The residency mismatch.

n engl j med 369;4 nejm.org july 25, 2013 297 Association of American Medical Colleges (AAMC) recommended that medical school enrollments be increased by 30% over the next decade. Now, entering classes are projected to reach 21,434 students by the 2016–2017 academic year, almost a 30% increase over 2002 (see table). Colleges of osteopathic medicine have been growing for the past 20 years, doubling in number from 15 to 30 and increasing enrollments from 6892 students in 1990 to 21,743 in 2012. And every year, approximately 12,500 U.S.-citizen and foreign students earn degrees from international medical schools and apply for entry into U.S. graduate medical education (GME) programs. But there’s another barrier to creating enough practicing physicians: there are insufficient residency posts to accommodate all these medical graduates. After two decades (1980 to 2000) when the number of U.S. medical school graduates remained steady (about 16,000 annually), a burst of activity has led to the expansion of existing medical schools, the development of new ones, and rapid growth of colleges of osteopathy.1 In 2002, there were 125 U.S. medical schools; today, there are 141, and about one third of the recent growth in enrollment derives from new schools. Moreover, several additional schools, granted applicant status by the Liaison Committee on Medical Education, will probably begin enrolling students in the next year or two. State and local concerns about physician shortages have combined with national factors (population growth, the aging of the baby boomers, and an increasing number of retiring practitioners) to drive this growth of medical school capacity. Although the federal government was the major source of funding for the doubling of the number of medical schools in the 1970s, it did not lend direct financial support to this recent expansion. Indeed, federal funding is a key factor limiting the number of GME positions, which, in contrast to medical school seats, has increased remarkably slowly — at an annual rate of 0.9% from 2001 through 2010.2 The major stumbling block over the past 15 years has been a payment cap that Congress imposed on Medicare’s funding of advanced training in the Balanced Budget Act of 1997. Medicare is the primary supporter of GME programs, contributing $9.5 billion to fund The Residency Mismatch