The AMA Graduate Profile: Tracking Medical School Graduates Into Practice.

Abstract

Purpose: Medical schools aim to train competent physicians that meet the health care needs of society. Yet beyond the results of the residency match, medical schools often do not know what kind of workforce they are creating or how their graduates perform in practice. 1 Here, we describe the creation of a personalized Graduate Profile for 32 medical schools in the American Medical Association (AMA) Accelerating Change in Medical Education grant consortium. The Graduate Profile addressed 3 core questions: (1) Workforce: Where do graduates practice and to which communities do they contribute?, (2) Clinical Exposure: What prescriptions are graduates ordering for various patient types?, and (3) Quality of Care: What are graduates’ standardized quality measures? Approach: The Graduate Profile links the AMA Physician Masterfile—a nationwide database of physicians in training and practice—to multiple public data sources spanning undergraduate medical education, graduate medical education (GME), and post-GME practice using individuals’ unique national provider identification numbers. Medical students graduating from 32 institutions between 1981 and 2012 were included (n = 120,426 graduates). Graduates’ demographics, self-designated practice specialty, practice location, and practice setting in the year 2019 were tabulated. Specialties were coded as primary care or not primary care. Practice locations were geocoded to identify practice in underserved or rural areas. Additionally, Centers for Medicare and Medicaid Services (CMS) utilization data and Merit-based Incentive Payment System (MIPS) standardized quality scores from the year 2017—representing over 140 million Medicare beneficiary interactions—were tabulated. Outcomes: Graduate Profiles were delivered to 32 medical schools in November 2020. A webinar and 2 office hours were held to support rollout of the profiles. The profiles compared each institution’s graduates from 1981 to 2012 with an average across all medical schools in a series of tables and figures. Trends in graduate gender distribution, in-state retention, practice specialty, primary care practice, office-based practice, and underserved practice were visualized and benchmarked against all 32 medical schools. For example, practice in primary care specialties peaked in the late 1990s and has since declined. Practice in medically underserved communities remained largely constant across 3 decades of graduate cohorts, suggesting that programmatic and policy efforts have not dramatically increased underserved practice. Average MIPS scores were delineated by specialty and over time. Overall, more recent graduates were associated with higher MIPS scores. Finally, graduates’ most prescribed medications to Medicare beneficiaries were tabulated. Across these 32 medical schools, the most prescribed medications were hydrocodone–acetaminophen, lisinopril, atorvastatin, omeprazole, and levothyroxine; as expected, substantial prescribing differences were observed by specialty. Each institution’s personalized profile differed, with substantial interinstitutional differences in most assessed areas. Discussion: Harnessing the AMA Physician Masterfile and multiple open data sources, this project provided medical schools with detailed profiles of their graduates—some of whom had been in practice for nearly 40 years. The project relied on data science and informatics approaches, using a centralized process that had “economy of scale.” Early feedback from medical schools indicates that the profiles are hypothesis generating and may highlight alignment (or misalignment) with their stated educational mission. We envision a future state where the constituent institutions generate questions to be answered via the Graduate Profile, which then drives medical education innovation at the medical school level. 2 Significance: The AMA Graduate Profile uses informatics approaches to link multiple data sources for 3 decades of graduates, providing medical schools a tool to understand if their graduates’ practice patterns align with their stated mission and workforce needs. The Graduate Profile is unique as it incorporates actual practice specialties, practice locations, prescribing behaviors, and standardized quality scores of over 120,000 graduates—a proof of concept for future work exploring additional domains of graduates in practice.