The Current State of US Internal Medicine Primary Care Training
2016; Elsevier BV; Volume: 129; Issue: 9 Linguagem: Inglês
10.1016/j.amjmed.2016.05.006
ISSN1555-7162
AutoresPaul O’Rourke, Eva Tseng, Rachel B. Levine, Marc Shalaby, Scott M. Wright,
Tópico(s)Healthcare cost, quality, practices
ResumoPerspective Viewpoints•We compiled a comprehensive database of Internal Medicine primary care programs.•We identified 104 internal medicine primary care programs across the US.•Over half of the primary care programs are located in the Northeast.•Only 13.5% of programs are located in the Southeast and Mountain West collectively. •We compiled a comprehensive database of Internal Medicine primary care programs.•We identified 104 internal medicine primary care programs across the US.•Over half of the primary care programs are located in the Northeast.•Only 13.5% of programs are located in the Southeast and Mountain West collectively. Primary care has been associated with better health care quality and lower health care spending.1World Health Organization. The World Health Report 2008: primary health care now more than ever. Available at: http://www.who.int/whr/2008/en. Accessed March 30, 2015.Google Scholar, 2Macinko J. Starfield B. Shi L. Quantifying the health benefits of primary care physician supply in the United States.Int J Health Serv. 2007; 37: 111-126Crossref PubMed Scopus (234) Google Scholar, 3Chang C.H. Stukel T.A. Flood A.B. Goodman D.C. Primary care physician workforce and medicare beneficiaries' health outcomes.JAMA. 2011; 305: 2096-2104Crossref PubMed Scopus (126) Google Scholar, 4Baicker K. Chandra A. Medicare spending, the physician workforce, and beneficiaries' quality of care.Health Aff (Millwood). 2004; (W4-184-97)Google Scholar New health policy developments expanding access, coupled with the aging population, have increased the need for primary care physicians (PCP).5Bodenheimer T. Pham H.H. Primary care: current problems and proposed solutions.Health Aff (Millwood). 2010; 29: 799-805Crossref PubMed Scopus (459) Google Scholar, 6Schwartz M.D. Health care reform and the primary care workforce bottleneck.J Gen Intern Med. 2012; 27: 469-472Crossref Scopus (58) Google Scholar At the same time, recent studies have forewarned of a significant PCP shortage, with 2 recent analyses projecting that at least 44,000 additional PCPs will be necessary by 2025 to meet the anticipated patient demand.7Petterson S.M. Liaw W.R. Phillips Jr., R.L. Rabin D.L. Meyers D.S. Bazemore A.W. Projecting US primary care physician workforce needs: 2010-2025.Ann Fam Med. 2012; 10: 503-509Crossref PubMed Scopus (441) Google Scholar, 8Colwill J.M. Cultice J.M. Kruse R.L. Will generalist physician supply meet demands of an increasing and aging population?.Health Aff (Millwood). 2008; 27: w232-w241Crossref PubMed Scopus (266) Google Scholar Due to current uneven geographical distribution of PCPs, some areas of the country are more severely affected than others.9Petterson S.M. Phillips Jr., R.L. Bazemore A.W. Koinis G.T. Unequal distribution of the U.S. primary care workforce.Am Fam Physician. 2013; 87 (Online)Google Scholar, 10Fordyce MA, Chen FM, Doescher MP, Hart LG. 2005 physician supply and distribution in rural areas of the United States. Available at: http://depts.washington.edu/uwrhrc/uploads/RHRC%20FR116%20Fordyce.pdf. Updated 2007. Accessed March 31, 2015.Google Scholar Internal medicine residency programs are responsible for training 20% of all US medical residents and are a major source of generalist physicians.7Petterson S.M. Liaw W.R. Phillips Jr., R.L. Rabin D.L. Meyers D.S. Bazemore A.W. Projecting US primary care physician workforce needs: 2010-2025.Ann Fam Med. 2012; 10: 503-509Crossref PubMed Scopus (441) Google Scholar, 11Accreditation Council for Graduate Medical Education. Graduate Medical Education Data Resource Book 2011-2012. Available at: https://www.acgme.org/acgmeweb/Portals/0/PFAssets/PublicationsBooks/2011-2012_ACGME_DATABOOK_DOCUMENT_Final.pdf. Accessed March 31, 2015.Google Scholar Over one-third of practicing PCPs were general internists in 2010.7Petterson S.M. Liaw W.R. Phillips