title: US residency training before and after the 1997 Balanced Budget Act.
abstract: BACKGROUND
  Graduate medical education (GME) determines the size and characteristics of the future workforce. The 1997 Balanced Budget Act (BBA) limited Medicare funding for additional trainees in GME. There has been concern that because Medicare is the primary source of GME funding, the BBA would discourage growth in GME.
  
  
  OBJECTIVE
  To examine the number of residents in training before and after the BBA, as well as more recent changes in GME by specialty, sex, and type and location of education.
  
  
  METHODS
  Descriptive study using the American Medical Association/Association of American Medical Colleges National GME Census on physicians in Accreditation Council for Graduate Medical Education (ACGME)-accredited programs to examine changes in the number and characteristics of residents before and after the BBA.
  
  
  METHODS
  Differences in the number of physicians in ACGME-accredited training programs overall, by specialty, and by location and type of education.
  
  
  RESULTS
  The number of residents and fellows changed little between academic year (AY) 1997 (n = 98,143) and AY 2002 (n = 98,258) but increased to 106,012 in AY 2007, a net increase of 7869 (8.0%) over the decade. The annual number of new entrants into GME increased by 7.6%, primarily because of increasing international medical graduates (IMGs). United States medical school graduates (MDs) comprised 44.0% of the overall growth from 2002 to 2007, followed by IMGs (39.2%) and osteopathic school graduates (18.8%). United States MD growth largely resulted from selection of specialties with longer training periods. From 2002 to 2007, US MDs training in primary care specialties decreased by 2641, while IMGs increased by 3286. However, increasing subspecialization rates led to fewer physicians entering generalist careers.
  
  
  CONCLUSIONS
  After the 1997 BBA, there appears to have been a temporary halt in the growth of physicians training in ACGME programs; however, the number increased from 2002 to 2007.
authors.affiliation: Center for Workforce Studies, Association of American Medical Colleges, 2450 N St NW, Washington, DC 20037, USA. esalsberg@aamc.org
authors.forename: Edward
authors.initials: E
authors.lastname: Salsberg
authors.forename: Paul H
authors.initials: PH
authors.lastname: Rockey
authors.forename: Kerri L
authors.initials: KL
authors.lastname: Rivers
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Brotherton
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Jackson
mesh_terms: D000328:Adult; D002017:Budgets; D002321:Career Choice; D003710:Demography; D004470:Economics, Medical; D004501:Education, Medical; D004503:Education, Medical, Graduate / Q000191:economics* / Q000706:statistics & numerical data*; D035082:Federal Government; D005257:Fellowships and Scholarships; D005260:Female; D005550:Foreign Medical Graduates / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000191:economics* / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare; D008511:Medicine / Q000706:statistics & numerical data*; D010021:Osteopathic Medicine / Q000191:economics / Q000193:education / Q000706:statistics & numerical data; D013038:Specialization; D014481:United States