The biggest single factor affecting the physiatrist
population is the number of residency positions offered and the number of
those positions that are filled annually. The 1995 study gave little
explicit attention to this issue, since it was assumed that the numbers
would persist into the future. In the 1998 study, the issue was consider one
of the most important to reexamine because of actual and projected changes
in graduate medical education (GME) funding, increased numbers of
international medical school graduates (IMGs) filling PM&R positions,
and other factors.
The trend in the number of PM&R residency
positions available and filled in approximately the last 10 years is
illustrated in Figure 2. The assumption in 1995
was that these numbers would remain at about the 1993-1994 level of 1,250
positions with a 95% fill rate, resulting in about 350 new entrants to the
specialty annually. At that rate, the number of practicing physiatrists
would roughly double between 1995 and 2015.
Although the number of residents in 1997-1998 did not
differ greatly from the 1995 assumptions, the 1998 study panel was concerned
that trends in GME funding could result in reductions in those numbers. The
formula for determining the amounts of indirect medical education (IME)
payments has been recently modified to reduce those payments. Elements of
the direct medical education (DME) formula have been frozen, and a cap has
been imposed on the number of residency positions that are eligible for GME
expenditures at training hospitals. Moreover, a trend toward a greater
proportion of IMGs filling residency positions (Figure
3) suggested to some panel members that there are problems in filling
positions through the normal matching process, and that if that is the
situation, it perhaps portends future cutbacks.
The panel was asked to estimate the number of
residency positions and the number of new entrants in selected years; the
median response is presented in Table 1.
The estimates suggest that the original assumptions about the numbers of
positions and new entrants was about right through 2005, after which
slightly lower numbers of both entrants and positions are predicted. The
point was made that there will be fewer PM&R residents entering at PGY2
after 2005, and with the number of total slots roughly fixed, more PGY1
slots will be substituted for the PGY2 positions. Hence, although residency
positions are projected to increase modestly after 2010, the number of
entrants will decline slightly below the number projected in the 1995 study.
Some panel members observed that the effective work
week may be changing for physiatrists. In particular, older physicians may
be working fewer hours because of their advancing age, while younger
physiatrists may choose to give more time to other activities and to not
practice as many hours a week as did earlier generations. Managed care may,
in some of its forms, also result in fewer hours of work per physician. The
panel expressed the effect of this phenomenon as a percentage change in
effective clinical hours relative to 1996. The median percentage changes are
shown in
Table 3.
