Tracking Trainee Movement: A Scalable Framework for Analyzing Geographic Retention in Graduate Medical Education

Background Geographic maldistribution of the physician workforce persists, despite substantial investment in expanding graduate medical education (GME). Training programs remain concentrated in urban centers, and physicians often practice near where they train, reinforcing regional imbalances in workforce distribution. Understanding trainee mobility patterns is essential for identifying how uneven resource distribution perpetuates workforce shortages in underserved areas and developing targeted interventions to improve geographic disparities in physician supply. Objective To develop and apply a scalable framework for evaluating regional retention and mobility patterns of physician trainees across 3 sequential stages of GME using ophthalmology as an exemplar specialty. Methods This is a retrospective cohort study of 800 ophthalmology residency graduates between 2019 and 2022 from 52 Accreditation Council for Graduate Medical Education accredited programs. Using publicly available data from the FREIDA Residency Program Database and residency program websites, geographic transitions were tracked between medical school and residency (T1), residency and fellowship (T2a), and residency and first attending position (T2b). Primary outcomes were regional retention and travel distance in miles between medical school or residency-affiliated hospital addresses. Results The South had the highest retention during T1, while the West retained the most graduates during T2a and T2b. The West showed the lowest retention during T1, and the Midwest during T2a. Trainees traveled farthest during T2a compared to T1 and T2b (P<.005). Conclusions Trainee relocation and retention patterns varied by training stage and region, with the greatest mean travel distance occurring between residency and fellowship.