Does graduate medical education also follow green?

I n his 2008 research letter, Ebell 1 highlights the relationship between residency fill rates and physician specialty salary (r=0.82). Mullan referred to this as the “white-follows-green law.” In the same issue, Salsberg et al reported that graduate medical education (GME) expansion since funding caps were put in place favored nonprimary care specialties and was associated with a reduction in primary care production. Hospital supply of residency positions is known to play a role in determining the composition of the physician workforce. As noted in the May letter from the Council on Graduate Medical Education (COGME) to Congress, “financial concerns have affected the majority of teaching hospitals’ decisions about selection of training positions.” In the hope of informing these concerns that hospitals may be responding to financial incentives over workforce needs in their allocation of GME positions, we explored the relationship between physician income and 10-year growth in primary care residency positions vs those in a group traditionally noted for their “lifestyle” appeal and higher likelihood of driving hospital revenues.