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Changes in Primary Care Graduate Medical Education Are Not Correlated With Indicators of Need: Are States Missing an Opportunity to Strengthen Their Primary Care Workforce?

Coutinho, Anastasia J. MD, MHS; Klink, Kathleen MD; Wingrove, Peter; Petterson, Stephen PhD; Phillips, Robert L. Jr MD, MSPH; Bazemore, Andrew MD

doi: 10.1097/ACM.0000000000001539
Research Reports

Purpose Federal and state graduate medical education (GME) funding exceeds $15 billion annually. It is critical to understand mechanisms to align undergraduate medical education (UME) and GME to meet workforce needs. This study aimed to determine whether states’ primary care GME (PCGME) trainee growth correlates with indicators of need.

Method Data from the American Medical Association Physician Masterfile, the Association of American Medical Colleges, the American Association of the Colleges of Osteopathic Medicine, and the U.S. Census were analyzed to determine how changes between 2002 and 2012 in PCGME trainees—a net primary care physician (PCP) production estimate—correlated with state need using three indicators: (1) PCP-to-population ratio, (2) change in UME graduates, and (3) population growth.

Results Nationally, PCGME trainees declined by 7.1% from the net loss of 679 trainees (combined loss of 54 postgraduate year 1 trainees in internal medicine, family medicine, and pediatrics and addition of 625 fellowship trainees in those specialties). The median state PCGME decline was 2.7%. There was no correlation between the percent change in states’ PCGME trainees and PCP-to-population ratio (r = −0.06) or change in UME graduates (r = 0.17). Once adjusted for population growth, PCGME trainees declined by 15.3% nationally; the median state decline was 9.7%.

Conclusions There is little relationship between PCGME trainee growth and state need indicators. States should capitalize on opportunities to create explicit linkages between UME, GME, and population need; strategically allocate Medicaid GME funds; and monitor the impact of workforce policies and training institution outputs.

Supplemental Digital Content is available in the text.

A.J. Coutinho is a second-year family medicine resident, Santa Rosa Family Medicine Residency Program, Santa Rosa, California.

K. Klink is chief, Health Professions Education, Office of Academic Affiliations, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, DC.

P. Wingrove is a research analyst, Robert Graham Center, Washington, DC.

S. Petterson is research director, Robert Graham Center, Washington, DC.

R.L. Phillips Jr is vice president of research and policy, American Board of Family Medicine, Lexington, Kentucky.

A. Bazemore is director, Robert Graham Center, Washington, DC.

Supplemental digital content for this article is available at

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Previous presentations: A portion of this material was presented at the North American Primary Care Research Group Annual Conference; October 2015; Cancun, Mexico.

Correspondence should be addressed to Anastasia Coutinho, Santa Rosa Family Medicine Residency, 3569 Round Barn Circle, Suite 200, Santa Rosa, CA 95403; telephone: (707) 583-8806; e-mail:

© 2017 by the Association of American Medical Colleges