L. Chodroff1, W. H. Schwesinger1, R. E. Willis1, K. Sirinek1 1University Of Texas Health Science Center At San Antonio,General Surgery/Surgery,San Antonio, TX, USA
Introduction:
For 35 years, the # of graduating US medical students has dramatically ↑. Total annual enrollment ↑ 33% (65, 189 to 86,746) while the # of medical schools ↑ 25% (115 to 145). In contrast, the # of Medicare-funded residency positions has remained frozen at 1996 levels as a result of the Balanced Budget Act of 1997 (public law 105-33). This study assesses the # of residencies and PGYI positions, and the # of medical students (MS) and residents (RES) per 105 population (pop) and their in-state retention patterns for 30 states below and 20 above the US x? for the # of physicians/surgeons per 105 pop.
Methods:
Data were obtained from the 2015 State Physician Workforce Data Book of the Association of American Medical Colleges for 2014 and the 2014 Main Residency Match. Results were analyzed by t-Test (Significance P<0.05). Data for MS were calculated for 45 states with medical schools and RES for all 50 states.
Results:
30 states (x? 206, range 170.3 – 234.6) were below the US x? (235) and 20 were above it (x? 270, range 235.5 – 349.5) for the # of actively practicing physicians / surgeons per 105 pop. (206 vs 270, P<.05). 16 of 30 states below the US x? for physicians and surgeons per 105 pop were below the US x? and the 20 state x? (P<.05) for General Surgeons per 105 pop (6.3 vs 6.9, 8.5). Compared to 20 states above the US x?, 30 states below the US x? had a statistically significant lower # of residences, PGYI residency positions, and residents per 105 pop but a higher MS in-state matriculation rate (Table). There was no statistical difference in-state physician retention rates between these two groups of states for those who completed either medical school, residency, or same state medical school + residency. The highest in-state physician retention rate occurred for those who completed both medical school and residency in the same state (58.9%)
Conclusion:
High in-state matriculation rate for 30 states below the x? for number of physicians/surgeons per 105 pop (66%) was nullified by the fact that only 36% of them practiced in-state. The root cause of this physician manpower exodus may in part be due to an insufficient number of both residencies and resident positions in those 30 states. Since the highest retention rates occurred when MS completed a residency located in the same state as their medical school, it would seem prudent for states with a significant physician workforce shortage to start early and aggressive recruiting of their state MS. At a national level, Congress should be encouraged to repeal that part of the Balanced Budget Act of 1997 which is inhibiting further growth in the # of Medicare-funded residents and residencies.
