Medicine Graduates Research Articles

A Qualitative Study on the Outcomes of Participation in a Longitudinal Clinician Educator Curriculum During Internal Medicine Residency.

Despite increasing prevalence of longitudinal clinician educator tracks (CETs) within graduate medical education (GME) programs, the outcomes of these curricula and how participation in these tracks affects early career development remains incompletely understood. To describe the experience and outcomes of participating in a CET and its effects on recent internal medicine residency graduates' perceived educator skills and early career development. We conducted a qualitative study between July 2019 and January 2020 using in-depth semi-structured interviews of recently graduated physicians from 3 internal medicine residencies at one academic institution who had participated in a CET, the Clinician Educator Distinction (CED). Iterative interviews and data analysis was performed via an inductive, constructionist, thematic analysis approach by 3 researchers to develop a coding and thematic structure. Results were sent electronically to participants for member checking. From 21 (out of 29 eligible) participants, thematic sufficiency was reached at 17 interviews. Four themes related to the CED experience were identified: (1) motivation to go beyond the expectations of residency; (2) educator development outcomes from Distinction participation; (3) factors enabling curricular efficacy; and (4) opportunities for program improvement. A flexible curriculum with experiential learning, observed teaching with feedback, and mentored scholarship allowed participants to enhance teaching and education scholarship skills, join a medical education community, transform professional identities from teachers to educators, and support clinician educator careers. This qualitative study of internal medicine graduates identified key themes surrounding participation in a CET during training, including positively perceived educator development outcomes and themes surrounding educator identity formation.

Osteopathic manipulative treatment for the allopathic resident elective: does it change practice after graduation?

Osteopathic manipulative treatment (OMT) for the allopathic resident is an elective at the University of Minnesota North Memorial Residency that engages the resident in the basic tenants of osteopathic medicine, with exposure to the vast application of OMT with a curricular focus on low back pain management. Implementing an elective curriculum is a feasible way to improve attitudes in OMT for MDs in a Family Medicine residency, and residents can learn OMT in an elective rotation. This article aims to determine if MDs who complete an OMT for the allopathic physician elective rotation have higher comfort caring for patients with back pain compared to those who do not complete the elective. Further, this article is designed to evaluate if these MDs continue to incorporate OMT into the care they provide once they graduate from their residency programs. Graduates from the University of Minnesota North Memorial Family Medicine Residency (2013 to 2019) were sent an email invitation in August 2020 to complete a Qualtrics survey regarding their comfort with caring for patients with back pain, referral patterns for these patients, and the ongoing use of OMT in their practices. Doctor of Osteopathic Medicine (DO) graduates who responded to the survey were removed from the analysis. Among emailed graduates, 61.8% (42/68) completed the survey, with representation from each class ranging from 1 to 7years postresidency. The five DO graduates who responded were removed from the analysis. Among the remaining 37 respondents, 27 had completed the OMT for the allopathic rotation ("elective participants") during their residency training and 10 had not ("control"). Half (50.0%) of the control group provide OMT care compared to 66.7% of the elective participants, with a comfort score of 22.6 (standard deviation [SD] 32.7) in the control group vs. 34.0 (SD 21.0) in elective participants (on a 0-100 scale; 100 being completely comfortable; p=0.091). Among the control group, 40.0% regularly refer to a DO provider compared to 66.7% of those who completed the elective (p=0.257). The mean comfort score for performing a physical examination on patients presenting with back pain was 78.7 (SD 13.1) and 80.9 (SD 19.3) in the control and elective participants groups, respectively (p=0.198). Allopathic Family Medicine residents who completed an elective rotation in OMT have a slight increase in frequency of referring to DOs. They also have a meaningful increase in comfort performing OMT. With the limited number of DOs being a common barrier to OMT care, more widely implemented training in OMT for allopathic Family Medicine residents may be a reasonable intervention to improve the care of patients with back pain.

