미국 졸업후 의학교육(레지던트)에 관한 트렌드(1999년~2008년)

Trends in Graduate Medical Education, 1999 through 2008

10 years of GME data collected through the National GME Census

As has been observed elsewhere, training in accredited subspecialty programs has increased dramatically in the past decade. By 2008, there were 916 more subspecialty programs and 4,470 more physicians training in them compared to 1999. There was a loss of 168 core specialty programs during this period, with a gain of 5,447 residents. Physicians training in subspecialty programs made up 47% of the overall increase in the number of physicians training in ACGME-accredited programs, although overall they made up 16% of the GME population.

Graduates of osteopathic medical schools are increasingly seeking and obtaining training positions in ACGME-accredited training programs. There are fewer training opportunities for DOs in AOA-accredited specialty and subspecialty programs compared to ACGME programs, so increasing participation in ACGME programs is not unexpected. The number of graduates of Canadian medical schools training in the US, never a large number, has declined by 39%. Until recently, the number of graduates of allopathic medical schools was flat, and therefore the number in ACGME-accredited programs overall has been relatively stable, particularly for entrants to GME, GY1 residents. Growth in the number of USMDs in GME has been in further specialty and subspecialty training.

Other substantial changes in the characteristics of residents includes the increase in the number of women in training, and the increase in the number of US citizen IMGs. The proportion of female trainees went from 38.1% to 45.1%; more than a quarter of that growth was in women in subspecialty programs. In total, the number of men in GME dropped by 1,150 (1.9%); this is borne entirely by the drop in the number of men in specialty programs. There were 1,707 more men in subspecialty training in 2008 compared to 1999, an increase of 19.6%. Echoing other reports, there are more US citizens going to medical school abroad and returning to the US for GME. The variability in reporting citizenship/visa status prevents too many comparisons, however the gain of 2,135 is substantial, a 43.3% increase.

Racial/ethnic changes over this time period have included increases in the Under-Represented Minorities (URM) of Hispanics and Native Americans/Alaskans, but not a noticeable increase in the number of blacks. All three categories of URM gained in subspecialty training. The number of Asian/Pacific Islander physicians training in specialty and subspecialty programs grew faster than the number of trainees overall.

Looking only at USMD and DOs, who are products of the US medical education system, the growth rate of blacks in specialty programs was only slightly more than the growth rate overall; however, the annual growth rate in subspecialty training was 45% higher than the the total annual growth rate. The largest annual growth rate was in the number of Native Americans/Alaskans, for both specialty and subspecialty training, growing at a rate of 7.15% and 24.7%, respectively. The number of Hispanic USMDs and DOs in both types of training has also grown substantially more than the growth overall. The number of Asian/Pacific Islander USMDs and DOs had nearly nearly doubled and tripled, in specialty and subspecialty training, respectively. The racial and ethnic characteristics of the US medical workforce, in the near future at least, will continue to not reflect the characteristics of the US population at large.

(출처 : http://www.ama-assn.org/resources/doc/med-ed-products/graduate-medical-education-trends-1999-2008.pdf)