Jr., R.L. Rabin D.L. Meyers D.S. Bazemore A.W. Projecting US primary care physician workforce needs: 2010-2025.Ann Fam Med. 2012; 10: 503-509Crossref PubMed Scopus (441) Google Scholar To promote training in general medicine, internal medicine primary care programs were developed in the 1970s.12McPhee S.J. Mitchell T.F. Schroeder S.A. Perez-Stable E.J. Bindman A.B. Training in a primary care internal medicine residency program. The first ten years.JAMA. 1987; 258: 1491-1495Crossref Scopus (50) Google Scholar Internal medicine primary care residents are more likely to pursue a general medicine career than internal medicine categorical residents.13West C.P. Dupras D.M. General medicine vs subspecialty career plans among internal medicine residents.JAMA. 2012; 308: 2241-2247Crossref PubMed Scopus (86) Google Scholar, 14Witzburg R.A. Noble J. Career development among residents completing primary care and traditional residencies in medicine at the Boston city hospital, 1974-1983.J Gen Intern Med. 1988; 3: 48-53Crossref Scopus (12) Google Scholar, 15Stanley M. O'Brien B. Julian K. et al.Is training in a primary care internal medicine residency associated with a career in primary care medicine?.J Gen Intern Med. 2015; 30: 1333-1338Crossref Scopus (19) Google Scholar Survey data from the Internal Medicine In-Training Examination demonstrated that almost 40% of internal medicine primary care residents plan to pursue a general medicine career, in contrast to only about 20% of internal medicine categorical residents.13West C.P. Dupras D.M. General medicine vs subspecialty career plans among internal medicine residents.JAMA. 2012; 308: 2241-2247Crossref PubMed Scopus (86) Google Scholar Internal medicine primary care programs have witnessed increasing popularity in recent years. Among internal medicine residency programs with a distinct internal medicine primary care National Resident Matching Program (NRMP) code, there were 6 applications per available position compared to 1.7 applications per internal medicine categorical position in 2014.16National Resident Matching Program. Results and data 2014 main residency match. Available at: http://www.nrmp.org/wp-content/uploads/2014/04/Main-Match-Results-and-Data-2014.pdf. Updated 2014. Accessed March 31, 2015.Google Scholar In conjunction with this applicant interest, the number of available positions in programs with distinct internal medicine primary care program codes has increased, from 259 attainable positions in 2010 to 335 positions in 2014.16National Resident Matching Program. Results and data 2014 main residency match. Available at: http://www.nrmp.org/wp-content/uploads/2014/04/Main-Match-Results-and-Data-2014.pdf. Updated 2014. Accessed March 31, 2015.Google Scholar While internal medicine primary care training programs may serve to diminish the looming national PCP shortage, a comprehensive public database of all internal medicine primary care programs does not currently exist. Only a portion of programs explicitly publicize such an offering in the NRMP match, while others merely offer optional tracks within their internal medicine categorical programs. A consolidated inventory of all internal medicine primary care programs would be beneficial for potential applicants, medical students, advisors, researchers, and policy-makers. Our paper primarily set out to identify all US internal medicine primary care programs to create a database for interested parties and stakeholders. We also aimed to clarify which of these programs participate in the NRMP match as distinct entities and to compare the geographic locations of primary care programs relative to PCP availability across the country. Because there are no established standards or guidelines for internal medicine primary care programs, we defined a “primary care program” for this study as one that participates in the NRMP match with a distinct match number or offers a “primary care track” within an internal medicine categorical residency. We identified internal medicine primary care programs using a step-wise exploratory approach (Figure 1). First, data from the NRMP 2014 Residency Match was