New Residency Positions May Exacerbate Urban-Rural Disparities

MONDAY, June 29, 2026 (HealthDay News) — The 1,000 new residency positions created from 2023 to 2025 may have exacerbated urban-rural training disparities, according to a research letter published online June 15 in the Journal of the American Medical Association.

Tarun Ramesh, M.D., from Massachusetts General Hospital in Boston, and colleagues examined the geographic and specialty distribution of new residency positions funded by rounds 1 through 4 of the Consolidated Appropriations Act of 2021 (800 graduate medical education [GME] slots) and the 2023 appropriations act (200 more GME slots). 

The researchers found that of the positions authorized by the 2021 act, 100 percent were in a Health Professional Shortage Area, compared with 81.6 percent of those authorized in the 2023 act. Just over half of positions (53 percent) in round 1 of the 2021 act were for primary care. Across the four rounds, there was a decrease in the percentage of primary care positions, while the percentage for psychiatry increased. From round 1 to 4, primary care positions experienced a 22-percentage point decline. More than half of positions (54.5 percent) created by the 2023 appropriations act were allocated to psychiatry. For the 2021 allocations, six percent of positions in the first round were for rural counties, decreasing each subsequent round to three percent in round 4. Only one percent of the positions in the 2023 appropriations act were allocated to rural counties. For postgraduate year 1 positions, compared with the 2021 baseline, interventional radiology (15.8 percent) and psychiatry (12.5 percent) accounted for the greatest increases, while primary care positions increased by two percent.

“We found that new residency positions are not consistently reaching rural areas or supporting primary care as intended,” senior author Hao Yu, Ph.D., from Harvard University in Boston, said in a statement.

One author disclosed financial ties to the biopharmaceutical industry.

Abstract/Full Text (subscription or payment may be required)