A comparative analysis of graduate preparedness for a career in General Internal Medicine before and after national subspecialty recognition to inform curricular changes: have we met the mark?

A survey of General Internal Medicine (GIM) graduates published in 2006 revealed large training gaps that informed the development of the first national GIM objectives of training in 2010. The first recognized GIM certification examination was written by candidates in 2014. The landscape is again changing with the introduction in 2019 of competency-by-design (CBD) to GIM training. This study aims to examine pre-existing and emerging training gaps with standardization of GIM curricula and identify new training needs to inform CBD curricula. GIM graduates from all 16 Canadian programs from 2014 -2019 were emailed a survey modeled after the original study published in 2006. Graduates were asked about their preparedness and importance ratings for various elements of practice. Many of the previously identified gaps (difference between importance and preparedness ratings) have been resolved in specific clinical areas (obstetrical and perioperative medicine) and skills (exercise stress testing) although some still require ongoing work in areas such as substance use disorders. Importantly, gaps still exist in preparedness for some intrinsic roles (e.g. managerial skills). The development of a national GIM curriculum has helped close some educational gaps but some still exist. Our study provides data needed to meet the evolving needs of our graduates.

The influence of excessive stress on medical students in the Czech Republic – national sample

PurposeThe Czech Republic has been dealing with a long-term shortage of doctors, which, according to demographic forecasts, will continue to worsen due to the retirement of stronger generations of doctors in contrast to the gradual aging of the population, which will require more health care over time. The country´s political set is trying to respond to this shortage and demographic forecasts by gradually increasing financial funding of medical faculties with the aim of increasing the number of graduates of the program in the field of general medicine.MethodsAnonymous questionnaire survey was conducted among students and graduates of general medicine at all eight Czech medical faculties. A total of 3183 respondents participated in the survey. There were 2843 medical students, which represents approximately 28% of all medical students in the Czech Republic. The distribution of respondents within the study years was approximately even and approximately corresponded to the real distribution of students between individual faculties in country, which makes survey a national sample. The statistical processing was performed in the statistical software R. Apart from the basic comparison using percentage relative frequencies and Pearson´s chi-squared test, in this study we used Odds ratios (OR) with CI 0,95 from logistic regression model for a better interpretation of some outputs.ResultsThe results show that the vast majority of Czech medical students experience excessive stress during their studies, which increases the risk of students´ somatic problems (OR = 4.89, CI 0.95 = (4.11;5.83), p < 0.001)., targeted alcohol use (OR = 2.29, CI 0.95 = (1.73;3.04), p < 0,001) and the use of anxiolytic or antidepressant medication to reduce it (OR = 2.99, CI 0.95 = (2.24;4.01), p < 0.001). Students experiencing higher levels of excessive stress are more likely to leave their studies based on their own decision (4.20 (CI 0.95 (3.39;5.19), p < 0.001) and not to enter clinical practice after graduation (OR = 2.62, CI 0.95 = (2.06;3.33), p < 0.001).ConclusionsThe survey shows the need for an open discussion at the highest level about the possibilities of reasonable reduction of unnecessary stress during medical studies. Medical students in the Czech Republic are exposed to excessive stress with all the consequences described above. All that remains is to state the existence of unnecessary components of stress, which represent an opportunity to reduce it, thereby achieving better conditions for studying, improvement in the staff situation in the Czech healthcare system and a reduction in inefficiently spent financial resources for the education of young doctors.Trial registrationNo registration.

Characteristics among six generations of medicine graduates

Characteristics among six generations of medicine graduates

The Effect of Rural Underserved Opportunities Program Participation on Medical Graduates' Decision to Work in Rural Areas.

