Royce Trevor J, Jones Gavin P, Muralidhar Vinayak, Chowdhary Mudit, Holmes George M
is Assistant Professor, Department of Radiation Oncology, University of North Carolina at Chapel Hill.
is a Resident Physician, Department of Radiation Oncology, University of Kentucky.
J Grad Med Educ. 2021 Jun;13(3):385-389. doi: 10.4300/JGME-D-20-00941.1. Epub 2021 Jun 14.
Much of the Affordable Care Act (ACA) and subsequent US health care policies were designed to address deficiencies in health care access and enhance primary care services. How residency positions and physician incomes have changed in the post-ACA era is not well characterized.
We evaluated the growth of US trainee positions and physician income, in the pre- vs post-ACA environment by specialty and among primary care vs specialty care.
Total resident complement by specialty and year was extracted from the National Graduate Medical Education (GME) Census and stratified into primary care vs specialty care. Median incomes were extracted from Medical Group Management Association surveys. Piecewise linear regression with interaction terms (pre-ACA, 2001-2010, vs post-ACA, 2011-2019) assessed growth rate by specialty and growth rate differences between primary care and specialty care. Sensitivity analyses were performed by focusing on family medicine and excluding additional GME positions contributed by the introduction of the 2015 single GME accreditation system.
Resident complements increased for primary care (+0.16%/year pre-ACA to +2.06%/year post-ACA, < .001) and specialty care (+1.49%/year to +2.07%/year, = .005). Specialty care growth outpaced primary care pre-ACA ( < .001) but not post-ACA ( = .10). Family medicine had the largest increase in the pre- vs post-ACA era (-0.77%/year vs +2.09%/year, < .001). Excluding positions contributed by the single GME accreditation system transition did not result in any statistically significant changes to the findings. Income growth increased for primary care (+0.84%/year to +1.37%/year, = .044), but decreased for specialty care (+1.44%/year to +0.49%/year, = .011). Specialty care income growth outpaced primary care pre-ACA ( < .001), but not post-ACA ( = .22).
We found significant growth differences in resident complement and income among primary care versus specialty care in the pre-/post-ACA eras.
《平价医疗法案》（ACA）以及随后的美国医疗保健政策大多旨在解决医疗保健可及性方面的不足，并加强初级保健服务。ACA后时代住院医师职位和医生收入的变化情况尚未得到充分描述。
我们评估了ACA实施前后美国按专业以及初级保健与专科保健划分的培训学员职位和医生收入的增长情况。
从国家毕业后医学教育（GME）普查中提取按专业和年份划分的住院医师总数，并分为初级保健和专科保健。中位数收入从医疗集团管理协会的调查中提取。带有交互项的分段线性回归（ACA之前，2001 - 2010年，与ACA之后，2011 - 2019年）评估按专业的增长率以及初级保健和专科保健之间的增长率差异。通过关注家庭医学并排除2015年单一GME认证系统引入所带来的额外GME职位进行敏感性分析。
初级保健的住院医师总数增加（ACA之前每年增长0.16%至ACA之后每年增长2.06%，P <.001），专科保健也是如此（从每年增长1.49%至每年增长2.07%，P =.005）。在ACA之前，专科保健的增长超过初级保健（P <.001），但在ACA之后并非如此（P =.10）。在ACA前后时代，家庭医学的增长幅度最大（从每年 - 0.77%增至每年 + 2.09%，P <.001）。排除单一GME认证系统转变带来的职位对研究结果没有产生任何统计学上的显著变化。初级保健的收入增长有所增加（从每年增长0.84%至每年增长1.37%，P =.044），但专科保健的收入增长下降（从每年增长1.44%至每年增长0.49%，P =.011）。在ACA之前，专科保健的收入增长超过初级保健（P <.001），但在ACA之后并非如此（P =.22）。
我们发现ACA前后时代初级保健与专科保健在住院医师总数和收入方面存在显著的增长差异。
