Changes in Primary Care Graduate Medical Education Are Not Correlated With Indicators of Need: Are States Missing an Opportunity to Strengthen Their Primary Care Workforce?

PURPOSE: Federal and state graduate medical education (GME) funding exceeds $15 billion annually. It is critical to understand mechanisms to align undergraduate medical education (UME) and GME to meet workforce needs. This study aimed to determine whether states' primary care GME (PCGME) trainee growth correlates with indicators of need.

METHOD: Data from the American Medical Association Physician Masterfile, the Association of American Medical Colleges, the American Association of the Colleges of Osteopathic Medicine, and the U.S. Census were analyzed to determine how changes between 2002 and 2012 in PCGME trainees-a net primary care physician (PCP) production estimate-correlated with state need using three indicators: (1) PCP-to-population ratio, (2) change in UME graduates, and (3) population growth.

RESULTS: Nationally, PCGME trainees declined by 7.1% from the net loss of 679 trainees (combined loss of 54 postgraduate year 1 trainees in internal medicine, family medicine, and pediatrics and addition of 625 fellowship trainees in those specialties). The median state PCGME decline was 2.7%. There was no correlation between the percent change in states' PCGME trainees and PCP-to-population ratio (r = -0.06) or change in UME graduates (r = 0.17). Once adjusted for population growth, PCGME trainees declined by 15.3% nationally; the median state decline was 9.7%.

CONCLUSIONS: There is little relationship between PCGME trainee growth and state need indicators. States should capitalize on opportunities to create explicit linkages between UME, GME, and population need; strategically allocate Medicaid GME funds; and monitor the impact of workforce policies and training institution outputs.