Too many applicants for available graduate medical education positions--are we on a collision course?

Until the last few years, graduate medical education (GME) positions were so plentiful in the United States that even with a heavy influx of both U.S. and alien graduates of foreign medical schools, many positions remained unfilled. In the future, however, it is unlikely that all those planning to enter GME in the United States will be able to do so. Applicants for U.S. GME positions increased from 15,000 in 1980 to 20,000 in 1983, while the positions offered declined to fewer than 18,000. Increasing financial pressure may cause some U.S. hospitals to cut back on their GME positions. Recent Federal regulations require them to isolate the cost of education from patient care costs, and community hospitals may no longer with to provide GME if they can no longer recover educational costs. On the other hand, State legislatures may react to pressures to provide GME positions for U.S. citizens graduating from foreign medical schools. Another factor increasing the demand for GME positions is the greater number of U.S.-citizen graduates from foreign medical schools in the Caribbean. The Caribbean schools generally lack the facilities to provide clinical training, so that efforts are made to provide such training for U.S. citizens in the United States. For example, it has been reported that opportunities for two to five thousand clerical clerkships exist in New York State. Alien and U.S. graduates of foreign medical schools have been required to take different examinations to qualify for GME in the United States, but beginning in 1984, both groups will be required to pass a new Foreign Medical Graduate Examination in the Medical Sciences. Ways are also being sought to assess the clinical skills of these graduates. It is hoped that an equitable system to evaluate all foreign medical graduates will soon be in place, so that those who meet standards comparable to the ones required of U.S. medical students will be able to enter U.S. graduate medical education programs.