shows the changes in the number of pipeline specialty graduates, the number and percent of graduates continuing GME for each year, and the change in the absolute number of graduates continuing GME, for the period from AY 2002–2003 to AY 2006–2007. The total increase in the number of graduates since AY 2002–2003 was proportionally small (1171, or 5.3%), while the number of graduates entering additional training over the same time period showed a much larger proportional increase (1059, or 16.7%). The percentage of graduates continuing their training increased, overall and within most pipeline specialties, across the 5-year period. Among pipeline specialty graduates in AY 2002–2003, 28.5% (6331/22229) continued training in an additional residency or fellowship program, compared with 31.6% residents (7390/23400) in AY 2006–2007. Across all years, approximately 95% of the residents continuing GME entered a fellowship program rather than entering another pipeline residency.
Table 1 Residents Who Graduate From Accreditation Council for Graduate Medical Education–Accredited Pipeline Specialty Programs and Continue Graduate Medical Education (GME), From Academic Year (AY) 2002–2003 to AY 2006–2007, by Specialty (more ...)
Among pipeline specialties, the largest increases in the percent of graduates continuing training were in nuclear medicine (21.3% [17/80] to 28.2% [22/78]), pediatrics (32.7% [791/2417] to 39.2% [996/2538]), anesthesiology (19.9% [268/1349] to 26.2% [388/1479]), and neurology (46.6% [203/436] to 52.3% [267/511]). Specialties with the lowest percentage of graduates continuing training (<1%) across all AYs were obstetrics and gynecology, ophthalmology, and radiation oncology. These are specialties with no ACGME-accredited fellowship programs. An analysis that excluded the graduates from pipeline specialties without ACGME-accredited fellowships (nuclear medicine, obstetrics and gynecology, ophthalmology, and radiation oncology) showed an overall rate of continuing GME that was slightly higher but increased similarly across all years (30.8% [6307/20500] versus 28.5% [6331/22229] in AY 2002–2003 and 34.0% [7362/21653] versus 31.6% [7390/23400] in AY 2006–2007).
Our findings show differences in these trends for USMG and IMG graduates. The number of USMG pipeline graduates remained relatively stable during this time period (14
752 in AY 2002–2003 versus 14
941 in AY 2006–2007), while the number of USMGs entering additional training increased substantially (3896 versus 4718, respectively; see ). In contrast, the number of IMGs graduating from pipeline specialties increased from 6023 in AY 2002–2003 to 6647 in AY 2006–2007, but the numbers of those seeking further GME training increased to a lesser extent (2118 versus 2246, respectively). This resulted in an overall increase in the rate of continuing GME among USMGs (26.4% [3896/14752] in AY 2002–2003 to 31.6% [4718/14941] in AY 2006–2007) and a net decrease in the rate of continuing GME among IMGs (35.2% [2118/6023] to 33.8% [2246/6647], respectively; see ).
Figure 2 Total Number of Accreditation Council for Graduate Medical Education–Accredited Pipeline Program Graduates and the Number Continuing Graduate Medical Education (GME), From Academic Year (AY) 2002–2003 to AY 2006–2007, by Type of (more ...)
Rate of Continuing Graduate Medical Education (GME), From Academic Year (AY) 2002–2003 to AY 2006–2007, by Type of Medical School Education. IMG Indicates International Medical Graduate; USMG Indicates US Medical School Graduate
shows the number of USMG and IMG pipeline graduates and the continuance rates for those specialties having large graduate classes and at least 5% of graduates continuing GME. The largest increases in the number of USMG graduates during this time period occurred in anesthesiology, pathology, and diagnostic radiology; decreases occurred in the number of USMG graduates in surgery, family medicine, internal medicine, and pediatrics. The percent of USMG graduates continuing GME increased during this time across all specialties, with the largest percentage increases occurring in anesthesiology (13.5% [93/688] to 24.0% [263/1095]) and pathology (51.9% [96/185] to 63.9% [227/355]).
Table 2 Residents Who Graduate From Accreditation Council for Graduate Medical Education–Accredited Pipeline Specialty Programs and Continue Graduate Medical Education (GME), From Academic Year (AY) 2002–2003 to AY 2006–2007, by Specialty (more ...)
The largest increases in the number of IMG pipeline graduates occurred in primary care specialties, while there were decreases in the number of IMGs graduating from anesthesiology, neurology, pathology, psychiatry, and diagnostic radiology. The decrease in the percent of IMGs continuing GME is particularly notable in diagnostic radiology (43.8% [67/153] versus 34.2% [26/76]) and surgery (49.6% [62/125] versus 40.1% [87/217]). For the majority of specialties, however, the continuing GME rate was still higher among IMGs compared to USMGs—especially in pathology (63.9% [227/355] for USMGs versus 74.3% [136/183] for IMGs in AY 2006–2007).