There is a persistent rural physician shortage in the United States. Policies to scale up the health workforce in response to this shortage must include measures to draw and maintain existing and newly trained health care workers to rural regions. Prior studies have found that experience in community medicine in rural practice settings increases the likelihood of medical graduates practicing in those regions but have not accounted for selection bias. This study examined the impact of a community-based clinical immersion program on medical graduates' decision to work in rural regions, adjusting for covariates to control for selection bias. Data on sociodemographic characteristics and career interests and preferences for all 1,172 University of Washington School of Medicine graduates between 2009 and 2014 were collected. A logistic model (model 1) was used to evaluate the impact of Rural Underserved Opportunities Program (RUOP) participation on the probability of physicians working in a rural region. Another model (model 2) included the propensity score as a covariate in the regression to control for possible confounding based on differences among those who did and did not participate in the RUOP. Of the 994 students included in the analysis, 570 (57.3%) participated in RUOP training, and 111 (11.2%) were currently working in rural communities after their training. Regression analysis results showed that the odds of working in a rural region were 1.83 times higher for graduates who participated in RUOP in model 1 ( P = .03) and 1.77 times higher in model 2 ( P = .04). The findings of this study emphasize that educational programs and policies are crucial public health interventions that can promote health equity through proper distribution of health care workers across rural regions of the United States.

Simulation in emergency medicine graduate medical education: a call to lead.

Simulation in emergency medicine graduate medical education: a call to lead.

Perceptions of portfolio assessment in family medicine graduates: a qualitative interview study

BackgroundThe use of the portfolio methodology in medical education can serve as a tool for learning, assessment, and reflection on practice. This study concentrates on perceptions of the portfolio assessment methodology among participants in the Saudi Diploma of Family Medicine program.MethodsIn this qualitative interview study, data were collected and analysed using a grounded theory approach.ResultsNine codes emerged: (1) Importance of understanding the definition, objectives, and process of portfolio assessment, (2) Impact of different understandings on the part of various trainers, (3) Role of the type of assessment, (4) Workload and stress of portfolio assessment, (5) Effectiveness of the portfolio contents, (6) Role of the mentor’s feedback, (7) Role in the learning process, (8) Role in practice, (9) Suggestions for portfolio improvement. Open codes were then regrouped into three axial codes: context, strategy, and outcome of portfolio assessment.ConclusionThis study explored a general explanation of portfolio assessment shaped by the postgraduate students. It identifies the importance of portfolio understanding in student acceptability of the portfolio assessment methodology. Thus, proper implementation is vital for the success of assessing the student by the portfolio methodology. The students perceived reflection as the most valuable part of the process, which facilitated their learning, confidence, and self-assessment. Mentor feedback is a good strategy for coping with portfolio challenges. Our findings provide some evidence of positive outcomes of portfolio assessment in practice and professional development.

The results of testing medical university graduates (majoring in «General Medicine») and residency graduates (majoring in «Therapy») on the organization of preventive activities

The quality of readiness of university graduates (majoring in General Medicine) and residency graduates (majoring in Therapy) to provide primary health care to the adult population is an objective problem in practical healthcare. In this regard, the goal of the study was set: to determine the level of knowledge of university graduates majoring in General Medicine and residency graduates majoring in Therapy of medical educational organizations of the constituent entities of the Russian Federation on conducting medical, preventive medical examinations, dispensary observation of patients with diseases and (or) conditions according to the major Therapy and monitoring the effectiveness of measures for dispensary observation. The methodological basis of the study was a systematic and competent approach to determining the level of knowledge of graduates. The level of knowledge of graduates was determined by using a testing method. 1695 sixth-year students of medical faculties and 449 second-year residency students majoring in Therapy took part in the testing. The study has showed that the level of knowledge among graduates is heterogeneous. The identified problem in the development of knowledge in preventive activities among students majoring in General Medicine and residency students majoring in Therapy determined the directions for improving the system of students training.

