US Residency Training Shifts Toward Academic Medical Centers, Study Finds

Graduate medical education in the United States is undergoing a quiet but consequential structural shift, according to a longitudinal observational study published in BMC Medical Education. Between 2014 and 2024, the institutions that sponsor residency training moved steadily in two opposite directions: academic medical centers and medical schools expanded their share of the training enterprise, while general and teaching hospitals contracted. Because these two sponsor types together account for roughly 82 percent of all residents and residency programs nationally, the trend reshapes where the next generation of American physicians will be trained.

The research team, led by Chelsea H. Chang and colleagues, analyzed publicly available data from the Accreditation Council for Graduate Medical Education to track residents, residency programs, and sponsoring institutions across the decade, comparing academic medical center and medical school sponsors with general and teaching hospital sponsors. The numbers reveal a stark divergence. General and teaching hospital sponsors lost an average of 808 residents per year (95 percent confidence interval 557 to 1058; P < 0.001), along with 50 residency programs annually (95 percent CI 18 to 82; P = 0.01) and 7.5 sponsoring institutions per year (95 percent CI 5 to 9; P < 0.001).

Over a full decade, that trajectory implies the disappearance of dozens of hospital-based sponsors and thousands of training positions from that sector. Academic medical centers and medical schools moved in precisely the opposite direction. Their sponsors gained an average of 3216 residents each year (95 percent CI 2954 to 3476; P < 0.001), 309 new residency programs annually (95 percent CI 282 to 334; P < 0.001), and 3.7 additional sponsoring institutions per year (95 percent CI 3 to 4; P < 0.001).

The growth was not uniform across the sector: increases in the number of academic sponsors occurred primarily among large institutions, while the losses among hospital sponsors were concentrated among small ones. Methodologically, the study combined descriptive national trends with formal statistical modeling. Linear regression with interaction terms allowed the researchers to test whether annual trajectories differed by sponsor type, and negative binomial regression was used to examine associations between the count of sponsoring institutions and factors including sponsor type, ownership, size, and calendar year.

This design distinguishes the study from simple headcounts, though it remains observational and cannot establish why the shift is occurring. One of the more nuanced findings emerged from the adjusted analysis. After accounting for sponsor type, size, and ownership, calendar year was no longer independently associated with the number of sponsoring institutions.

In other words, the apparent decade-long decline in hospital sponsors appears to be explained by the composition of the field — which types, sizes, and ownership structures of institutions were present — rather than by time itself exerting an independent effect. The study's scope and limitations deserve emphasis. It relied on public ACGME data covering all sponsor types but focused its longitudinal modeling on the two dominant categories, which together represent the overwhelming majority of training capacity.

As an observational analysis of institutional counts and positions, it documents where training is concentrated but does not measure effects on resident education quality, physician workforce distribution, or patient care outcomes. A decade of movement toward the academic pole, driven largely by growth at large institutions and attrition among small hospital sponsors, suggests that residency training capacity is consolidating. The authors characterize the period as one in which sponsorship shifted decisively toward academic medical centers and medical schools, with concurrent declines among general and teaching hospitals — a structural realignment of the two systems responsible for most US residency training.

Whether consolidation into large academic sponsors affects the supply of physicians practicing in community and rural settings remains an open question that this study, by design, cannot answer — but the trend it documents is unambiguous and measurable across the entire accredited training system.

Subject of Research: Longitudinal trends in sponsoring institutions in US graduate medical education from 2014 to 2024

Article Title: National trends in academic and hospital sponsoring institutions in US graduate medical education: a longitudinal observational study, 2014–2024

Article References: Chang, C. H., Alvarenga, J. L., Jones, W. S., Knudsen, A., & Bello, F. O. (2026). National trends in academic and hospital sponsoring institutions in US graduate medical education: a longitudinal observational study, 2014–2024. BMC Medical Education. https://doi.org/10.1186/s12909-026-10695-9

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10695-9

Keywords: graduate medical education, ACGME, sponsoring institutions, academic medical centers, teaching hospitals, residency programs, workforce, longitudinal study, BMC Medical Education, health policy, National, trends