Benchmarking graduate medical education in neurology: a cross-specialty comparison and analysis of residency matching data.

Abstract

The American Academy of Neurology membership, [1] health policy scholars, [2-13] and the federal government [14,15] have agreed that there are too many residency positions in neurology, and the era of carte blanche governmental subsidization of Graduate Medical Education (GME) may be coming to a close. If GME funding is reduced from 140% to 110% of US Medical School seniors, as has been proposed, the federal underwriting for nearly two-thirds of residency positions in neurology will be eliminated. The impact of this downsizing will be magnified as organized medicine is subjected to the additional forces of economic competition familiar to the business world. Pressures to maximize production and reduce overhead have transformed continuous quality improvement (CQI) from a visionary concept to a necessary reality. [16,17] Halfway through the Decade of the Brain, we neurologists must choose either to watch this coming transformation passively and reactively or to focus on a diversified, proactive approach to CQI. The first approach would impel us to deal post hoc with across-the-board cuts in GME funding; the second would allow us to determine the standards for our specialty. To move toward CQI, neurology first must examine comparative profiles of other medical disciplines. This report aims to do such benchmarking of GME in neurology. Residency matching data from years 1989 to 1995 were analyzed for the five largest specialties: Family Practice, Internal Medicine, Pediatrics, Obstetrics/Gynecology, and General Surgery, as well as the allied disciplines of Neurosurgery, Physical Medicine & Rehabilitation, (PGY-1 and PGY-2), and Psychiatry. Family Practice, Internal Medicine, Pediatrics were collectively termed Primary Care; OB-Gyn, General Surgery, and Neurosurgery were grouped as Specialty Care. Preliminary PGY-1 positions in Medicine, Pediatrics, and Surgery and combined programs of all types (e.g., Medicine/Neurology, Medicine/Psychiatry, etc.) were considered less comparable with neurology and were thus excluded from analysis. Raw …