US graduate medical education, 2001-2002: changing dynamics.

The National Graduate Medical Education (GME) Census, jointly administered by the American Medical Association and the Association of American Medical Colleges, completed its second year as an online survey of all GME programs accredited by the Accreditation Council for Graduate Medical Education as well as combined specialty programs approved by their corresponding medical specialty boards. Continuing trends include the growing number of subspecialty programs, which increased by 65 since last year to 3822, and a smaller number of specialty programs, which decreased by 25 to 4203. There were corresponding shifts in the number of residents training in them. The number of graduates from osteopathic medical schools in allopathic GME has increased from 3288 in 1996-1997 to 4658 in 2001-2002, an increase of 42%. Overall, the total number of residents in GME has declined slightly, to an estimated 96 410 this year. The number of residents in graduate year 1 (GY1) positions (entry positions in GME, for which prior training is not required) has also decreased, although the proportion of residents in GY1 positions who have not had prior GME has increased. The number of international medical graduates (IMGs) in GY1 positions has decreased from a high of 6727 in 1999-2000 to 5898 in 2001-2002, a decrease of 12.3%. However, the number who have entered GME immediately on graduation has grown from 310 in 1996-1997 to 936 in 2001-2002. Most of these IMGs were citizens or permanent residents of the United States and attended medical schools in the Caribbean. New race and ethnicity questions, which parallel those of the US Census, continue to reveal disparities in the racial/ethnic distribution of the training physician population relative to the US population. Despite continued interest in resident work hours, there was no decrease in reported hours worked between 2000-2001 and 2001-2002. Physicians training in surgical specialties are reported to work the most hours per week, while internal medicine and pediatrics allow for the most consecutive time on duty, at 30 hours or more. Specialties and subspecialties with limited on-call schedules, such as forensic psychiatry and pediatric pathology, have, on average, the lowest number of duty hours.