THE SHIFTING SANDS OF GRADUATE MEDICAL-EDUCATION

Each year the American Medical Association (AMA) surveys all programs in graduate medical education (GME) accredited by the Accreditation Co uncil for Graduate Medical Education. Because of the importance of GME in the national workforce policy debate, this year's survey report ha s been expanded to provide more detailed GME data. The authors describ e the historical basis of the current GME workforce dilemma and the mu ltiple forces that now tend to neutralize efforts to adapt to a changi ng marketplace. For example, as resident physicians find it increasing ly difficult to locate suitable employment, one would expect a reducti on in hospital-based programs and in the number of their resident phys ician appointments. Yet, while US medical graduates (USMGs) did not pu rsue certain programs in this year's National Resident Matching Progra m, AMA data show that during the past 2 years the reduced number of re sidents in hospital-based programs was almost exactly offset by the in creased number in new and expanded programs. Also, more USMGs are leav ing residency training to enter practice after 3 years of basic traini ng in primary care (internal medicine, pediatrics, and family practice ). At the same time, an increasing number of international medical gra duates are remaining in subspecialty programs. Other examples are cite d to show the ebb and flow of GME activities that behave like ''shifti ng sands.''