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Journal of ASPR - Fall 2012 - The Partial Changing Face of GME
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The Partial Changing Face of GME

By Christopher Kashnig, FASPR, Manager of Physician Services, Dean Clinic, Madison, WI

Chris Kashnig, FASPRThis is a synopsis of the session “The Partial Changing Face of Graduate Medical Education: A Comparison of 2000 and 2010” presented at the 2012 ASPR Annual Conference.

There are approximately 111,500 residents and fellows training in allopathic programs approved by the Accreditation Council for Graduate Medical Education. The makeup of physicians in training changes with certain programs over time, but does not change with others. Thus, we have only a “Partial Changing Face.” This article examines changes in the ethnic, gender, racial, and educational mixes of core residency groups over the past 10 years. It will review the current representation of these traditional minority groups and identify some of the major issues that physician recruitment professionals must address in the future. The five sub-groups that will be discussed consist of international medical graduates; women; African Americans; Hispanic Americans; and doctors of osteopathy who train in allopathic residency programs.

The year 2000 marked the end of heavy primary care recruitment and its related gatekeeper focus. It ushered in a significant increase of specialty care focus and recruitment. After 10 years, the result is a physician shortage, especially in primary care. This shortage is expected to exacerbate, particularly given the aging population of America.

Consider these 18 core specialties in medicine: anesthesiology, dermatology, emergency medicine, family medicine, general surgery, internal medicine, neurology, OB/GYN, ophthalmology, orthopedic surgery, otolaryngology, pathology, pediatrics, physical medicine and rehabilitation (PM&R), psychiatry, radiation oncology, radiology, and urology. These are the specialties that one might expect in an average size hospital of 200-250 beds. Then consider how the five sub-groups are represented both in 2000 and 2010.

1. International Medical Graduates (IMGs)

The definition of an international medical graduate, as it pertains to the United States, is a physician who has graduated from a medical school outside of the US, Puerto Rico, or Canada, irrespective of nationality. The overall percentage of IMGs in training has only increased from 26% in 2000 to 27% in 2010; however, the makeup within certain residency programs has changed dramatically. The percentages of IMGs in emergency medicine and family medicine have increased substantially with 250% for emergency medicine and 225% for family medicine. On the other hand, the percentages in anesthesiology and radiology have dropped significantly, 75% in anesthesiology and 50% in radiology. The result of these and other shifts in residency composition, is that in 2010 the two specialties with the highest percentage of IMGs were internal medicine and family medicine. However, this is only a partial changing face since orthopedic surgery, otolaryngology, and urology continue to have a very low percentage of IMG residents.

2. Women

The percentage of women in US residency programs has increased from 37% to 46% over the past 10 years. Women are increasingly prevalent in OB/GYN (81% of all residents) and pediatric (73%) residency programs, however, the number of women in surgical fields remains low. In fact, the subset of women exceed their overall numbers in only 6 of the 18 core specialties. In addition to OB/GYN and pediatrics, women exceed 46% of residents in training in dermatology, family medicine, psychiatry, and pathology, but remain under-represented in the other 12 core specialties.

3. African Americans and Hispanic Americans

These two groups represented only 6% and 8% of residents in training in 2010. In both cases, their numbers increased only slightly since 2000. Within both of these minority groups, the OB/GYN and family medicine percentages exceed the overall percentages.

4. Doctors of Osteopathy (DO)

DOs currently account for 7% of all residents in training at allopathic programs. This is a significant increase from 2000, when they comprised only 4% of the total number of residents in training. Over the years, many allopathic hospitals have welcomed DO family physicians; in fact, DOs comprise 17% of family medicine residents. However, the specialty with the largest concentration of osteopaths is physical medicine and rehabilitation. Osteopaths currently represent 26% of the resident population in PM&R but are also well represented in OB/GYN and psychiatry residency programs.

Where do we see a changing face in the new graduates and where is it not seen? How does this affect the recruitment strategies of physician recruitment professionals? In short, how does The Partial Changing Face of Graduate Medical Education affect recruitment now, and how will it affect it in the future?

1. International Medical Graduates (IMGs)

Now, internal medicine and family medicine specialties have the highest percentages of IMGs, which will have a profound impact on the future of primary care for adults. The impending physician shortage will be exacerbated because a significant number of IMGs will have visas that restrict their hiring. Psychiatry also has a high percentage of IMGs and their visa issues will have an impact on hiring for mental health care as well.

2. Women

As mentioned earlier, women are over-­represented in 6 of the core specialties in medicine and under-represented in 12. Since many women are interested in part-time work, shared job arrangements, outpatient work, or reduced call responsibilities, recruitment for primary care and mental health may be challenging. Successful hospitals and clinics will be those that develop flexible work schedules to accommodate the work/life balance of women in the physician work force.

3. African Americans and Hispanic Americans

While the number of residents in these minority groups remains low, recruiters who recruit to minority communities may take solace in knowing that the percentages of residents in OB/GYN and Family Medicine exceed their overall numbers.

4. Doctors of Osteopathy

Recruiters should not overlook this small group of candidates. They exceed their overall numbers in PM&R, primary care, OB/GYN, and Psychiatry. As noted above, these figures identify osteopaths in allopathic residency programs only. There is another set of Osteopaths who are trained in Osteopathic residency programs.

Recruiting physicians is certainly challenging and it will become even more challenging with the looming physician shortage. Understanding the makeup of various groups within graduate medical education will be vital to a recruiter’s success. The days of recruiting the fictional Dr. Marcus Welby are long past. The pool of physicians entering the work force is diverse; gaining an understanding of it must not be overlooked.

Sources: September 6, 2000 and September 7, 2011 issues of the Journal of the American Medical Association.

Journal of ASPR - Fall 2012

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