Is a GME Squeeze Likely? Analysis of Trends in US Graduates and GME Entrants Edward Salsberg George Washington University Presentation to: GW Health Workforce Institute April 14, 2016

The Campaign for More Federal Funds for GME Source: American Medical Association (www.savegme.org).

Source: The Washington Post, March 11, 2013

Overview MD/DO Grads Projections Historical data from AAMC and AACOM on graduates Future enrollment: Annual AAMC and AACOM surveys of medical school enrollment plans for next 5 years Report on 2014 surveys (Published by AAMC April 2015) 1st Year enrollment through AY 2019-20 Assume 98% of current enrollment and projected enrollment will graduate 4 years later through 2022-23 MD /DO grads grow from 22,537 in 2014 to 29,537 in 2024

Projected Growth of US Medical and Osteopathic Graduates Academic Year Number of US MD/DO graduates the year prior 2013-2014 2014-2015* 22,960 23,056 2015-2016* 24,518 2016-2017* 24,993 2017-2018* 26,157 2018-2019* 26,586 2019-2020* 27,154 2020-2021* 27,605 2021-2022* 28,169 2022-2023* 28,845 2023-2024* 29,537 *Denotes projection; Note: Includes both MD and DO graduates and GME positions Sources: Authors analysis AAMC and AACOM data.

Source: ACGME Data Resource Book, Academic Year 2014-15 Total Number of ACGME Entry Level Pipeline Positions Growing Slowly but Steadily Source: ACGME Data Resource Book, Academic Year 2014-15 7

Overview of GME Projections ACGME entrants into “pipeline programs” 2004 – 2013 Estimate DOs going into AOA accredited GME DO grads per year from AACOM Assume 98% go on to GME Subtract out DOs entering ACGME pipeline programs Assume remainder go into AOA programs Add ACGME pipeline entrants to estimated AOA entrants GME entrants grew 1.66%/year from 2003 to 2014; apply to future years growth

Projected Growth of US Medical School Graduates and US GME Entry Positions Academic Year GME Entry Positions (Historical 1.66%/ year growth rate ) Number of US MD & DO graduates the year prior Excess Pipeline Positions 2014-2015* 29,443 23,056 6,387 2015-2016* 29,931 24,518 5,414 2016-2017* 30,428 24,993 5,435 2017-2018* 30,933 26,157 4,776 2018-2019* 31,447 26,586 4,860 2019-2020* 31,969 27,154 4,815 2020-2021* 32,500 27,605 4,895 2021-2022* 33,039 28,169 4,870 2022-2023* 33,588 28,845 4,743 2023-2024* 34,145 29,537 4,608 *Denotes projection Sources: Author analysis of ACGME, AAMC and AACOM data. Note: Includes both MD and DO graduates and GME positions

Actual and Projected Growth in MD/DO Graduates and GME Entrants: Scenario 1 Based on 1.66% Annual Growth in GME Positions. Dotted line indicates projections. Data are from the ACGME, the AAMC, and the AACOM.

Three Scenarios

# of IMGs Entering GME Has Been Steady Source: ACGME Resource Data Book, Academic Year 2014-15

What Decrease in Excess Positions? Academic Year Projected Excess Pipeline Positions ACGME Actual NRMP (IMGs) 2014-2015* 6,387 6,837 6,355 2015-2016* 5,414 6,301 2016-2017* 5,435 6,638 2017-2018* 4,776 2018-2019* 4,860 2019-2020* 4,815 2020-2021* 4,895 2021-2022* 4,870 2022-2023* 4,743 2023-2024* 4,608 *Denotes projection Sources: Author analysis of ACGME, AAMC and AACOM data. Note: Includes both MD and DO graduates and GME positions

The GME Squeeze is Limited & There will be Plenty of Slots for US Grads Based on current enrollment plans of MD and DO schools, there will be about 29,500 graduates in 2024; Assuming a continuation of the 1.66% annual growth in GME PGY 1 pipeline positions, there would be more than 34,000 PGY-1 pipeline positions in 2024; There would enough slots for all MDs and DOs and about 4,500 PGY-1 positions for IMGs.

Rapidly Increasing GME Slots Will Further Promote the Use of IMGs Adding a few thousand PGY1 slots does not guarantee slots for US MDs Facilitating more IMGs is contrary to the WHO Global Code of Practice on the International Recruitment of Health Personnel which was signed by the US and 182 other countries Medicine is an outlier in its dependence on foreign grads 25% vs. 5 – 8 % for most health professions The main beneficiary is likely to be for-profit Caribbean schools

A Key Question is: Why were 6,638 IMGs selected over some gradates of US accredited programs in the Match for 2016? Unrealistic specialty choices by some students? Do some GME programs prefer IMGs over US MDs/DOs? If so, why? Does this say something about these GME programs? Does it say something about the US students? Does it say something about the schools that educated these physicians?

Edward Salsberg esalsberg@gwu.edu