US residency training before and after the 1997 Balanced Budget Act

Area of Science:

• Medical Education
• Physician Workforce Development
• Health Policy Analysis

Background:

• Graduate Medical Education (GME) shapes the future physician workforce.
• The 1997 Balanced Budget Act (BBA) impacted Medicare funding for GME, raising concerns about potential discouragement of GME growth.

Purpose of the Study:

• To analyze resident training numbers and characteristics before and after the 1997 Balanced Budget Act (BBA).
• To examine recent trends in GME by specialty, sex, and educational setting.

Main Methods:

• A descriptive study utilizing the National GME Census data from the American Medical Association and Association of American Medical Colleges.
• Analysis focused on physicians in Accreditation Council for Graduate Medical Education (ACGME)-accredited programs.
• Examined changes in resident numbers and characteristics pre- and post-BBA.

Main Results:

• Physician trainee numbers remained stable between 1997 and 2002 but rose by 8.0% by 2007.
• Increased GME entry was primarily due to a rise in international medical graduates (IMGs).
• While US MDs grew, they shifted towards longer subspecialty training, decreasing primary care physicians, whereas IMGs increased in primary care.

Conclusions:

• The 1997 BBA may have caused a temporary stagnation in GME physician training.
• A notable increase in residents and fellows occurred between 2002 and 2007 in ACGME-accredited programs.