Focused practice in family medicine

To determine factors associated with having a focused practice among a sample of family medicine graduates in Canada and to assess the characteristics of FPs with focused practices and the range of services provided by these FPs in relation to the full scope of office-based care. Secondary analyses of cross-sectional data from the 2013-2014 Western Family Medicine Resident Follow-Up Survey. Western University in London, Ont. Western University family medicine residency graduates who completed the program between 1985 and 2012. Physician and practice characteristics and the clinical services that survey participants provide. Completion of postgraduate third-year (PGY3) training was associated with having a focused practice. Focused practice FPs were more likely to be remunerated by fee-for-service, alternative payment plans, or alternative funding plans compared with non-focused practice FPs, who were more likely to participate in group payment models. Focused practice FPs appeared to be a heterogeneous group who were distinguished by being either an office-based focused practice FP (OBFFP) or a non-office-based focused practice FP (NOBFFP). Office-based focused practice FPs were less likely than NOBFFPs to have completed PGY3 training and more likely to work under a fee-for-service or group payment model. Further, the OBFFP group offered a greater variety of primary care services than the NOBFFP group, but offered less variety than non-focused practice FPs. Completion of PGY3 training and payment through certain remuneration models were both associated with focused practice. Important differences exist between OBFFPs and NOBFFPs. The overall service provision of focused practice FPs was centred on specialized areas, especially among those practising in non-office-based settings. Novel findings from this study provide insights for family medicine education, work force planning, and policy making in the Canadian health system.

Trends in Industry Payments to Physicians in the First 6 Years After Graduate Medical Training

Financial incentives and conflicts of interest may influence physician decision-making. It is important to understand financial interactions between the pharmaceutical and medical device industries and newly independent physicians who have recently completed their graduate medical education using a national transparency program. To identify trends in industry payments to recent graduates of Accreditation Council for Graduate Medical Education-accredited residency or fellowship programs in orthopedic surgery, neurosurgery, and internal medicine. This retrospective cohort study analyzed Open Payments reports of industry payments made between July 1, 2015, and June 30, 2021, to newly independent physicians from residency or fellowship programs in neurosurgery, orthopedic surgery, and internal medicine who graduated between January 1, 2015, and December 31, 2019. Specialties (neurosurgery and orthopedic surgery, with internal medicine as a comparison group). Industry payments to newly independent physicians, including any general payments (noninvestment or nonresearch) and at least $5000 of general payments in aggregate value per year, which are considered significant financial conflicts of interest. The percentage of newly independent physicians accepting general payments during the first 6 years after graduation was analyzed by specialty and sex using cumulative incidence curves and hazard ratios (HRs) in univariable and multivariable analyses. There were 45 745 recent graduates (28 137 men [62%]; median age at graduation, 33.0 [IQR, 31.0-35.0 years]) in neurosurgery (n = 595), orthopedic surgery (n = 3481), and internal medicine (n = 41 669). In the first 2 years of independent practice, 95% (n = 3297), 92% (n = 546), and 59% (n = 24 522) of newly independent physicians in orthopedic surgery, neurosurgery, and internal medicine, respectively, accepted any general payments. A higher percentage of the newly independent physicians in orthopedic surgery and neurosurgery accepted any general payments (orthopedic surgery vs internal medicine: HR, 5.36 [95% CI, 4.42-6.51] for women and 7.01 [95% CI, 6.35-7.73] for men; neurosurgery vs internal medicine: HR, 3.25 [95% CI, 2.24-4.72] for women and 4.08 [95% CI, 3.37-4.94] for men; P = .03). A higher percentage of male physicians compared with female physicians accepted any general payments (orthopedic surgery, 2884 of 3026 [95%] vs 413 of 455 [91%]; P < .001; neurosurgery, 466 of 502 [93%] vs 80 of 93 [86%]; P = .01; and internal medicine, 15 462 of 24 609 [63%] vs 9043 of 17 034 [53%]; P < .001) and at least $5000 of general payments (orthopedic surgery, 763 of 3026 [25%] vs 71 of 455 [16%]; P < .001; neurosurgery, 87 of 502 [17%] vs 5 of 93 [5%%]; P < .001; and internal medicine, 882 of 24 609 [4%] vs 210 of 17 034 [1%]; P < .001). In this cohort study of newly independent physicians in orthopedic surgery, neurosurgery, and internal medicine, the financial relationship with potential conflicts of interest between newly independent physicians and industry began to develop soon after training programs and continued to expand in the early years of newly independent physician practice. Newly independent physicians in surgical specialties and male physicians accepted significantly higher industry payments. Further studies are needed to evaluate whether modifiable factors are associated with the future outcome of newly independent physicians accepting general payments.

