Medical Residency

The U.S. has several health professional shortage areas.

Nationally, 74 million people are in a geographic health professional shortage area (HPSA) for primary care (U.S. Health Resources and & Services Administration (HRSA) 2024a). There are 7,475 geographic HPSAs for primary care and 12,973 practitioners are needed to fill these shortage areas. In MO, there are a total of 332 geographic HPSAs.

• In 2019, there were 18, 297 active physicians in MO (AAMC 2021).
• As of November 2023, 48% of the U.S. population and 20% of the MO population had their primary care needs met (S. HRSA 2024b).

The Association of American Medical Colleges (AAMC) predicts a shortage of 13,500 to 86,000 physicians by 2036 (AAMC 2024). This includes a shortage of 20,200 to 40,400 primary care physicians.

A residency program is required to become a licensed physician.

To become a licensed physician, graduates of an accredited medical school must complete a residency program, also known as graduate medical education (GME) (AAMC). GME is formal education during which doctors learn skills for their specialty, ranging from 3-5 years depending on specialty.

In 2024, 27,788 U.S. medical school seniors applied for residency (National Residency Matching Program (NRMP) 2024a). About 93% of these students matched to a residency program (NRMP 2024a). However, U.S. medical school seniors filled about 72% of 35,984 total filled positions. The rest were filled by graduates of U.S. medical schools who did not complete a residency following their senior year of medical school, and individuals from non-U.S. medical schools (NRMP 2024a, 2024b).

• The number of applicants and residency positions has increased steadily since residency programs were first established (Figure 1).

In MO, 774 out of 828 residency spots were filled in 2024 (NRMP 2024c). In 2019, 50% of active physicians in MO completed their GME in-state (AAMC 2021). Thirty eight percent of MO GME students stayed in MO to practice medicine (AAMC 2021).

The number of residency spots is determined by federal, state, and institutional funding.

Medicare is the largest funder of residency programs, with payments to hospitals dependent on the number of residency doctors and Medicare patients (Congressional Research Service (CRS) 2022). The number of residency positions funded by Medicare is capped by Congress (CRS 2022). The Consolidated Appropriations Act of 2021 opened 1,000 new Medicare funded physician residency spots, phasing in 200 spots each year for 5 years (Centers for Medicare & Medicaid Services (CMS) 2023). The first set of 200 spots opened in July 2023 (CMS 2023).

States fund GME through Medicaid, although they are not required to do so (National Conference of State Legislatures (NCSL) 2024). States can also choose to make Medicaid payments to teaching facilities that are not hospitals and for the training of health professionals that are not physicians (e.g., ambulatory care centers, graduate nurses).

The Health Resources and Services Administration (HRSA) funds the training of primary care residents in community health centers, rural health clinics, and tribal health centers (NCSL 2024). HRSA also funds training of residents in children’s hospitals that care for low-income children.

Using general revenue funds, MO Department of Health and Senior Services provides funding to hospitals through the Missouri Graduate Medical Education Grant Program (RsMo§191.592). The goal of this program is to increase the number of residency positions and physicians in specialties with shortages.

• The HRSA funds the Bothwell-University of Missouri Rural Family Medicine Residency to promote medical practice in rural areas (Bothwell Regional Health Center).

Other states also have grant programs or have appropriated funding to promote specialty shortage areas or to increase the number of residency spots.

• FL, IA, and NM have grant programs to expand or establish residency programs that focus on specialties with shortages.
• IA has appropriated funding to add nine residency positions in University of Iowa hospitals.
• OH, OR, and TN have appropriated funding to pay for GME costs to hospitals in relation to their Medicaid services.

Figure 1. The number of applicants and positions for residency programs in the U.S. over time. The purple line shows the total number of PGY-1 (first year post graduate) residency positions each year since the inception of residency programs in 1952. The green line shows the number of individuals (U.S. medical school seniors, graduates, and individuals from non-U.S. medical schools) that applied each year. Figure from NRMP 2023.

References

(n.a.). Notice of Change in Medicaid State Plan. https://www.tn.gov/content/dam/tn/tenncare/.

Association of American Medical Colleges. (n.a.). State-by-State Graduate Medical Education Data. https://www.aamc.org/advocacy-policy/.

Association of American Medical Colleges. (2021). Missouri Physician Workforce Profile. https://www.aamc.org/media/58246/download.

Association of American Medical Colleges. (2024). The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. https://www.aamc.org/media/75236/download?attachment.

Bothwell Regional Health Center. (n.a.). Bothwell-University of Missouri Rural Family Medicine Residency. Accessed March 25, 2024. https://www.brhc.org/careers/bothwell-mu-rural-family-medicine-residency/.

Centers for Medicare & Medicaid Services. (2023). CMS Awards 200 New Medicare-funded Residency Slots to Hospitals Serving Underserved Communities. https://www.cms.gov/newsroom/press-releases/.

Congressional Research Service. (2022). Medicare Graduate Medical Education Payments: An Overview. https://crsreports.congress.gov/product/pdf/IF/IF10960.

Florida Agency for Health Care Administration. (n.a.). Graduate Medical Education (GME). Accessed March 26, 2024. https://ahca.myflorida.com/medicaid/.

Graduate Medical Education Reimbursement for Public Teaching Hospitals. Ore. Admin. Rules 410-125-0142. (2021). https://oregon.public.law/rules/oar_410-125-0142.

Medical Residency Grant Program. Mo. Stat. § 191.592 (2023). https://revisor.mo.gov/main/OneSection.aspx?section=191.592.

Medical Residency Training State Matching Grants Program. Iowa Stat. § 135.176. (2024). https://www.legis.iowa.gov/docs/code/135.176.pdf.

National Conference of State Legislatures. (2024). Graduate Medical Education Funding. https://www.ncsl.org/health/graduate-medical-education-funding.

National Residency Matching Program. (2023). Results and Data: 2023 Main Residency Match. https://www.nrmp.org/wp-content/uploads/2023/05/2023-Main-Match-Results-and-Data-Book-FINAL.pdf.

National Residency Matching Program. (2024a). 2024 Main Residency Match by the Numbers. https://www.nrmp.org/wp-content/uploads/2024/03/2024-Match-by-the-Numbers.pdf.

National Residency Matching Program. (2024b). Advance Data Tables: 2024 Main Residency Match. https://www.nrmp.org/wp-content/uploads/2024/03/Advance-Data-Tables-2024.pdf.

National Residency Matching Program. (2024). 2024 NRMP Main Residency Match: Match Rates by Specialty and State. https://www.nrmp.org/wp-content/uploads/2024/03/Main-Match-Results-by-State-Specialty-and-App-Type-2024.pdf.

New Mexico Human Services Department. (n.a.). GME Expansion. Accessed March 26, 2024. https://www.hsd.state.nm.us/gme-expansion/.

Reimbursement of Graduate Medical Education Costs. Ohio Stat. § 5164.74. (2013 Rev. 2021). https://codes.ohio.gov/ohio-revised-code/section-5164.74.

State-funded Psychiatry Residency Program. Iowa Stat.§135.180. (2023). https://www.legis.iowa.gov/docs/code/2023/135.180.pdf.

U.S. Health Resources & Services Administration. (2024a).89 Health Workforce Shortage Areas. Accessed March 25, 2024. https://data.hrsa.gov/topics/health-workforce/shortage-areas.

U.S. Department of Health & Human Services. (2024b). Designated Health Professional Shortage Areas Statistics. https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport.

**This Note has been updated since its original publication. Previous versions are not up-to-date, but can be found here: Version 1 (November 2021).