. The advantage of the NRMP data is that it is available several months before the training year begins and about 18 months before the ACGME data.

While NRMP data is not as complete as ACGME data, it is getting more complete. Until recently, only US MD seniors were required to go through the NRMP. Each year, several thousand physicians, predominantly international medical school graduates (IMGs), went outside the NRMP and directly secured positions in residency programs.

With the recent introduction of the “all in” NRMP policy, programs cannot recruit residents both through and outside the NRMP. Almost all residency programs are now participating through the NRMP. However, the NRMP data does not encompass the matches for AOA-accredited programs, the military matches, or the San Francisco match (which includes ophthalmology and several sub-specialties). At this time, we do not know how many residency positions are obtained outside of the NRMP.

Key Findings From The 2014-15 ACGME Data Resource Book

1. The number of entrants into ACGME residency programs continues to grow. Between AY 2005-06 and AY 2014-15, the number of residents entering pipeline programs grew from 24,368 to 27,534, an increase of 3,166 residents or 13 percent. The represents a growth rate of about 1.2 percent per year. (Again, this does not include the growth in programs solely accredited by AOA.)

Source: ACGME Data Resource Book, Academic Year 2014-2015

2. The number of IMGs entering pipeline positions has been relatively constant, with more than 6,800 entrants in 2014-15. The net effect is that IMG entrants into ACGME programs as a portion of all entering residents fell from 27.9 percent (6773/24,386) to 24.8 percent (6837/27,534) over the decade.

Source: ACGME Data Resource Book, Academic Year 2014-2015

3. Over the past decade, each year an average of 250 GME programs have been newly accredited while 62 have had their accreditation withdrawn. While most of the additions have been sub-specialty programs, there has been growth in pipeline specialties as well.

Observations

There has been a common belief that the cap on Medicare GME funding has led to a freeze in new GME positions. As demonstrated by the ACGME data, this has not been the case. Funding for expansion of GME pipeline programs appears to come from a number of sources, including funding from the Health Resources and Services Administration for primary care programs, new teaching hospitals eligible for Medicare GME, expanded funding for GME through the Veterans Health Administration, state funding, and hospital self-funded positions.

Importantly, this growth has included entry positions into pipeline programs that lead to initial board certification. However, by percentage most of the growth in GME positions has been in hospital-based specialty and subspecialty continuing programs, where teaching hospitals have self-funded additional GME positions “over the cap.”

With the growth in MD and DO graduates over the past decade, it might have been expected that the GME positions available to IMGs would decrease. Again, as indicated by the ACGME data, this has not happened, and in 2014-15 more than 6,800 IMGs entered pipeline programs.

Note 1

This estimate is based on data from the American Association of Colleges of Osteopathic Medicine (AACOM), and a comparison of graduates of osteopathic schools and the number of DOs entering ACGME programs. There about 500 entry-level positions that are accredited by both the ACGME and the AOA — for this analysis these positions are only included in the ACGME numbers to avoid double counting.

from Health Affairs Blog http://ift.tt/1lTHSHH