The effect of Medicaid graduate medical education spending on physician workforce development in primary and non-primary care specialties

PURPOSE: In the context of federal and state policy efforts to address health workforce shortages, this study examines whether US states' Medicaid programs increase the total number of graduate medical education (GME) positions in primary versus non-primary care physician specialties when increasing financial investment in GME. METHOD: Fixed effects regression estimation was employed to evaluate the association of Medicaid GME payments with residency positions in primary care and non-primary care specialties in 8 years from 1998 to 2022, controlling for changes in poverty rates and health professions regulation. Sensitivity analyses examined this association in the presence of caps on federal direct GME (DGME) reimbursement payments. RESULTS: Per 10,000 population, an additional $1 million of Medicaid GME funding was associated with 0.934 more residents in primary care specialties (95% CI [0.170, 1.697]) and 1.229 more residents in non-primary care specialties (95% CI [0.345, 2.092]). Similar results were obtained in sensitivity analyses that controlled for state-level changes to Medicare DGME caps. CONCLUSIONS: Additional Medicaid GME payments were associated with increases in residency positions, exhibiting similar effects in primary and non-primary care specialties. Additional structures, processes, or policy measures may be needed to optimize Medicaid GME funding as a means of addressing physician workforce shortages in primary care and other high-need areas. Further evaluations of GME financial investment are needed to inform future policy and spending decisions related to health workforce development.