Exploring the Magnitude and Timing of Physician Specialty Changes

Investigators: Erin Fraher PhD MPP, Andy Knapton MSc

Background/Study Purpose:  Congressional proposals to expand Graduate Medical Education have set a goal of funding 3,000 new PGY1 slots for five years for a total of 15,000 new residency positions.  The Resident Physician Shortage Reduction Act of 2015 (S.1148), its companion bill in the House (H.R. 2124) and another bill, Training Tomorrow’s Doctors Today Act (H.R. 1201) seek to target residency expansion toward needed specialties and geographies. While these proposals are critical to ensuring that public investments in GME produce the workforce needed to meet population health needs, simply increasing the number of residency positions in core specialties such as internal medicine (IM) and general surgery (GS) will produce only a fraction of the number of physicians needed.  This is because a significant proportion of IM and GS residents pursue subspecialty training.

Specialization behaviors during training have been well-documented, particularly in internal medicine, pediatrics and surgery (Jolly, Erikson, and Garrison 2013; Stitzenberg and Sheldon 2005; Garibaldi, Popkave, and Bylsma 2005; Freed et al. 2009). Less well understood is the probability of residents completely switching specialties during training.  This adjustment is critical because the specialty of a resident can differ from the specialty in which they exit training and become board certified.  For example, on average between 2006 to 2011, there were 1,493 anesthesiology residents in PGY2 positions. An analysis of these residents’ specialties in PGY1 reveals that 45.5% were in anesthesiology; 26.1% were in internal medicine; 18.5% were transitional programs; 8.4% came from surgery and the remainder came from 13 other specialties.  (Knapton, Fraher,  and Jolly 2014).

Study Aims:  This project will provide data on the magnitude and timing of residents’ branching and switching behaviors during training between 35 specialties.  The analysis will quantify the number of residents who change specialties during training and identify when (i.e. in which year of postgraduate training) residents switch specialties.