U.S. graduate medical education and physician specialty choice

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.