Piloting web-based structural competency modules among internal medicine residents and graduate students in public health.

Fewer than half of internal medicine program directors report any health disparities curriculum. We piloted a web-based healthcare disparities module among internal medicine (IM) residents to test effectiveness and feasibility, compared to a convenient sample of graduate students enrolled in a public health equity course. IM residents participated in an in-person session (module 1: introduction to racial and ethnic health disparities), but first, they completed a pre-module knowledge quiz. Two weeks later, they completed module 2: "unconscious associations" and a post-module knowledge quiz. For the control arm Yale School of Public Health (YSPH) students enrolled in a course on health disparities completed the pre-module knowledge quiz, module 1, and 2 as required by their course instructor. Forty-nine IM residents and 22 YSPH students completed the pre-module quiz and Module 1. The mean (SD) score out of 25 possible points for the IM residents on the pre-module quiz was 16.1/25 (2.8), and 16.6/25 (3.2) for YSPH students, with no statistically significant difference. Nineteen residents (38.8%) completed the post-module quiz with a mean score of 16.7/25 (2.2), Hedge's g =0.23, compared to 18 (81.8%) YSPH students, whose mean (SD) score was 19.5/25 (2.1), Hedge's g=1.05. YSPH students' post-module quiz average was statistically significantly higher than their pre-module test score, as well as the residents' post-module test (P < 0.001). In examining participants' responses to specific questions, we found that 51% (n = 25) of residents wrongly defined discrimination with an emphasis on attitudes and intent as opposed to actions and impact, compared to 22.7% (n = 5) YSPH students before the module, vs. 63.2% (n = 12) and 88.9% (n = 16) respectively after. After completing a healthcare disparities course, graduate students in public health saw greater gains in knowledge compared to IM residents. Residents' responses showed knowledge gaps such as understanding discrimination, and highlight growth opportunity in terms of health equity education. Furthermore, embedding health equity education in required curricular activities may be a more effective approach.

The value of admissions characteristics for predicting the practice location of University of Saskatchewan College of Medicine graduates.

The physician workforce in Saskatchewan depends upon the retention of locally trained physicians. Characteristics collected at the time of medical school application may predict future practice location, but these associations have not been explored. We identified the current practice location of University of Saskatchewan College of Medicine graduates who matriculated between 2000 and 2013 and extracted data from their admission applications including gender, age, high school, previous university, and current location at the time of application. We then conducted univariate and multivariate analyses to evaluate associations between these characteristics and rural- and Saskatchewan-based practice. We identified the current practice location of 1,001 (98.9%) of the graduates of the included cohorts. Attending a Saskatchewan high school (p < 0.001), a high school in a smaller population center (p < 0.01), and a Saskatchewan university (p < 0.001) were predictive of Saskatchewan-based practice. Attending a high school outside of Saskatchewan (p < 0.05), a high school in a smaller population center (p < 0.001), and living in a small population centre at the time of application (p < 0.05) were predictive of rural-based practice within or outside of Saskatchewan. Demographic characteristics collected at time of medical school application are associated with future Saskatchewan- and rural-based practice. These findings will guide admissions policies in Saskatchewan and may inform admission practices of other medical schools.

Evaluating the Teaching Health Center Graduate Medical Education Model at 10 Years: Practice-Based Outcomes and Opportunities.

