Geographic and Program Size Disparities in Medicare Funding for Graduate Medical Education

Area of Science:

• Health Policy
• Medical Education
• Health Economics

Background:

• Medicare direct graduate medical education (DGME) payments are crucial for residency training and physician workforce development.
• Existing research details geographic variations in total DGME spending, but inequities in per-resident funding across states and program sizes remain underexplored.

Purpose of the Study:

• To analyze variations in Medicare DGME payments per resident across US states and residency program sizes.
• To identify patterns in DGME funding relevant to achieving equitable graduate medical education (GME) distribution.

Main Methods:

• Retrospective cross-sectional analysis of Medicare DGME payment data from 2014-2024.
• Inclusion of 439 US hospitals, stratified by state and program size (small: 0-20, mid-sized: 21-200, large: >200 residents).
• Primary outcome: DGME payment per resident; sensitivity analyses included resident count and hospital bed capacity.

Main Results:

• Significant variations in per-resident DGME payments by state and program size (p<0.001).
• National median payment was ~$22,000 per resident, with Mississippi highest and California lowest.
• Small programs had higher mean per-resident payments than mid-sized programs (p<0.01); resident count predicted payments more than bed capacity.

Conclusions:

• Persistent geographic and program-size inequities exist in per-resident DGME funding nationwide.
• These disparities may disadvantage mid-sized and underserved residency programs.
• Consideration of these inequities is vital for promoting equitable GME funding and physician workforce distribution.