evaluated to find internal medicine primary care programs that have a distinct NRMP match number.16National Resident Matching Program. Results and data 2014 main residency match. Available at: http://www.nrmp.org/wp-content/uploads/2014/04/Main-Match-Results-and-Data-2014.pdf. Updated 2014. Accessed March 31, 2015.Google Scholar NRMP distinguishes primary care internal medicine programs that participate separately in the match from categorical internal medicine programs via a distinct code; 55 internal medicine primary care programs were so designated. Internal medicine primary care programs can receive distinct internal medicine primary care program NRMP designation through payment of a fee; there are no special requirements to be designated as a primary care track program. Second, after reviewing all 408 internal medicine categorical residency programs participating in the 2014 NRMP match, 9 additional programs–not identified previously by distinct internal medicine primary care program code–were recognized as potentially primary care programs because they refer to primary care in their program names. This NRMP surveillance identified 64 internal medicine primary care programs. To identify internal medicine primary care tracks that did not participate in the NRMP match, we used the American Medical Association FREIDA database.17American Medical Association. About FREIDA Online. Available at: http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online/about-freida-online.page?. Updated 2015. Accessed April 8, 2015.Google Scholar The FREIDA database is primarily composed of data derived from the National Graduate Medical Education Census, an annual survey of graduate medical education programs administered by the American Medical Association and the Association of American Medical Colleges.17American Medical Association. About FREIDA Online. Available at: http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online/about-freida-online.page?. Updated 2015. Accessed April 8, 2015.Google Scholar Using the FREIDA search engine, internal medicine programs that potentially offered a primary care track were noted by using the search terms “internal medicine” and “primary care track.” As of January 2015, 272 internal medicine programs met these criteria. We excluded any programs that had been previously identified through NRMP data (n = 53). We also omitted any programs that were not located in the 50 US states or within the District of Columbia (n = 3). For the remaining programs (n = 216), we evaluated each program's FREIDA link under the “Educational Environment” subheading to determine whether it offered a primary care track. If the program explicitly indicated that it offered a primary care track on this site, the program was included in the preliminary internal medicine primary care database (n = 80). If it explicitly stated that they did not offer a primary care track, they were excluded (n = 101). All programs that did not provide explicit information about whether they offered a primary care track were included to receive further investigation during the verification stage (n = 35). One or more of the following methods were used to substantiate the presence of a primary care program at each of the entries in the preliminary database (n = 115): e-mail to a designated program leader or coordinator that included a brief electronic survey inquiring about the presence of a primary care track, phone or e-mail contact with the program administration, or evaluation of individual program Web sites. We incorporated information on the PCP-to-population ratio for each state using data from Petterson et al.7Petterson S.M. Liaw W.R. Phillips Jr., R.L. Rabin D.L. Meyers D.S. Bazemore A.W. Projecting US primary care physician workforce needs: 2010-2025.Ann Fam Med. 2012; 10: 503-509Crossref PubMed Scopus (441) Google Scholar In their analysis of 2010 national data, these authors identified 208,807 active PCPs (general internal medicine, general pediatrics, family medicine, general practice, and geriatric physicians) after adjusting for retirement and non-office-based care (ie, working as hospitalists, in