Medicare funding of medical residencies

 I'm always puzzled by the fact that much of the discussion of the wages of medical residents ignores that many residency positions are paid at rates established by Medicare, which also has a big influence on the number of residency positions.

MedpageToday has the story: 

CMS Funds 400 New Residency Slots — Most new Medicare-funded positions will go to primary care, psychiatry programs by Joedy McCreary 

"The Centers for Medicare & Medicaid Services (CMS) last week allocated the 400 Medicare-funded residency slots to 135 hospitals in 37 states. Nearly two-thirds of the positions will support primary care and psychiatry residency programs.

...

"The announcement "marks a critical milestone in enabling academic health systems and teaching hospitals to continue providing top-quality patient care," said Jonathan Jaffery, MD, the AAMC's chief healthcare officer. "Academic health systems are already incurring a significant financial burden by choosing to train a portion of their medical residents without federal support. This new round of residency positions will allow them to continue investing in physician training to the benefit of patients nationwide." 

...

"Under the Consolidated Appropriations Act of 2021, Congress authorized 1,000 new residency positions to be distributed over 5 years. The 200 positions announced this month represent the fourth allocation from that total. An additional 200 slots were authorized under the Consolidated Appropriations Act of 2023, with at least 100 positions required to support psychiatry or psychiatry subspecialty residency training programs.

"The Balanced Budget Act of 1997 capped the number of Medicare-supported residency positions at each teaching hospital. Lifting that cap, the AAMC's 2024 report concluded, would help alleviate -- though not fully eliminate -- current and projected physician shortages. "

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On a lighter note, here's  their headline about Xmas-time emergency medicine:

Deck the Halls With Ow's From Folly: What the Numbers Tell Us About Holiday Injuries

 

Visa delays likely to disrupt American hospitals and foreign doctors beginning American residencies on July 1

 Each year American hospitals seek to fill several thousand medical residencies in excess of the number of new American medical graduates.  So thousands of young foreign physicians will need visas in time to start work on or around July 1.  But visas have been delayed (in various different ways), so some physicians aren't going to be able to arrive in time, and some may be denied visas.  This is going to hit some hospitals (and some residents) hard.

NRMP Statement Regarding Recent Trump Administration Orders Related to International Citizens
June 24th, 2025

"*UPDATE* (06/24/25) On Wednesday, June 18, the NRMP learned from Intealth that the U.S. Department of State has lifted the pause on new visa applications and that J-1 physicians have been prioritized for visa interview scheduling. The NRMP is asking programs to consider a delayed start or a one-year deferral of the match commitment in lieu of a waiver. A one-year deferral allows programs to recruit for this appointment year and IMGs the opportunity to finalize visa processing and honor their match commitments next year.  

Please visit the NRMP Policies webpage for more information and send any questions to policy@nrmp.org.

The NRMP is issuing this statement in response to recent actions taken by the Trump Administration related foreign nationals.

    On May 27, the U.S. Department of State instructed embassies and consular posts to pause the scheduling interviews/appointments for J, F, and M visa applicants. The pause extends to all those applying for J-1 visas, including physicians.

    On June 4, the administration issued an order barring entry into the United States for foreign nationals from 12 countries – Chad, Congo-Brazzaville, Equatorial Guinea, Eritrea, Libya, Somalia, Sudan, Afghanistan, Myanmar, Haiti, Iran and Yemen – and partially restricting entry for citizens from Burundi, Cuba, Laos, Sierra Leone, Togo, Turkmenistan and Venezuela.

We recognize that international medical graduates (IMGs) who are seeking or have secured residency training in the United States apply for J-1 visas and may intend to travel to the United States from countries specified under the June 4th restrictions. We are working with ECFMG, a division of Intealth,  to understand the scope of impact for individuals anticipated to begin training on or around July 1 of  this year. Programs with matched applicants from a restricted country(s) may request a waiver of the Match commitment through the NRMP website."

House panel launches antitrust probe of medical residency system

 What's old is new again, as questions about the market for doctors focuses on the Match (as opposed to accreditation of residencies by medical specialty boards, etc.)

Reuters has the story:

US House panel launches antitrust probe of medical residency system  By Mike Scarcella 

"March 17 (Reuters) - A U.S. congressional committee is investigating how medical students are placed in residency training programs, seeking documents from major university hospitals, the American Medical Association and other organizations as part of an antitrust probe.
The Republican leadership of the House Judiciary Committee’s antitrust panel sent the hospitals and groups letters on Friday saying they are investigating whether restrictions on hiring practices in the medical residency market suppress aspiring doctors' mobility and pay and contribute to doctor shortages."

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Earlier:

Monday, May 28, 2018

Protecting and Preserving Competition in Matching Markets--Antitrust and the Medical Match (video)

 My talk there begins with a description of the Match and its history, and I address antitrust starting right around minute 30.  (There's also a bonus video about how the Match would work at Harry Potter's Hogwarts...)

Match Day: new doctors can be eloquent

 Last Friday was Match Day, when medical students learn where they matched to a residency position.

Here's the story from Stanford:

Students open envelopes and learn their futures on Match Day
In concert with graduating medical students around the nation, members of Stanford School of Medicine’s Class of 2025 discovered where they’re spending the next leg of their training journey. 

"on the third Friday in March, all at the same time (noon on the East Coast), the medical students learn their fates.

This year, 81 Stanford Medicine graduates matched to residency programs in specialties ranging from psychiatry to ophthalmology to pediatrics. About 40% are staying at Stanford Health Care – a typical proportion.

...

"Basil Baccouche (who matched to internal medicine at Brigham and Women’s), chosen by his classmates to speak at the event, highlighted emotional moments during medical school.

“Medical school was the first time many of us saw the beginnings of life and the coming of death. The astonishing responsibility of caring for another person,” he said.

“I’ll never forget the first time I delivered a baby. Suddenly, there was one more of us in the room, and I began to cry.”

Signaling to decongest job applications and interviews: update on the market for medical residents

 Signaling for interviews is evolving in the market for new doctors, i.e. for medical residencies.  Some specialties are allowing a relatively small number of signals (as in Economics), while others are moving towards many signals, which are functioning as soft caps on the number of applications, since many residency programs in those specialties won't give an interview to someone who doesn't signal them.

Ozair, A., Hanson, J. T., Detchou, D. K., Blackwell, M. P., Jenkins, A., Tissot, M. I., Barrie, U., & McDermott, M.  W. (2024). Program Signaling and Geographic Preferences in the United States Residency Match for Neurosurgery. Cureus, 16(9), e69780. https://doi.org/10.7759/cureus.69780