Tuesday, June 1, 2021

Domestic and foreign medical residents in the U.S.

 From the Health Affairs blog:

Graduate Medical Education Positions And Physician Supply Continue To Increase: Implications Of The 2021 Residency Match  by Edward S. Salsberg Candice Chen

"With the merger of the Accreditation Commission for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) accreditation system between 2015 and 2020, the “NRMP Main Match” now covers an estimated 96 percent of the physicians entering GME in the US. This post looks at some of the major takeaways from the 2021 NRMP Match including the implications for the physician workforce.

"Serious concerns have been expressed that there are too few residency training positions in the US and that this is contributing to a gap between the number of medical school graduates and the number of training slots, often referred to as the “GME squeeze,” and that this shortage of residency positions is also contributing to a potential future physician shortage. In 2020, the Association of American Medical Colleges (AAMC) released their annual report projecting primary and non-primary care physician shortages between 55,100 and 141,900 physicians over the next decade.


"In this piece, we focus on the 35,194 first-year positions offered in the 2021 Match, and the 26,967 US MD and DO seniors actively participating in the Match for a first-year position.  


"Key Takeaways

"The Number Of Entry GME Positions Continues To Grow 

"There were 35,194 first-year positions offered in the 2021 Main Residency Match representing an increase of 2.7 percent from 2020. Comparing the combined number of ACGME- and AOA-accredited first-year positions in 2013 with the 2021 data indicates a 24.5 percent increase in positions over the eight years for an annual increase of 2.8 percent (exhibit 1). The net increase of 6,930 first-year positions over such a short period will be surprising to many given the absence of a major new federal funding initiative or change in GME policy.


"There Are No Signs Of A Major GME Squeeze For US MD And DO Seniors

"The number of new first-year GME positions is growing more rapidly than the annual number of graduating US medical school seniors. As noted above, the number of first-year positions grew by 6,930 positions at a 2.8 percent annual rate between 2013 and 2021.


"International Medical Graduates Continue To Be A Major Source Of Residents And Physicians For America 

In 2021, there were 13,238 active IMG applicants in the NRMP Match of which 7,508 IMGs were matched to first-year positions (excluding SOAP). Overall, IMGs represented 22.5 percent of all applicants who matched to first-year positions. IMGs include two very different cohorts: US IMGs, US citizens who have gone to medical school outside of the US, mostly at for-profit schools in the Caribbean; and non-US citizens who attended medical school in a foreign country, usually their home country.


"The numbers of both types of IMGs matched in the Main Match has been increasing slowly (exhibit 2), with 4,356 non-US IMGs and 3,152 US IMGs matching to first-year positions in 2021 (excluding SOAP). Interestingly, while the number matched went up 22.5 percent for non-US IMGs and 17.1 percent for US IMGs between 2013 and 2021, the number of active applicants was more consistent, rising only 5.0 percent and 3.9 percent over the same time period for each group."

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