emergency departments, or in urgent care centers.) Over one-third of the active PCPs were general internists (n = 71,487.) They used these data to determine the PCP-to-population ratio for each state. We then divided all 50 states and the District of Columbia into quartiles based on their PCP-to-population ratios, with the first quartile representing the lowest relative PCP-to-population ratio and the fourth quartile representing the highest relative ratio. We used these data to create a map, with each state shaded based on their respective PCP-to-population ratio quartile and displayed the approximate location of all identified primary care programs on this map. To compare the regional distribution of internal medicine primary care programs with categorical programs, categorical internal medicine programs were identified via a distinct categorical internal medicine NRMP program code using 2014 NRMP data. Programs were excluded from this categorical list if previously identified as primary care programs by suggestion of primary care in the program name (n = 9). We evaluated the characteristics of primary care programs in our database, specifically their regional location, total number of applications, and number of available and filled program positions in 2014. For primary care tracks offered within established internal medicine categorical programs that lacked a distinct NRMP program code, information about the number of applications and number of available, and filled positions in 2014 was not publicly available, and therefore not included in our analysis. We calculated the percentage of programs and positions offered by region for all primary care programs with distinct NRMP program codes because this information was readily accessible. We then compared the geographic location of all internal medicine primary care programs in relation to the state's PCP-to-population ratio. To evaluate if any regional variation among primary care programs was due primarily to a similar geographic distribution of internal medicine categorical programs, we conducted the Fisher's exact test comparing categorical vs primary care programs by region. To ensure independence of variables, we only included categorical programs with no affiliation to a primary care program in this analysis. This study was approved by the Johns Hopkins Institutional Review Board. Analyses were performed using SAS 9.4 (SAS Institute Inc, Cary, NC). We identified a total of 104 internal medicine primary care programs (Appendix). Over one-half of these programs are located in the Northeast (51.9%), whereas only 13.5% of the programs are located in the Southeast and Mountain West collectively. Among the 64 programs that were identified through NRMP (61.5%), the majority are located in the Northeast (60.9%), with the fewest programs located in the Mountain West (1.6%) (Table 1). The percentage of positions filled in 2014 was high across all regions (98%-100%).Table 1Baseline Characteristics of Identified Internal Medicine Primary Care Programs Grouped by Region (n =104)RegionTotalNortheastSoutheastMountain WestPacificMidwestPrograms with distinct NRMP code, n (%)39 (60.9)7 (10.9)1 (1.6)11 (17.2)6 (9.4)64 (100)Number of positions offered in 2014 for programs with distinct NRMP code, n (% of total number of such positions)273 (71.1)24 (6.3)12 (3.1)58 (15.1)17 (4.4)384 (100)Number of positions filled in 2014 for programs with distinct NRMP code, n (% of offered positions filled)271 (99.3)24 (100)12 (100)57 (98.3)17 (100)381 (99.2)∗Represents total number of positions filled/total number of positions offered in 2014.Programs without distinct NRMP code (offered within a categorical program), n (%)15 (37.5)5 (12.5)1 (2.5)7 (17.5)12 (30.0)40 (100)NRMP = National Resident Matching Program.