US Primary Care vs Specialty Care Trainee Positions and Physician Incomes: Trends From 2001 to 2019

Abstract

Background Much of the Affordable Care Act (ACA) and subsequent US health care policies were designed to address deficiencies in health care access and enhance primary care services. How residency positions and physician incomes have changed in the post-ACA era is not well characterized. Objective We evaluated the growth of US trainee positions and physician income, in the pre-vs post-ACA environment by specialty and among primary care vs specialty care. Methods Total resident complement by specialty and year was extracted from the National Graduate Medical Education (GME) Census and stratified into primary care vs specialty care. Median incomes were extracted from Medical Group Management Association surveys. Piecewise linear regression with interaction terms (pre-ACA, 2001–2010, vs post-ACA, 2011–2019) assessed growth rate by specialty and growth rate differences between primary care and specialty care. Sensitivity analyses were performed by focusing on family medicine and excluding additional GME positions contributed by the introduction of the 2015 single GME accreditation system. Results Resident complements increased for primary care (þ0.16%/year pre-ACA to þ2.06%/year post-ACA, P