Edward Salsberg, M.P.A., of the Association of American Medical Colleges, Washington, D.C., and colleagues examined, in an article published in the September 10 issue of JAMA, the number of residents in training before and after the 1997 Balanced Budget Act (BBA). There has been concern that because Medicare is the primary source of graduate medical education (GME) funding, the BBA would discourage growth in GME.
The researchers found that the number of residents remained relatively steady between 1997 and 2002 but then increased, for a net gain of eight percent between 1997 and 2007. The annual number of new entrants into GME increased by 7.6 percent, primarily because of increasing international medical graduates (IMGs). United States medical school graduates (M.D.'s) comprised 44.0 percent of the overall growth from 2002 to 2007, followed by IMGs (39.2 percent) and osteopathic school graduates (18.8 percent). Increasing subspecialization rates have led to fewer physicians entering generalist careers.
"Based on the change in the number of residents and fellows in ACGME-accredited programs over 5-year intervals before and after the BBA, it appears that the cap on Medicare-supported GME positions was associated with at least a temporary decrease in the growth in GME positions."
(JAMA. 2008;300[10]:1174-1180. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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