∗ Represents total number of positions filled/total number of positions offered in 2014. Open table in a new tab NRMP = National Resident Matching Program. The majority of the remaining 40 programs (discovered beyond NRMP) are located in the Northeast (37.5%) and Midwest (30.0%), with few programs located in the Mountain West (2.5%) (Table 1). The geographic distribution of the 104 internal medicine primary care programs is presented in Figure 2. The states with the lowest PCP-to-population ratio also have no or very few primary care programs (for example: Mississippi, Oklahoma, and Texas). In contrast, many of the states with the highest quartile of PCP-to-population ratio have several primary care programs (including Massachusetts and the District of Columbia). Table 2 shows the regional distribution of internal medicine primary care programs vs internal medicine categorical programs. A Fisher's exact test revealed that the regional distribution of internal medicine categorical vs primary care programs is significantly different (P <.001). Fifty-two percent of US primary care programs are located in the Northeast, while this region accounts for only 31.8% of the nation's categorical programs that are unaffiliated with a primary care program (Table 2). By contrast, the Southeast, an area with a lower PCP-to-population ratio, is home to 11.5% of US primary care programs and contains 26.8% of the nation's categorical programs that lack an affiliation with a primary care program.Table 2Identified Internal Medicine Primary Care Programs with Distinct NRMP Code, Internal Medicine Categorical Programs with an Optional Primary Care Track, and Internal Medicine Categorical Programs Without an Optional Primary Care Track or Affiliated Primary Care Program, Grouped by RegionRegionTotalNortheastSoutheastMountain WestPacificMidwestIM primary care programs with distinct NRMP code, n (%)39 (60.9)7 (10.9)1 (1.6)11 (17.2)6 (9.4)64 (100)IM categorical programs with an optional primary care track (primary care track without distinct NRMP code), n (%)15 (37.5)5 (12.5)1 (2.5)7 (17.5)12 (30.0)40 (100)IM categorical programs without an optional primary care track or affiliated primary care program, n (%)89 (31.8)75 (26.8)13 (4.6)28 (10.0)75 (26.8)280 (100)Total14387154693IM = internal medicine; NRMP = National Resident Matching Program. Open table in a new tab IM = internal medicine; NRMP = National Resident Matching Program. To our knowledge, a comprehensive database of primary care internal medicine programs does not currently exist and we sought to fill this gap. Through our systematic approach, we identified 104 internal medicine primary care programs in the US. We found that the majority of primary care programs are located in the Northeast where there is, correspondingly, a higher PCP-to-population ratio. The Mountain West and Southeast contain the lowest number of programs, a region with many states with low PCP-to-population ratios. Because primary care providers play significant roles in effective health systems, it is imperative that successful interventions be undertaken to avert the impending PCP shortage.1World Health Organization. The World Health Report 2008: primary health care now more than ever. Available at: http://www.who.int/whr/2008/en. Accessed March 30, 2015.Google Scholar, 2Macinko J. Starfield B. Shi L. Quantifying the health benefits of primary care physician supply in the United States.Int J Health Serv. 2007; 37: 111-126Crossref PubMed Scopus (234) Google Scholar, 3Chang C.H. Stukel T.A. Flood A.B. Goodman D.C. Primary care physician workforce and medicare beneficiaries' health outcomes.JAMA. 2011; 305: 2096-2104Crossref PubMed Scopus (126) Google Scholar, 4Baicker K. Chandra A. Medicare spending, the physician workforce, and beneficiaries' quality of care.Health Aff (Millwood). 2004; (W4-184-97)Google Scholar, 5Bodenheimer T. Pham H.H. Primary care: current problems and proposed solutions.Health Aff (Millwood). 2010; 29: 799-805Crossref PubMed Scopus (459) Google Scholar, 6Schwartz M.D. Health care reform and the primary care workforce bottleneck.J Gen Intern Med. 2012; 27: 469-472Crossref Scopus (58) Google Scholar, 7Petterson S.M. Liaw W.R. Phillips Jr., R.L. Rabin D.L. Meyers D.S. Bazemore A.W. Projecting US primary care physician workforce needs: 2010-2025.Ann Fam Med. 2012; 10: 503-509Crossref PubMed Scopus (441) Google Scholar, 8Colwill J.M. Cultice J.M. Kruse R.L. Will generalist physician supply meet demands of an increasing and aging population?.Health Aff (Millwood). 