Medical School Enrollment Growth Limited by Space Constraints in Clinical Training and Residency Programs

Last month, MedPage Today reported that applications to medical school have risen significantly compared to the same period last year, according to both the American Association of Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM). AAMC reported a year-over-year increase of 14 percent in early August, and AACOM reported an uptick of 17.7 percent as of mid-August.

Sources speaking to MedPage Today pointed to the pandemic as a reason for the spike, suggesting that the current high-profile nature of medical personnel may be inspiring applications to medical school. Other applicants may be taking advantage of idle time to submit their applications early, while some may be seeking alternative paths to mitigate economic uncertainty. Geoffrey Young, AAMC’s Senior Director of Student Affairs and Programs, told MedPage that the early indicators may not necessarily indicate a more competitive year, noting that the pandemic has created “an unconventional time.”

While both AAMC and AACOM schools are expanding their capacity where possible, both note that their growth is limited due to a lack of corresponding residency spots. The AAMC has launched a few new schools, which has increased overall enrollment, and remains optimistic that many schools will be able to make incremental increases in class size. Larger updates to class sizes, however, would have to be approved by the accrediting agency. Osteopathic school enrollments are growing faster, with a 6.6 percent increase approved for the upcoming year by the accrediting agency, up from a 5.6 percent increase the year before.

This capacity constraint suggests that many qualified candidates may not find a place in medical school, despite a national need to grow the physician workforce. Results released last week from the AAMC Annual Survey also focus on the significance of the clinical experience constraint. In the survey, which was administered in November 2019 to 154 medical schools, school leaders voiced apprehension about the number of residency positions and clinical training sites available to students.

Just under half of the schools reported “major or moderate” concern about their students finding post-graduate residency positions of their choice. While medical school enrollment has seen significant growth over the last two decades, an increase of 33 percent since 2002, residency availability has grown much more slowly. Federal support for Graduate Medical Education (GME) provided through Medicaid, has been capped for the last two decades, effectively leaving funding for GME at teaching hospitals at 1996 levels. The National Resident Matching Program reports that this year 40,084 MD and DO graduates applied for only 37,256 residency positions though the Main Residency Match.

In addition to concerns about residency, a large majority of medical school leaders reported concern over the availability of clinical training sites for students. As demand increases for clinical experiences from other medical trainees, including nurse practitioners, physician assistants, and DO programs, AAMC medical schools are feeling more stretched to meet their students’ needs. Most of the survey respondents reported concern about clinical training sites and qualified primary care preceptors, 84 and 86 percent respectively, and just under three-fourths, 71 percent, mentioned concern about students having access to qualified specialty preceptors.