Graduate Medical Education in Florida
Report 23-GME, December 2023
- Florida has made significant investments in growing graduate medical education (GME), and these investments have yielded more GME positions. Florida’s investment in GME through Medicaid increased by 1,205% from state Fiscal Year 2013-14 to state Fiscal Year 2023-24. In 2021-22, Medicaid comprised approximately half of all GME funding in the state. The majority of the state match for GME funding was through local government contributions in the form of IGTs. As state funding increased, so too did the number of residents. Specifically, as Florida’s Medicaid program funding for GME increased from state Fiscal Year 2013-14 ($80 million) to state Fiscal Year 2021-22 ($718.4 million), the number of filled GME positions steadily increased (from 4,686 to 8,065).
- Research shows that physicians often remain in the state where they complete their training. Expanding the number of residency positions in a state may thus increase the number of physicians in the state’s workforce. Because Florida is retaining GME graduates at approximately the same rate over time, it is retaining more physicians to practice in the state as GME positions have increased. OPPAGA found that Florida retained approximately 50% of individuals who started GME from academic year 2003-04 through academic year 2014-15. The retention of Florida GME students is most successful when the individuals are also graduates of Florida medical schools. Between 2008 and 2015, 75% of those who completed both medical school and GME in Florida were retained, while only 42% who completed medical school outside of Florida were retained.
- Although Florida has made strides in creating more GME positions and retaining more physicians, the need is still great. Recent studies have found that the number of physicians in Florida is inadequate to meet demand, and one study estimated that Florida will have the second largest physician shortage in 2030 among all states. Although the number of practicing physicians in Florida has increased, in part because of the state’s investment in GME, the state’s population has also increased. The number of physicians per capita was approximately the same in Fiscal Year 2021-22 as it was 10 years prior. However, it is likely too early to know if the recent funding growth will result in even more rapid growth in GME in Florida and an improvement in current and projected future physician workforce sufficiency.
- While Florida has retained more residents to the state as the Legislature has increased state funding, strategies could be implemented to further increase the retention rate. In addition, Florida lacks state level planning that includes policy priorities and clear objectives, which hinders the tracking of outcomes to gauge progress over time. The Legislature could direct OPPAGA to conduct periodic assessment of Florida’s GME system, and to facilitate such analyses, direct the Department of Health to convene a data workgroup to enhance graduate medical education data collection and reliability, which aligns with the department’s statutory responsibilities related to GME and the physician workforce. The Legislature could also strengthen the Agency for Health Care Administration’s ability to receive financial data from participating health care facilities so that the agency could employ a payment methodology that reflects true costs to the facilities it funds.
Graduate medical education, GME, medical school, residency, internship, fellowship, subspecialty, retention, doctors, supply, demand