2008; 27: w232-w241Crossref PubMed Scopus (266) Google Scholar, 18Phillips RL Jr, Dodoo MS, Petterson S, et al. Specialty and geographic distribution of the physician workforce: what influences medical student and resident choices? Available at: http://www.graham-center.org/online/etc/medialib/graham/documents/publications/mongraphs-books/2009/rgcmo-specialty-geographic.Par.0001.File.tmp/Specialty-geography-compressed.pdf. Updated 2009. Accessed March 30, 2015.Google Scholar, 19Whitcomb M.E. Cohen J.J. The future of primary care medicine.N Engl J Med. 2004; 351: 710-712Crossref Scopus (75) Google Scholar General internists are just one of the contributors to the primary care workforce; however, they provide general medical care to a substantial portion of the US population.7Petterson S.M. Liaw W.R. Phillips Jr., R.L. Rabin D.L. Meyers D.S. Bazemore A.W. Projecting US primary care physician workforce needs: 2010-2025.Ann Fam Med. 2012; 10: 503-509Crossref PubMed Scopus (441) Google Scholar, 11Accreditation Council for Graduate Medical Education. Graduate Medical Education Data Resource Book 2011-2012. Available at: https://www.acgme.org/acgmeweb/Portals/0/PFAssets/PublicationsBooks/2011-2012_ACGME_DATABOOK_DOCUMENT_Final.pdf. Accessed March 31, 2015.Google Scholar Internal medicine primary care residency programs promote generalist careers and they have been growing in number in recent years in conjunction with rising applicant interest.13West C.P. Dupras D.M. General medicine vs subspecialty career plans among internal medicine residents.JAMA. 2012; 308: 2241-2247Crossref PubMed Scopus (86) Google Scholar, 14Witzburg R.A. Noble J. Career development among residents completing primary care and traditional residencies in medicine at the Boston city hospital, 1974-1983.J Gen Intern Med. 1988; 3: 48-53Crossref Scopus (12) Google Scholar, 15Stanley M. O'Brien B. Julian K. et al.Is training in a primary care internal medicine residency associated with a career in primary care medicine?.J Gen Intern Med. 2015; 30: 1333-1338Crossref Scopus (19) Google Scholar The absence of consolidated information on these programs may be responsible for the lack of research evaluating their educational attributes and learner outcomes. Our study may allow for empiric research looking at effectiveness of programs in directing learners to primary care careers and providing service in locations of greatest need. Our database can also help primary care-oriented medical students and their mentors identify programs of interest and evaluate training opportunities by region. This study shows that the geographic landscape of internal medicine primary care programs is unbalanced. While the Southeast and Mountain West regions of the US have the greatest deficit of PCPs, collectively they share 50% of generalist physicians continue to practice in the state of their graduate medical education program.20Seifer S.D. Vranizan K. Grumbach K. Graduate medical education and physician practice location. Implications for physician workforce policy.JAMA. 1995; 274: 685-691Crossref PubMed Google Scholar It could be argued that areas of the US more affected by a PCP shortage should be targeted for new or expanded internal medicine primary care program sites (states such as Arkansas, Oklahoma, and Wyoming). Several limitations of this study should be considered. First, despite a systematic approach to identify all US internal medicine primary care programs, we may not have captured all existing programs. Because there is no standardized approach for ascertaining all such programs, we established a step-wise algorithmic approach that included identification of programs through major publicly available data sources and deliberate measures to verify individual program information. Given the thoroughness of the process, we believe that the number of missing programs is small. Second, we decided to separate the programs into 2 distinct categories (NRMP code vs no distinct NRMP code) because we felt that there may be differences in the structure, curriculum, and administration of the