Effect of changes in graduate medical education funding on emergency medicine residency programs

Objective: To determine whether changes in graduate medical education (GME) funding have had an impact on emergency medicine (EM) residency training p rograms. Methods: A 34-question survey was mailed to the program directors (PDs) of all 115 Accreditation Council for Graduate Medical Education (ACGM E)-accredited EM residency programs in the United States in the fall of 199 8, requesting information concerning the impact of changes in GME funding o n various aspects of the EM training. The results were then compared with a similar unpublished survey conducted in the fall of 1996. Results: One hun dred one completed surveys were returned (88% response rate). Seventy-one ( 70%) of the responding EM residency programs were PGY-I through PGY-III, co mpared with 55 (61%) of the responding programs in 1996. The number of PGY- II through PGY-IV programs decreased from 25 (28%) of responding programs i n 1996 to 17 (16%). The number of PGY-I through PGY-IV programs increased s lightly (13 vs 10); the number of EM residency positions remained relativel y stable. Fifteen programs projected an increase in their number of trainin g positions in the next two years, while only three predicted a decrease. O f the respondents, 56 programs reported reductions in non-EM residency posi tions and 35 programs reported elimination of fellowship positions at their institutions. Only four of these were EM fellowships. Forty-six respondent s reported a reduction in the number of non-EM residents rotating through t heir EDs, and of these, 11 programs reported this had a moderate to signifi cant effect on their ability to adequately staff the ED with resident physi cians. Sixteen programs limited resident recruitment to only those eligible for the full three years of GME funding. Eighty-seven EM programs reported no change in faculty size due to funding issues. Sixty-two programs report ed no change in the total number of hours of faculty coverage in the ED, wh ile 34 programs reported an increase. Three EM programs reported recommenda tions being made to close their residency programs in the near future. Conc lusions: Changes in GME funding have not caused a decrease in the number of existing EM residency and fellowship training positions, but may have had an impact in other areas, including: an increase in the number of EM progra ms structured in a PGY-I through PGY-III format (with a corresponding decre ase in the number of PGY-II through PGY-IV programs); a decrease in the num ber of non-EM residents rotating through the ED; restriction of resident ap plicants who are ineligible for full GME funding from consideration by some EM training programs; and an increase in the total number of faculty clini cal hours without an increase in faculty size.