An article published in this week’s edition of the NEJM suggests that residency positions are expanding on pace with the growing US medical student population. Concern for a “GME bottleneck” exists within academic medicine. Medical school class sizes are steadily increasing and, between 2002 and 2014, a total of 16 new allopathic and 15 new osteopathic medical schools opened in the United States. Coupled with fixed medicare GME funding since 1997, this mismatch creates the potential for an insufficient number residency positions for graduates of US medical schools in the future. Fortunately, despite well founded concern, current projections argue against this shortcoming over the next 10 years. Assuming GME positions continue to expand at their current rate (1.66% per year), a significant surplus of residency positions should persist through 2024 (4500 more available positions than U.S. graduates in 2023-2024).
Despite fixed federal funding, a variety of other sources have met the financial needs of expanding resident demand: Veterans Health Administration, the Affordable Care Act Primary Care Residency Expansion Program, the Teaching Health Center Graduate Medical Education program, and hospitals themselves. As indicated by the above graph, the gap between the number of medical students and residency slots is certainly narrowing. This may create enhanced competition for certain specialties. However, at least for the foreseeable future, there should be sufficient residency positions for all US graduates. The author’s projection is reassuring but assumes that non-federal funding for GME will sustain. Furthermore, the data does not address whether or not the the projected GME expansion will palliate our country’s expanding physician shortage.