programs. Although this categorization may be unnecessary, we thought that it was a sensible way to organize the data; we plan to evaluate potential differences based on this categorization in subsequent research. Programs may wish to consider applying for an NRMP internal medicine primary care program code to distinguish themselves as having primary care programs to potential applicants. Third, public data pertaining to the number of applications, available positions, and filled positions was universally available only for programs with a distinct NRMP program code. For programs that did not have a separate NRMP program code, data about positions and fill rate was universally available only for the overall program (categorical plus primary care), and we were unable to include information about their embedded primary care track. Fourth, the authors are well aware that multiple potential confounders beyond the scope of this paper may influence the PCP-to-population ratio in substantive ways. That said, it is interesting to consider the locations of training programs that produce a considerable proportion of PCPs and the variation in these ratios across our nation. Internal medicine primary care programs contribute substantively to the US PCP workforce. Growth, both in terms of the number of positions within programs and the total number of programs, may be justified, given high levels of applicant interest, and to alleviate the projected provider shortage. A growth strategy may be particularly relevant in underserved areas. Further research is necessary to evaluate individual program characteristics and their effectiveness in retaining generalists. We would like to thank Craig Pollack and Nisa Maruthur for their helpful review of the manuscript. Tabled 1All Identified Internal Medicine Primary Care Residency Programs (n = 104)Program NameDistinct NRMP Program Code (1 = Yes, 0 = No)No Distinct NRMP Program Code (1 = Yes, 0 = No)State or DistrictRegionAlameda County Med Ctr (Oakland) Medicine-Primary10CAPacificKaiser Perm- Santa Clara Internal Medicine/CHOICE track10CAPacificLoma Linda University Medicine-Primary10CAPacificLoma Linda University Med-Primary/Global Health10CAPacificSt. Mary Med Ctr – Long Beach, CA Medicine-Primary10CAPacificUC Davis Med Ctr – Sacramento Medicine-Primary10CAPacificUC San Francisco Medicine-Primary/UC10CAPacificUC San Francisco Medicine –Primary/SFGH10CAPacificUCLA Med Ctr – Los Angeles Medicine-Primary10CAPacificU of Colorado SOM – Denver Medicine - Primary10COMountainDanbury Hospital – CT Int Med/Primary Care10CTNortheastU of Connecticut SOM Medicine - Primary10CTNortheastYale-New Haven Hospital Medicine - Primary10CTNortheastYale-New Haven Hospital Medicine - Primary/HIV10CTNortheastGeorge Washington Univ – DC Medicine - Primary10DCNortheastWashington Hospital Center – DC Medicine - Primary Care10DCNortheastEmory Univ SOM Medicine - Primary10GASoutheastCook County-Stroger Hospital (Chicago) Medicine - Primary10ILMidwestU of Kentucky Med Ctr Medicine - Primary10KYSoutheastTulane University SOM Int Med - Primary Care10LASoutheastB.I. Deaconess Med Ctr Medicine - Primary10MANortheastB.I. Deaconess Med Ctr Medicine - Primary/HIV10MANortheastJohns Hopkins Bayview Medicine - Primary10MDNortheastBaystate Med Ctr (Springfield, Massachusetts) Medicine - Primary10MANortheastBoston Univ Med Ctr Medicine - Primary10MANortheastBrigham & Women Hospital Medicine - Primary/DGM10MANortheastBrigham & Women Hospital Medicine - Primary/HVMA10MANortheastCambridge Health Alliance Medicine - Primary10MANortheastMGH Medicine - Primary10MANortheastMGH Med-Primary/Global PC10MANortheastU of Mass Med School Internal Medicine - Primary Care10MANortheastGreater Baltimore Medical Center Medicine - Primary10MDNortheastJohns Hopkins Hospital Internal Med/Urban Health10MDNortheastUniversity Hospitals – Jackson, MS Medicine - Primary10MSSoutheastWake Forest Baptist Med Ctr Medicine - Primary10NCSoutheastDartmouth-Hitchcock Med Ctr Medicine - Primary10NHNortheastNewark Beth Israel Med Ctr Medicine - Primary10NJNortheastCooper University Hospital Medicine - Primary10NJNortheastBassett Medical Center (Cooperstown) Medicine - Primary10NYNortheastBrooklyn Hospital Center Medicine - Primary10NYNortheastEinstein/Jacobi Med Ctr (Bronx) Medicine - Primary10NYNortheastEinstein/Montefiore Med Ctr (Bronx) Medicine - Primary/Social Int Med10NYNortheastIcahn SOM at Mount Sinai Int Med/Comm Prim Care10NYNortheastIcahn SOM-Elmhurst Medicine - Primary10NYNortheastNYP Hospital-Weill Cornell Med Ctr Medicine - Primary10NYNortheastNYU SOM Medicine - Primary10NYNortheastNorth Shore-LIJ Health System (Great Neck) Medicine-Primary/Lenox Hill10NYNortheastStony Brook Teach Hosps Medicine - Primary10NYNortheastUnity Health System (Rochester, NY) Medicine - Primary10NYNortheastWilson Mem Reg/UHS-NY (Johnson City) Medicine - Primary10NYNortheastWoodhull Med Ctr (Brooklyn) Medicine - Primary10NYNortheastCase Western/Univ Hosps Case Med Ctr Int Med/Primary Care10OHMidwestCleveland Clinic Fdn Medicine - Primary10OHMidwestOhio State Univ Med Ctr Medicine - Primary10OHMidwestHosp of the Univ of PA Medicine - Primary10PANortheastBrown Medical School/Memorial Hospital (Pawtucket) Medicine - Primary10RINortheastRhode Island Hospital/Brown Univ. (Providence) Medicine - Primary10RINortheastU of Tennessee COM-Memphis (unique situation with 0 quota) Medicine - Primary10TNSoutheastUVA Medicine - Primary10VASoutheastUVM/Fletcher Allen (Burlington) Medicine - Primary10VTNortheastU of Washington Affil Hosps Medicine - Primary10WAPacificVirginia Mason Med Ctr (Seattle) Medicine - Primary10WAPacificMedical College of Wisconsin Affil Hosps (Milwaukee) Medicine - Primary10WIMidwestUniversity of Wisconsin Hospital and Clinics (Madison) Medicine - Primary10WIMidwestSt Vincent Hospitals and Health Care Center Program01INMidwestUniversity of Minnesota Program01MNMidwestVirginia Commonwealth University Health System Program01VASoutheastKaiser Permanente Medical Group (Northern California/Oakland) Program01CAPacificProvidence Health & Services – Oregon/Providence Medical Center Program01ORPacificOregon Health & Science University Program01ORPacificUniversity of Missouri at Kansas City Program01MOMidwestThomas Jefferson University Program01PANortheastEisenhower Medical Center Program (CA)01CAPacificSanta Clara Valley Medical Center Program01CAPacificUniversity of Alabama Medical Center Program01ALSoutheastReading Hospital Program (PA)01PANortheastSt Mary Mercy Hospital Program (MI)01MIMidwestUniversity of New Mexico Program01NMMountainPenn State Milton S Hershey Medical Center Program01PANortheastGrand Rapids Medical Education Partners/Michigan State University Program01MIMidwestKaiser Permanente Medical Group (Northern California)/San Francisco Program01CAPacificUniversity of Iowa Hospitals and Clinics Program01IAMidwestUniversity of Connecticut Program01CTNortheastSaint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School Program01NJNortheastMount Auburn Hospital Program (MA)01MANortheastLouisiana State University Program01LASoutheastOchsner Clinic Foundation Program01LASoutheastUniversity of Michigan Program01MIMidwestWashington University/B-JH/SLCH Consortium Program01MOMidwestUniversity of Nebraska Medical Center College of Medicine Program01NEMidwestNew York Presbyterian Hospital (Columbia Campus) Program01NYNortheastUniversity of Rochester Program01NYNortheastDuke University Hospital Program01NCSoutheastTemple University Hospital Program01PANortheastHennepin County Medical Center Program (MN)01MNMidwestUniversity of Illinois College of Medicine at Chicago/Advocate Christ Medical Center Program01ILMidwestCedars-Sinai Medical Center Program01CAPacificTufts Medical Center Program01MANortheastAllegheny General Hospital-Western Pennsylvania Hospital Medical Education Consortium (AGH) Program01PANortheastLouis A Weiss Memorial Hospital Program01ILMidwestSinai Hospital of Baltimore Program01MDNortheastSeton Hall University School of Health and Medical Sciences Program01NJNortheastSt Barnabas Hospital Program01NY (Bronx)NortheastProvidence Hospital Program (DC)01DCNortheastNRMP = National Resident Matching Program. Open table in a new tab NRMP = National Resident Matching Program.
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