Institutional Retention of US MD–Granting Medical School Graduates for Graduate Medical Education: A National, Cross-Specialty Study

OBJECTIVE: To assess the prevalence and characteristics of institutional retention (IR), i.e., graduates entering a graduate medical education (GME) program at an institution affiliated with their medical school (a "home" residency program), among 5 recent national cohorts of US MD-granting medical school graduates. DESIGN: This is a retrospective, cross-sectional study that data from the Association of American Medical Colleges Student Records System, Electronic Residency Application Service (ERAS®), and National GME Census in GME Track® databases. Graduate characteristics included GME academic year and specialty. Multilevel logistic regression estimated the odds of IR, reporting adjusted odds ratios (AORs), and 95% confidence intervals (CIs). SETTING: US MD-granting medical school graduates in academic years 2018 to 2019 through 2022 to 2023 who entered categorical positions in GME programs immediately after graduation, and for whom it was possible to be retained at their undergraduate medical education institution due to an affiliation with a program in their specialty. PARTICIPANTS: A total of 69,860 (69.8% of 100,155) medical school graduates. RESULTS: IR prevalence was 24.2% (16,927/69,860), increasing in recent cohorts and varying by specialty (18.8% in emergency medicine to 48.1% in integrated thoracic surgery). Recent graduates (AOR = 1.03, 95% CI = 1.02-1.04), fewer ERAS applications (each vs. >25 ERAS applications; 0 or 1: AOR = 25.48, 95% CI = 20.27-32.03; 2-10: AOR = 6.91, 95% CI = 5.91-8.07; 11-25: AOR = 1.84, 95% CI = 1.74-1.94), and graduates from public (AOR = 1.49, 95% CI = 1.26-1.75) or research-intensive schools (AOR = 1.57, 95% CI = 1.23-2.02) had higher odds of IR. MD-PhD (AOR = 0.65, 95% CI = 0.57-0.73) and other advanced combined MD degree graduates (AOR = 0.86, 95% CI = 0.78-0.95) had lower odds. CONCLUSIONS: IR has become more common and varies by specialty. The findings highlight some of the many contextual factors shaping undergraduate medical education-to-GME transitions, provide national benchmarking data for US medical schools generally and for GME educators and leaders on a specialty-specific basis.