Changing Patterns of Graduate Medical Education: Analyzing Recent Trends and Projecting Their Impact

Postgraduate medical education underwent substantial change during the 1970s: medical-school classes grew, the internship year was eliminated, and the numbers of M.D.s entering primary-care specialties increased. The purpose of this study is to develop a planning model of graduate medical education that can project the impact of these and other changes on the numbers and specialty mix of physicians completing training. The model is applied to an analysis of trends in graduate medical education and to the probable consequences of policy recommendations made by the Graduate Medical Education National Advisory Committee (GMENAC). The results show that the trend toward increasing percentages of M.D.s entering primary-care specialties from 1970 to 1976 changed to no increase from 1976 to 1980. Thus, the GMENAC policy recommendation to increase primary care further is not likely to occur spontaneously in the near future. (N Engl J Med. 1982; 306:10–4.), The Graduate Medical Education National Advisory Committee (GMENAC) estimates that the 1975 physician-to-population ratio of 1.77 per thousand will climb to 2.45 per thousand in 1990.¹ In its final recommendations, GMENAC concluded that there will be an excess supply of physicians in 1990, whereas the distribution of specialties will not be consistent with the country's needs.² Specifically, too few physicians are being trained in general pediatrics, family practice, and general internal medicine. Many observers believe that unless the private sector soon deals with this problem, these findings by GMENAC will ultimately lead to new legislation intended to increase the percentage.