1. 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

2. The Campaign for More Federal Funds for GME
Source: American Medical Association (

3. Source: The Washington Post, March 11, 2013

5. 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
Assume 98% of current enrollment and projected enrollment will graduate 4 years later through
MD /DO grads grow from 22,537 in 2014 to 29,537 in 2024

6. Projected Growth of US Medical and Osteopathic Graduates
Academic Year
Number of US MD/DO graduates the year prior *
22,960
23,056 *
24,518 *
24,993 *
26,157 *
26,586 *
27,154 *
27,605 *
28,169 *
28,845 *
29,537
*Denotes projection;
Note: Includes both MD and DO graduates and GME positions
Sources: Authors analysis AAMC and AACOM data.

7. 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 7

8. 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

9. 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 *
29,443
23,056
6,387 *
29,931
24,518
5,414 *
30,428
24,993
5,435 *
30,933
26,157
4,776 *
31,447
26,586
4,860 *
31,969
27,154
4,815 *
32,500
27,605
4,895 *
33,039
28,169
4,870 *
33,588
28,845
4,743 *
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

10. 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.

11. Three Scenarios

12. # of IMGs Entering GME Has Been Steady
Source: ACGME Resource Data Book, Academic Year

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

14. 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.

15. 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

16. 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?

17. Edward Salsberg