Paul Jolly

The United States is facing a critical physician shortage. It will only get worse as many more Americans gain insurance coverage under the Affordable Care Act and as additional millions enter the Medicare system. There is a serious concern that the pipeline for the production of the physician workforce is inadequate to meet future needs. It is imperative to continue to monitor the structure and size of this pipeline-the purpose of the research reported here. This descriptive analysis uses data derived from the National Graduate Medical Education Census, which includes reports on the entire population of residents in programs accredited by the Accreditation Council for Graduate Medical Education. Data for the years 2001 to 2010 are reported both on specialties which can be entered directly from medical school or with one preliminary year and on subspecialty residencies and fellowships, which require completion of an earlier residency program. Estimates of the number of new trainees who will practice primary care are provided. In 2010, there were 4,754 residents reported in preliminary programs, 89,142 residents in core specialty and combined specialty programs, and 20,007 in subspecialty and sub-subspecialty programs. Between 2001 and 2010, there was a 13.6% (13,655) increase in all residents. Since 2001, there has been a 6.3% (540) decrease in the number expected to enter primary care. Without a substantially accelerated growth in graduate medical education, the physician workforce will fall short of the nation's needs, and competition for available residency positions will radically increase.

Analysts who assess trends in medical specialty choice often use statistics published by the National Resident Matching Program (NRMP), but a substantial minority of new residents find their positions outside of the NRMP. Rule changes to be implemented by the NRMP in 2013 may have a substantial impact on this behavior.The author quantified and characterized residents who found their positions outside of the NRMP. Using available data, the author was able to distinguish those who were unsuccessful in the NRMP from those who did not register and those who registered but failed to enter a rank order list of preferred programs. NRMP data on applicants in 2009 (n = 36,971) were combined with data from the national resident census contained in the GMETrack system on residents who began their graduate medical education in 2009-2010 (n = 25,432). Residents were classified into categories based on their participation in the NRMP and their success in matching to a position, and by the type of medical school from which they graduated. Applicants who matched in the NRMP were 79.8% of new residents in first-year residency positions (n = 20,287). An additional 5.2% (n = 1,325) participated in the NRMP but were unsuccessful in matching. Aside from a small number of military residents, the remaining 13.7% (n = 3,488) found positions without participating in the NRMP Match. Workforce studies that rely on NRMP statistics alone to establish national trends are seriously deficient.

International medical graduates (IMGs) are an important part of U.S. graduate medical education (GME) and medical practice. They make up a significant number of the participants in both the Electronic Residency Application Service (ERAS) and the National Resident Matching Program (NRMP). The authors analyze and report statistics describing the multiple pathways used by IMGs in pursuit of a U.S. residency position. This is a descriptive study of 10,328 IMGs certified by the Educational Commission for Foreign Medical Graduates (ECFMG) between July 1, 2005 and June 30, 2006. Linked data on this cohort were obtained from the ECFMG, ERAS, and the NRMP, combined with residency data from the National GME Census. The study determined the numbers of members of the study cohort who participated in ERAS and/or the NRMP in 2003 through 2009, and who found a residency appointment in the United States between 2003 and the first half of 2010. The IMGs in the study cohort began applying for residencies in significant numbers in the year immediately following ECFMG certification, but almost half were unsuccessful in their first attempts. Three-quarters of the members of the cohort had begun a residency by 2010. IMGs make up a very substantial fraction of ERAS and NRMP participants. Although they face significant hurdles in achieving their goal, the majority of those who persist are ultimately successful. If enrollments and graduations of U.S. MD- and DO-granting medical schools continue to rise, IMGs' difficulty in finding residencies is sure to increase.

Purpose To determine the size of the overall applicant pool for medical education (applicants to U.S. MD schools and DO schools, and to international medical schools) and to determine the degree of overlap of the three types of applicants. Method A cooperative agreement among the Association of American Medical Colleges, the American Association of Colleges of Osteopathic Medicine, and the Educational Commission for Foreign Medical Graduates permitted the authors to uniquely identify applicants and students of all three types and to combine their data into a study file containing data on applicants for each year. Overlaps in the three applicant pools were then determined, and repeat applicants were separated from first-time applicants. Results A key finding is that two thirds of osteopathic applicants in any recent year also applied to U.S. MD schools, whereas only one in seven U.S. MD applicants also applied to DO schools. Seventy-two percent of students in international medical schools did not apply to any U.S. school in the same year. After separating out repeat applicants, the authors found that 90% of all first-time applicants applied to a U.S. MD school. Conclusions If all first-time applicants applied to U.S. MD schools, the pool of first-time applicants would be increased by only 11%. It may be necessary to recruit additional applicants to meet projected growth in the aggregate capacity of both U.S. MD and DO schools. Although the number and quality of applicants seem to be adequate for the near term, it will be important to continue to monitor these trends.

Medical school tuition and medical student debt have increased dramatically during the past two decades, but loans are available on favorable terms, which makes it possible for students without personal or family means to get a medical education. As an investment, medical education is an excellent choice; its net present value is more than a million dollars. Cost is nevertheless a strong deterrent to potential applicants, especially minority applicants. If tuition and indebtedness continue to increase while physician incomes do not, there may come a time when only the wealthy can finance a medical education, and medical schools may have increasing difficulty recruiting qualified students.

Objective: The purpose of this work is to report on application patterns for residency positions in obstetrics and gynecology. Methods: The Electronic Residency Application Service (ERAS) of the Association of American Medical Colleges (AAMC) records each application for a position in a participating residency program. In the 1996–97 application cycle, all but 16 obstetrics and gynecology residency programs participated. Electronic records were analyzed to obtain a statistical picture of the residency application process. Results: Applications for residency positions in obstetrics and gynecology were processed for 1607 graduates of US medical schools, including 110 graduates of osteopathic medical schools. Canadian applicants were six, and other foreign applicants numbered 524. More than two-thirds of US applicants were women, and nine of ten were citizens or permanent residents. Most applicants sent official United States Medical Licensure Examination (USMLE) transcripts to all programs to which they applied. Ninety-five percent of applicants supplied an e-mail address. Conclusion: The introduction of ERAS has been successful for obstetrics and gynecology and has provided new information about patterns of applications. The ease of application using the electronic system did not lead to a substantial increase in numbers of applications. Statistics regarding the number of applicants, ratio of women to men, and participation of foreign medical graduates will be of interest to manpower planners.

Objective The purpose of this work is to report on application patterns for residency positions in obstetrics and gynecology. Methods The Electronic Residency Application Service (ERAS) of the Association of American Medical Colleges (AAMC) records each application for a position in a participating residency program. In the 1996–97 application cycle, all but 16 obstetrics and gynecology residency programs participated. Electronic records were analyzed to obtain a statistical picture of the residency application process. Results Applications for residency positions in obstetrics and gynecology were processed for 1607 graduates of US medical schools, including 110 graduates of osteopathic medical schools. Canadian applicants were six, and other foreign applicants numbered 524. More than two-thirds of US applicants were women, and nine of ten were citizens or permanent residents. Most applicants sent official United States Medical Licensure Examination (USMLE) transcripts to all programs to which they applied. Ninety-five percent of applicants supplied an e-mail address. Conclusion The introduction of ERAS has been successful for obstetrics and gynecology and has provided new information about patterns of applications. The ease of application using the electronic system did not lead to a substantial increase in numbers of applications. Statistics regarding the number of applicants, ratio of women to men, and participation of foreign medical graduates will be of interest to manpower planners.