20 States With Most, Least Graduate Medical Education Slots

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.

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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.”

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