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Special Communication |

Graduate Medical Education, 1997-1998

Marvin R. Dunn, MD; Rebecca S. Miller, MS; Thomas H. Richter, MA
JAMA. 1998;280(9):809-812. doi:10.1001/jama.280.9.809.
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In response to growing concerns that continued unlimited governmental funding of graduate medical education (GME) would lead to a physician surplus, Congress enacted provisions in the Balanced Budget Act (BBA) of 1997 to limit further growth, as well as to encourage reductions in GME. The measures incorporated in this section of the BBA reflect recommendations made by a number of major professional associations. The question now is how effective these efforts will be and whether they will produce unintended or deleterious consequences. We report the changes occurring in GME from 1993 to 1997, focusing on changes prior to and since the enactment of the BBA. The total number of residents in GME programs has remained relatively constant from 1993 to 1997. The number of residents entering GME programs without prior GME experience has also remained constant; however, over the same period, the number entering a new program with some prior GME experience has fallen by 5.8%. The number of international medical graduates in all GME programs has increased 12.4% during this same period, while the number of US allopathic medical school graduates has decreased 4.4%. As federal and state initiatives are introduced to change the number and distribution of GME positions, it is critical that the American Medical Association and other professional organizations monitor GME tracking data more systematically and accurately than ever before.

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Figure 1.—Total number of resident physicians in the Accreditation Council for Graduate Medical Education–accredited and combined specialty programs as reported in JAMA, 1980-1997. The data collected prior to 1993 were not reported consistently enough to be used for precise comparisons. The reported numbers illustrate the degree of graduate medical education growth over the past 17 years.
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Figure 2.—Total number of resident physicians in Accreditation Council for Graduate Medical Education–accredited and combined specialty programs and number of resident physicians in graduate year 1 positions, 1993-1997. GME indicates graduate medical education; GY1, graduate year 1.
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Figure 3.—Number of resident physicians in Accreditation Council for Graduate Medical Education–accredited and combined specialty programs according to medical school of graduation, 1993-1997. In 1993, 565 residents had unknown medical school type; in 1994, 2965 residents; in 1995, 454 residents; in 1996, 2638 residents; and in 1997, 1563 residents. USMGs indicates US medical graduates; IMGs, international medical graduates; DOs, doctors of osteopathic medicine; and CANMGs, Canadian medical graduates.
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Figure 4.—Total number of resident physicians and international medical graduate (IMG) resident physicians training in the specialties of family practice, internal medicine, and pediatrics and their combined programs, 1993-1997. Approximately 1500 preliminary positions are included in the internal medicine totals each year.
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Figure 5.—Percentage of international medicine graduates in internal medicine specialties and subspecialties, 1993-1997.
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Figure 6.—Percentage of international medical graduates in pediatric specialties and subspecialties, 1993-1997.



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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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