Since 2011, the Teaching Health Center Graduate Medical Education (THC GME) program has sought to expand access to care by training residents in safety net settings. To examine impact on physician scope, location, and patient population served using a unique data set. Using 2017-2020 data from the American Board of Family Medicine National Graduate Survey, we compared demographics, practice location, populations served, and scope of practice between graduates of THC GME programs and graduates of other family medicine programs. Our sample comprised 8608 (out of 13 465) eligible family medicine graduates 3 years after completion of residency training, for a response rate of 63.9%. THC graduates were significantly more likely than other graduates to practice in a rural location (17.9% to 11.8%), within 5 miles of their residency program (18.9% to 12.9%), and to care for medically underserved populations (35.2% to 18.6%). Their scope of practice was wider than other graduates and more likely to comprise services like buprenorphine prescribing, behavioral health care, and outpatient gynecological procedures. Regression results suggest that THC training is independently correlated with a broader scope of practice. Graduates of THC programs were significantly more likely than graduates of other programs to practice close to their training sites and in rural areas, and to care for underserved patients while maintaining a broader scope of practice than other graduates.

Horizontal job-education mismatches and earnings of university graduates in Russia

ABSTRACT The study is devoted to the evaluation of the determinants of job-education mismatches and their impact on salaries of university graduates. We use a comprehensive and nationally representative survey of Russian university graduates. The study employs a self-evaluated measure of mismatch and a statistical variant for robustness and interpretation purposes. We find that one-third of the graduates in Russia are horizontally mismatched, and that the share of mismatched graduates in Russia is higher than the average in OECD countries. Graduates from fields that generate more general human capital, or where low pay is common, are more likely to be mismatched. On the contrary, graduates in Medicine, which is a more specialised field, are more likely to be matched. We find that mismatches negatively affect the earnings of university graduates and, the higher is the degree of mismatch, the higher is the penalty for the mismatch. The study depicts that mismatch is penalised in the majority of fields except for low-paid ones.

Methodological Reflections of a Student- and Community-based Partnership on Operationalizing a Community-based Participatory Research Model: Recommendations for Building, Securing, and Sustaining Partnerships.

Community-based participatory research (CBPR) is an approach that values community expertise and ownership in creating knowledge. This approach's success is challenged by inherent cultural imbalances, making it difficult to sustain partnerships and build from what has been learned from a project as it develops. As student researchers and community members, we reflected on the challenges in CBPR and gave guidance to future novice researchers pursuing CBPR. From the application of an initial CBPR model as a framework to our partnership, we propose empirical avenues to continuously adapt the CBPR approach. A CBPR partnership between McGill's Family Medicine Graduate Student Society and Share the Warmth, a community-based organization aiming to fight poverty and hunger, was formed to collaboratively assess a music program offered in a socioeconomically disadvantaged community. The partnership process was based on a model that we conceptualized in three phases of our framework: building, securing, and sustaining. We reflect on the facilitators and challenges of this project and propose solutions to overcome identified barriers within the context of our partnership. We highlight the importance of integrating student partners in the community, reevaluating formal research agreements, and coordinating the transition of new partners in this adaptive CBPR model. We argue that this systematic and reflexive process has made the model especially useful as a framework for student and community partnerships. We propose adaptive components to the CBPR model. Our recommendations could help other partnerships cultivate CBPR to be more applicable in community health research.

Using the Residency Matched Method and Intent to Practice Method to Estimate Primary Care Workforce Production.

IntroductionMany medical schools overestimate the percentage of their graduates who enter the primary care workforce based on the “first-certificate” residency their graduates enter. To rectify this problem, Deutchman and colleagues proposed a new method of estimation. The objective of this study was to compare results from the traditional residency match and Deutchman methods to the actual percentage of University of Kansas School of Medicine (KUSM) graduates who practice primary care after completing medical school and all residency and subspeciality fellowship training.MethodsA retrospective study was conducted using a convenience sample of KUSM graduates from 2003–2014. Percentages of graduates classified as primary care by the traditional Residency Match Primary Care Method (RMPCM) and the percentages of graduates identified as primary care by Deutchman’s Intent to Practice Primary Care Method (IPPCM) were compared with the actual percentage of graduates who eventually entered the primary care workforce.ResultsOf the 1,944 KUSM graduates identified during the study period, the RMPCM predicted a 48.1% primary care output rate. The Deutchman’s IPPCM predicted a 22.8% primary care output rate. The actual known percentage of graduates practicing primary care was 34.2%.ConclusionsNeither the RMPCM nor the Deutchman’s IPPCM performed well in predicting the percentage or number of KUSM graduates who eventually practiced primary care. Due to predictions for the shortage of primary care physicians, there is a need to identify a method that more accurately predicts the medical schools’ contribution to the primary care workforce.

