Sarah E. Brotherton

This Appendix presents 2022 National GME Census data detailing the numbers and types of ACGME-accredited training programs and the residents and fellows in them.

This Appendix presents 2021 National GME Census data detailing the numbers and types of ACGME-accredited training programs and the residents and fellows in them.

Following medical school, most newly graduated physicians enter residency training. This period of graduate medical education (GME) is critical to creating a physician workforce with the specialized skills needed to care for the population. Completing GME training is also a requirement for obtaining medical licensure in all 50 states. Yet, crucial federal and state funding for GME is capped, creating a bottleneck in training an adequate physician workforce to meet future patient care needs. Thus, additional GME funding is needed to train more physicians. When considering this additional GME funding, it is imperative to take into account not only the future physician workforce but also the value added by residents to teaching hospitals and communities during their training. Residents positively affect patient care and health care delivery, providing intrinsic and often unmeasured value to patients, the hospital, the local community, the research enterprise, and undergraduate medical education. This added value is often overlooked in decisions regarding GME funding allocation. In this article, the authors underscore the value provided by residents to their training institutions and communities, with a focus on current and recent events, including the global COVID-19 pandemic and teaching hospital closures.

Background: A recent study found that states that expanded Medicaid under the Affordable Care Act (ACA) gained new general internists who were establishing their first practices, whereas nonexpansion states lost them. Objective: The objective of this study was to examine the level of social disadvantage of the areas of expansion states that gained new physicians and the areas of nonexpansion states that lost them. Research Design: We used American Community Survey data to classify commuting zones as high, medium, or low social disadvantage. Using 2009–2019 data from the AMA Physician Masterfile and information on states’ Medicaid expansion status, we estimated conditional logit models to compare where new physicians located during the 6 years following the expansion to where they located during the 5 years preceding the expansion. Subjects: A total of 32,102 new general internists. Results: Compared with preexpansion patterns, new general internists were more likely to locate in expansion states after the expansion, a finding that held for high, medium, and low disadvantage areas. We estimated that, between 2014 and 2019, nonexpansion states lost 371 new general internists (95% confidence interval, 203–540) to expansion states. However, 62.5% of the physicians lost by nonexpansion states were lost from high disadvantage areas even though these areas only accounted for 17.9% of the population of nonexpansion states. Conclusions: States that opted not to expand Medicaid lost new general internists to expansion states. A highly disproportionate share of the physicians lost by nonexpansion states were lost from high disadvantage areas, potentially compromising access for all residents irrespective of insurance coverage.

This Appendix presents 2020 National GME Census data detailing the numbers and types of ACGME-accredited training programs and the residents and fellows in them

Background: Some states expanded Medicaid under the Affordable Care Act, boosting their low-income residents’ demand for health care, while other states opted not to expand. Objective: The objective of this study was to determine whether the Medicaid expansion influenced the states selected by physicians just completing graduate medical education for establishing their first practices. Research Design: Using 2009–2019 data from the American Medical Association Physician Masterfile and information on states’ Medicaid expansion status, we estimated conditional logit models to compare where new physicians located during the 6 years following implementation of the expansion to where they located during the 5 years preceding implementation. Subjects: The sample consisted of 160,842 physicians in 8 specialty groups. Results: Thirty-three states and the District of Columbia expanded Medicaid by the end of the study period. Compared with preexpansion patterns, we found that physicians in one specialty group—general internal medicine—were increasingly likely to locate in expansion states with time after the expansion. The Medicaid expansion influenced the practice location choices of men and international medical graduates in general internal medicine; women and United States medical graduates did not alter their preexpansion location patterns. Simulations estimated that, between 2014 and 2019, nonexpansion states lost 310 general internists (95% confidence interval, 156–464) to expansion states. Conclusions: The Medicaid expansion influenced the practice location choices of new general internists. States that opted not to expand Medicaid under the Affordable Care Act lost general internists to expansion states, potentially affecting access to care for all their residents irrespective of insurance coverage.

This Appendix presents 2019 National GME Census data detailing the numbers and types of ACGME-accredited training programs and the residents and fellows in them

This Appendix presents 2017 National GME Census data detailing the numbers and types of ACGME-accredited training programs and the residents and fellows in them

The American Medical Association (AMA) and the Association of American Medical Colleges (AAMC) sponsor and administer the National GME Census through GME Track,

The American Medical Association (AMA) and the Association of American Medical Colleges (AAMC) jointly sponsor and administer the National GME Census through GM