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America’s medical residents, by the numbers

Patrick Boyle, Senior Staff Writer
January 5, 2021

The AAMC’s 2020 Report on Residents breaks down the demographic and racial makeup of the nation's doctors in training. It also provides a glimpse into their future career plans.

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Nearly 140,000 medical residents worked in health care systems across the United States in 2020, making their community as large as the population of Dayton, Ohio. If they formed a city of their own, the place would stand out like no other. For example:

  • Among some groups of workers, such as pediatricians, women residents outnumber men by more than 2-to-1; in others, like radiologists, the ratio flips.
  • Everyone is high-achieving, but a few strive for something extra: About 3% of active residents earned their MD and PhD degrees simultaneously.
  • When it’s time to move out of their residencies, many of America’s early-career doctors go where they’re needed most: One-quarter of those who completed residencies in the past decade practice in medically underserved areas (MUAs) across the country, with those who practice in some states (such as Alabama and Louisiana) being far more likely to do so than those who practice in others (such as Nevada and Iowa).

These are among the findings in the 2020 Report on Residents, an annual AAMC compilation of data on the characteristics of medical school graduates and residents, including test scores, demographics, and professional activities after residency — the multiyear training period when medical school graduates practice at hospitals and clinics under close supervision. 

Here are some of the more interesting findings:

More Residents

The number of active residents covered in the report increased from 134,951 in 2019 to 139,848 in 2020. This table shows the numbers of residents by type of medical school, graduate medical education specialty, and gender.

Race and Gender

Race

Racial diversity varies greatly among specialties, as this data table shows. Asked to identify their race, the 2019-20 MD residents selected:

  • White — 50.8%.
  • Asian — 21.8%.
  • Hispanic — 7.5%.
  • Black or African American — 5.5%.
  • American Indian or Alaska Native — 0.6%.
  • Native Hawaiian or Other Pacific Islander — 0.2%.

(Note: Residents could choose more than one race, and the figures do not include the 16.5% of residents who are neither U.S. citizens nor permanent U.S. residents.)

Gender

Women make up a larger percentage of residents in obstetrics and gynecology (83.8%), pediatrics (72.4%), and family medicine (53.7%), while men make up a larger percentage of residents in diagnostic radiology (73.0%), anesthesiology (66.9%), and emergency medicine (64.1%). See the gender distribution by specialty.

Changes in Specialties

The road to residency is rarely straight; most medical students change their routes along the way. Among students graduating in 2019-20, almost half (48.7%) reported that they will graduate with a different specialty than what they had planned at the outset of their medical education. Medical school graduates who plan on entering these specialties were most likely to have named different specialties when they began medical school:

  • Child neurology — 88.5%.
  • Vascular surgery — 74.4%.
  • Plastic surgery — 63.1%.

Alternatively, just over one-quarter (26.1%) of students reported that they will graduate with the same specialty preference as they had indicated at the start of medical school. The “continuity rate” was highest in these specialties:

  • Orthopaedic surgery — 48.7%.
  • Pediatrics — 39.1%.
  • Neurological surgery — 37.6%.
  • Emergency medicine — 36.8%.

See more about how specialty preferences changed or stayed the same for various specialties.

Service

Early-career doctors routinely seek to serve people in need both during and after their residencies.

Volunteering

First-year residents across all specialties routinely take up volunteer opportunities related to health and medical care. The residents reporting the highest average number of volunteer experiences (per person) were in obstetrics and gynecology (9.0), internal medicine/pediatrics (8.8), otolaryngology (8.1), and pediatrics (7.8).

Underserved Areas

Among those who completed residencies from 2010 through 2019, 25.4% reported practicing — that is, providing direct patient care — in MUAs around the country.  by the Health Resources and Services Administration as “having too few primary care providers, high infant mortality, high poverty, or a high elderly population.”

The percentages of those doctors practicing in MUAs were particularly high in some of the largest specialties — including internal medicine (27.3%), neurology (27.2%), family medicine (26.5%), and general surgery (26.3%) — but also in the relatively small specialty of child neurology (31.0%). 

MUA service varies significantly by state. More than half of early-career doctors report having practiced in MUAs in Alabama, Mississippi, and Montana, while the figure is less than 10% in Maine, North Dakota, Wisconsin, and Wyoming.

See tables that show how many early-career doctors practice in MUAs by state and by areas of specialty.

Step Scores

Residents’ test scores on the United States Medical Licensing Examination (USMLE) vary significantly among specialties. Below are some of the average scores among first-year residents in 2019-20:

USMLE Step 1

  • Thoracic surgery — 247.3 (with the 25th through 75th percentile scores ranging from 241.3 to 256.8).
  • Psychiatry — 222.8 (with the 25th through 75th percentile scores ranging from 210.0 to 236.0).

USMLE Step 2 CK (Clinical Knowledge)

  • Plastic surgery — 251.5 (with the 25th through 75th percentile scores ranging from 243.0 to 260.3).
  • Family medicine — 231.0 (with the 25th through 75th percentile scores ranging from 220.0 to 241.0).

Staying in State

After completing their residencies, the majority of doctors don’t move far away. Most residents (55.5%) who completed training from 2010 through 2019 continue to practice medicine in the states where they did their residencies. Physician retention among states after residency is highest in California (77.6%) and lowest in Delaware (38.3%), as this table shows.

Dual Degrees

In the most recent reporting year (2019), 3.3% of active residents who graduated from U.S. MD-granting schools were dual MD-PhD graduates. Among general specialties, pathology: anatomic and clinical had the highest percentage of active U.S. MD-PhD graduates (16.6%). This table shows the numbers of residents with MD-PhDs by specialty.

Paths to Academia

Among those who completed residency training from 2010 through 2019, nearly 1 in 5 (19.7%) hold a full-time faculty position at an MD-granting school in the United States. This table shows faculty appointments by specialty.

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