A federal effort to expand the physician workforce through new Medicare-funded residency positions may not be increasing primary care training or rural physician development as policymakers intended, according to a study published June 15 in the Journal of the American Medical Association.
Researchers from Harvard Medical School and the Harvard Pilgrim Health Care Institute, both in Boston, Brigham and Women’s Hospital, also in Boston, conducted a national analysis of 1,000 Medicare-funded residency positions created under the Consolidated Appropriations Act of 2021 and 200 additional positions created under the Consolidated Appropriations Act of 2023. The cross-sectional study examined residency slots allocated between 2023 and 2025.
The 2021 law required all new positions to be allocated to Health Professional Shortage Areas, with 10% reserved for rural areas. CMS also prioritized primary care positions, though it did not publish a target proportion, according to the study. Primary care specialties included internal medicine, family medicine, internal medicine-pediatrics and pediatrics.
Researchers found primary care’s share of new residency positions declined across the four allocation rounds under the 2021 law, falling from 53% in the first round to 31.5% in the fourth. At the same time, psychiatry’s share increased. Among positions created under the 2023 law, 54.5% were allocated to psychiatry.
The study also found the allocation of new positions did not meet the 2021 law’s 10% rural target. Rural counties received 6% of positions in the first round, declining to 3% in the fourth round. Under the 2023 law, 1% of positions were allocated to rural counties.
Compared with 2021 residency levels, primary care positions increased 2% overall, while interventional radiology and psychiatry saw the largest increases at 15.8% and 12.5%, respectively, according to the study.
The authors said the findings suggest the residency expansion may increase the physician workforce overall, particularly in psychiatry and shortage areas, but may not substantially improve primary care physician supply or physician distribution between urban and rural communities. They noted several study limitations, including a lack of information on how much time residents spent practicing in rural settings during training.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
