The number of Medicare-funded graduate medical education slots has been capped by the federal government since 1997, when the Balanced Budget Act passed, and the capped numbers of Medicare-sponsored residents per 100,000 people vary widely state to state, according to a recent analysis in Health Affairs.
The following are the 10 states with the highest resident cap per 100,000 people and the 10 states with the lowest cap.
Highest
1. New York: 77.13
2. Massachusetts: 66.08
3. Rhode Island: 61.48
4. Pennsylvania: 54.48
5. Michigan: 53.05
6. Connecticut: 49.65
7. Ohio: 42.62
8. Vermont: 40.28
9. Louisiana: 38.46
10. Illinois: 38.46
Lowest
1. Montana: 1.63
2. Idaho: 2.24
3. Alaska: 3.15
4. Wyoming: 6.64
5. South Dakota: 8.84
6. Nevada: 9.10
7. Mississippi: 11.25
8. North Dakota: 11.52
9. Oregon: 12.86
10. Hawaii: 13.84
Additionally, the average Medicare GME payment per resident varies from state to state, ranging from $155,135 per resident in Connecticut to $63,811 in Louisiana.
"Formula-driven GME and the blunt reforms that capped individual hospitals at their 1997 training levels have frozen in place a very irregular geography and, effectively, robbed current policy makers of the ability to make strategic judgments about the $10 billion provided annually to teaching hospitals in the name of graduate medical education," the study's authors concluded. "The GME system badly needs a central coordinating body or institution to deliberate and make policy about public investments in graduate medical education."