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

Sponsoring Institutions (SIs) play a central role in graduate medical education (GME), but national trends in GME capacity across SI types have not been well characterized. This study characterized longitudinal trends in residents, residency programs, and SIs across academic medical center/medical school and general/teaching hospital SI types in the United States from 2014 to 2024. Using public Accreditation Council for Graduate Medical Education (ACGME) data, we described all SI types and evaluated longitudinal trends among academic medical center/medical school and general/teaching hospital SIs, which together accounted for 82% of residents and residency programs nationally. We used linear regression with interaction terms to compare annual trends by SI type and negative binomial regression to assess associations between the number of SIs and SI type, ownership, size, and calendar year. General/teaching hospital SIs experienced an annual decline of 808 residents (95% CI 557-1058; P < 0.001), 50 programs (95% CI 18-82; P = 0.01), and 7.5 SIs (95% CI 5-9; P < 0.001). Academic medical center/medical school SIs experienced an annual increase of 3216 residents (95% CI 2954 to 3476; P < 0.001), 309 programs (95% CI 282-334; P < 0.001), and 3.7 SIs (95% CI 3-4; P < 0.001). Declines in the number of general/teaching hospital SIs occurred primarily among small SIs, whereas growth in the number of academic medical center/medical school SIs occurred primarily among large SIs. After adjustment for SI type, size, and ownership, calendar year was not independently associated with the number of SIs. From 2014 to 2024, GME sponsorship in the US shifted toward academic medical center/medical school SIs, with concurrent declines among general/teaching hospital SIs. These findings describe substantial changes in GME sponsorship across the two SI types responsible for most US residency training capacity.