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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