Internal medicine in the National Resident Matching Program 1978-1989.
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Biomedical subjects
Publications and source records attributed to J S Graettinger.
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The number and percentage of graduating seniors from medical schools in the United States who have matched to categorical programs in internal medicine in the National Resident Matching Program have decreased since 1985. Examination of the balance between undergraduate and graduate medical education in the 127 networks of each medical school in the United States and its associated hospitals showed major differences in the retention and recruitment of graduates. The service needs of hospitals rather than the number of graduates from schools in the United States would seem to have controlled the number of positions. Because the positions exceeding the number of graduates from the United States are filled by graduates of foreign schools, these positions are of major importance in determining the supply of internists. The clerkship programs must be restructured to provide students an improved introduction to internal medicine, and the number of entering positions in residencies must be reduced by the substitution of other personnel to do some of the service functions now done by residents.
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The results of the National Intern and Resident Matching Program for the past four years show a steadily increasing number of positions offered and filled in the primary care specialties. The number of percentage of unmatched U.S. students decreased. The number of foreign medical graduates matched remained constant. Marked differences in the numbers of positions offered and filled were found among the various regions of the country.
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When the 2,308 residencies obtained by U.S. medical school graduates outisde of th National Intern and Resident Matching Program were added to those of the 11,172 students who matched, the distribution of all 1977 graduates among specialties was found to be essentially the same as for those who matched, but regional differences were marked. A regional comparison of the location of the residencies obtained by the graduates with the location of the schools attended by students suggested that recruitment of graduates from other regions was as important in determining the number of first-year residents as was retention of graduates in a given region.
An analysis of programs and positions in the first year of graduate medical education regarded as acceptable by U.S. medical students suggests that the ratio for all positions is about one per graduate and even less in primary care programs. Since approximately 95 percent of positions are now in institutions affiliated with academic health centers, these medical-school-hospital complexes should be supported to increase positions in primary care programs in order to accommodate the two-thirds of U.S. graduates who want to begin their graduate medical education in these disciplines.
The total number of applicants for first-year programs in graduate medical education through the National Intern and Resident Matching Program in 1976 exceeded the number of positions offered for the second consecutive year. The number of positions available for U.S. medical school graduates in 1976 was approximately 1.22. Based on student preferences for their first-year graduate medical education programs, there were deficits in the number of openings offered in the primary care specialties and surfeits in medical and surgical subspecialties, pathology, psychiatry, and radiology.
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