Analyzing wage differentials by fields of study: Evidence from Sri Lanka

Aspirants of higher education and their parents often face a dilemma over the selection of a field of study which pays off handsomely in the job market. This article is based on a study which investigated investigates graduate wage differentials associated with primary employment by fields of study. It employed both mean and quantile regression specifications to the nationally representative labour force survey data. The study found Engineering, Medicine, Management, Commerce, and Law graduates enjoy statistically significant positive wage premiums compared to graduates of Arts. Moreover, these wage premiums are relatively larger in the upper segment of the graduate wage distribution compared to the lower segment. Relatively smaller and statistically weaker wage premiums were observed for Science and Information Technology fields of study whereas graduates of Agriculture and Indigenous Medicine do not enjoy a wage premium over graduates of Arts. The study also found a significant gender pay gap in Management, Commerce, and Science fields of study.

Growth of for-profit involvement in emergency medicine graduate medical education and association between for-profit affiliation and resident salary.

BackgroundFollowing projections of an emergency medicine (EM) physician oversupply, the growth of EM residency programs affiliated with for‐profit hospitals has been subject to increased attention and speculation. However, essentially no literature exists regarding these programs. Resident pay is one area where these programs could differ from nonprofit‐affiliated programs, as investor obligations could make for‐profit corporations more likely to reduce resident salaries to increase profit margins. Here, we aim to quantify the growth of EM for‐profit affiliated residency programs from 2001–2021 and determine if PGY1 salaries differ between these program types.MethodsMedicare and ACGME accreditation data were used to determine the profit status of hospitals affiliated with EM residency programs. ACGME new accreditation data from 2001–2021 were used to quantify the growth of both for‐profit and nonprofit affiliated programs over this period. We searched program websites and called programs to determine 2021–2022 PGY1 salary. Multiple regression was used to model the relationship between profit status and salary using program characteristic covariates to control for confounding variables.ResultsThe number of EM programs increased from 117 to 276 from 2001–2021 while the number of for‐profit affiliated EM residency programs increased from 1 to 29 during this period. Most (85.7%, [24/29]) for‐profit affiliated programs were accredited from 2016–2021. Mean for‐profit affiliated program salary ($55,658, n = 24) was $3840 lower than mean nonprofit affiliated program salary ($59,498, n = 203). For‐profit affiliation was a significant predictor of lower 2021–2022 PGY1 salary after controlling for other program characteristics using multiple regression ( ß = −1919.88, P = 0.010).ConclusionsWe found a substantial growth of newly ACGME accredited for‐profit affiliated EM residency programs from 2016–2021. We also found for‐profit affiliated programs pay lower PGY1 salaries than nonprofit–affiliated programs after controlling for potential confounding variables, which suggests more oversight over the salary determination process could be necessary to prevent resident underpayment.

Doctors of Osteopathic Medicine (DO) and their potential impact on Canadian rural health care

There are currently over 400 Canadian students studying at accredited Osteopathic Medical Schools in the United States, and the number of matriculants has been steadily rising annually [1]. In 2019–2020, there were approximately 100 Canadian Doctor of Osteopathic Medicine (DO) graduates and about 109 first-year matriculants [1,2]. With the increase of Canadian citizens training as Doctors of Osteopathic Medicine (DO) in the United States, it is essential to consider the positive effect this may have on the Canadian rural health care system and how these physicians can impact patients living in rural communities.