US graduate medical education, 1996-1997
M. R. Dunn and R. S. Miller
Division of Graduate Medical Education, American Medical Association, Chicago, Ill 60610, USA.
Workforce planners continue to be concerned that unlimited growth in
graduate medical education (GME)-principally fueled by unrestrained federal
support-will lead to a physician surplus. Because of this concern, in 1996
six major professional organizations called for a reduction in Medicare
support of GME to bring residency training programs into more rational
alignment with population needs. As of July 1, 1997, no final action had
been taken by Congress to limit GME funding, although extensive discussions
are under way. Even without governmental restrictions, the American Medical
Association's annual survey of GME programs showed a reduction in the
numbers of first-year residents in most major specialties and
subspecialties. Minor reductions were initially noticed last year; now, the
decreases are significant. Nearly all the specialties that had difficulty
placing their graduates for 2 consecutive years also reported at least 10%
fewer first-year residents than in 1994. More importantly, disciplines
without employment difficulties also reported downsizing. The overall
effect of these first-year reductions is easily masked by the addition of
programs in new disciplines and some residents staying in the GME system
longer. Entry-level reductions appear to be broader and more extensive than
can be explained by market forces alone.
