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The Changing Face of Graduate Medical Education: 2000 and 2004 Compared

May–June 2005

Source: Christopher Kashnig, Manager of Physician Recruitment, Christie Clinic, (217) 366-5374, ckashnig@christieclinic.com.

There are approximately 100,000 residents and fellows in training in U.S. teaching hospitals. Every year the American Medical Association (AMA) reports on the characteristics of the U.S. medical resident and fellow population. The AMA provides figures on the percentages of a variety of quantitative measures. This paper looks at the 2004 figures for International Medical Graduates (IMGs), women, African Americans, and Hispanics, and compares them to the comparable figures for 2000 for residents in training. Over a four-year period the quantitative representation of some subgroups has changed dramatically, and for others has not changed at all.

The AMA provides the statistical characteristics in its annual U.S. Graduate Medical Education issue in the Journal of the American Medical Association, which is normally printed in early September of each year. Each annual issue summarizes the numbers for the training year that ended on June 30. The 2004 figures were reported in the September 1, 2004 issue of JAMA, and the 2000 figures were reported in the September 6, 2000 issue of JAMA.

What are the results of a comparison of 2004 residents with 2000 residents?

• International Medical Graduates: There is a significant shift in the percentage of IMGs in certain specialties. Family practice saw a dramatic increase in the percentage of IMGs from 2000 to 2004 — the number jumped from 12 to 32%. OB/GYN was second, with a jump from 7 to 17%, and general surgery was third, with a jump from 13 to 18%. On the other hand, other specialties percentage of IMGs fell. The greatest drop was in anesthesiology, which fell from 53 to 24%. Neurology was second, dropping from 50 to 36%, and radiation oncology was third, dropping from 16 to 7%. While this shifting has been going on, the overall percentage of IMGs in U.S. residency programs increased minimally, from 26 to 27%.
• Women: The percentage of women in medical training increased from 37% in 2000 to 41% in 2004. There are only two significant increases by specialty worth noting. The percentage of women in OB/GYN increased from 64 to 74%. In dermatology, the increase was from 52 to 58%. In the other medical specialties the increase closely paralleled the overall increase of women in training.
• African Americans: The overall percentage of African Americans in training programs remained steady at 5%. Movements up or down over the past four years have been subtle. The only slight changes are in physical medicine, which increased from 5 to 7%, and radiation oncology, which decreased from 6 to 3%.
• Hispanics: The overall percentage of Hispanics in training programs increased from 5% in 2000 to 7% in 2004. Again, with a small population, changes are subtle. Pediatrics increased from 7 to 10% and OB/GYN increased from 5 to 8%.

In what specialties do the subgroups congregate?

• International Medical Graduates: In 2004 the specialties that had the greatest percentage of IMGs in residency programs were pathology (44%), internal medicine (40%), neurology (36%), and psychiatry (36%). The specialties with the lowest percentages of IMGs were orthopedic surgery (2%), otolaryngology (2%), dermatology (4%), and emergency medicine (4%).
• Women: In 2004 the specialties that had the greatest percentage of women in residency programs were OB/GYN (74%), pediatrics (68%), and dermatology (58%). The specialties with the lowest percentage of women were orthopedic surgery (9%), urology (15%), and otolaryngology (21%).
• African Americans: In 2004 the specialties that had the greatest percentage of African Americans in residency programs were OB/GYN (12%), physical medicine (7%), and psychiatry (7%). The specialties with the lowest percentage of African Americans were neurology and ophthalmology (both at 2%) and otolaryngology, radiation oncology, and radiology (all at 3%).
• Hispanics: In 2004 the specialties that had the greatest percentage of Hispanics in residency programs were pediatrics (10%), OB/GYN (8%), and physical medicine (8%). The specialties with the lowest percentage of Hispanics were orthopedic surgery, otolaryngology, and radiation oncology (all at 4%).

Where do we see a “changing face” of graduate medical education?

• Anesthesiology: As mentioned above, the percentage of IMG anesthesiology residents decreased from 53% in 2000 to 24% in 2004. This is a dramatic drop.
• Family Practice: As mentioned above, the percentage of IMG family practice residents increased from 12% in 2000 to 32% in 2004. This is a dramatic increase.
• OB/GYN: Resident percentage increases from 2000 to 2004 were significant among IMGs, women, and Hispanics. The 2004 percentages for women, African Americans, and Hispanics were all high within their subgroups. It is clear that white, American-educated men are selecting this specialty in decreasing numbers.

Where do we see little change in graduate medical education figures?

• Orthopedic Surgery, Otolaryngology, and Urology: In all three fields there were few changes from 2000 to 2004. The percentage of IMGs, women, African Americans, and Hispanics remains low. It is clear that white, American-educated men are selecting these specialties in steady and strong numbers.
• Radiation Oncology and Radiology: Though the numbers are not quite as compelling as orthopedic surgery, otolaryngology, and urology, it is also clear that white, American-educated men are also selecting these two specialties in strong numbers.
• Family Practice, Internal Medicine, and Pediatrics: The primary care specialties continue to be diverse. For the most part, the percentage of IMGs, women, African-Americans, and Hispanics in these specialties remained above average for the subgroup.

What is the significance of these developments? How should a physician recruiter, hospital administrator, clinic administrator, or practice manager use this information? Let’s review the major shifts from 2000 to 2004.

First, consider the changes in the percentage of international medical graduates. The popularity of certain medical specialties ebbs and flows over time. When American medical graduates under select a specialty, the open slots are frequently taken by IMGs. This result is perfectly reflected in the diverging IMG percentage changes from 2000 to 2004 in anesthesiology and family practice. The year 2000 was roughly the tail end of the period of growing managed care in America. Anesthesiology was having trouble attracting residents into its programs, whereas family practice was in high demand. The year 2004 reflects the dawn of a new century where the health care system places a high demand on specialization. The reversal of IMG percentages in these two fields should not surprise anyone.

Much has been written about the changing face of OB/GYN in the United States. In recent years women physicians have selected this specialty in vast numbers, thus addressing the demand that many women patients have for being seen by women physicians.

Clearly the American health care system continues to produce a diverse population of primary care physicians, whereas certain surgical specialties continue to be less diverse in terms of gender and racial and ethnic background.

In summary, American hospitals and clinics hire the bulk of new physicians each year. It is crucial that they be cognizant of the changing profile of physicians. By understanding the trends and diversity characteristics, they are better able to find the best possible match for their institution and, in turn, address the needs of their patient clientele.

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