CPPR Health Policy Seminar: "Effects of the Affordable Care Act’s Medicaid Expansion on Physician Residency Programs"

The CPPR Health Policy Seminars are a series of workshops that bring together faculty and distinguished speakers from numerous disciplines across Tulane’s campuses to connect with a network of professionals and produce interdisciplinary research that addresses critical policy issues. 

Organized by Mary Olson, Associate Professor of Economics at Tulane and leader of CPPR's Health Policy program, these working groups provide scholars with the opportunity to present new work to an incisive audience of researchers and practitioners. Papers are distributed beforehand to the participants who read the paper and prepare discussion questions for the presenter.

Dr. Ang is an applied microeconomist with research interests in health and urban economics. Ang recently received a PhD in Economics from Georgia State University, and joined Tulane University's Department of Economics and Murphy Institute as a postdoctoral scholar in health economics and policy in Fall 2024.

 ABSTRACT:

Physicians’ choice of practice location is often influenced by where they completed their residency training. Residency programs, typically affiliated with hospitals, vary in size and specialization options based on hospital resources and patient needs. When hospitals face increased demand for healthcare services, they may seek to expand residency programs to meet the growing need for medical staff. The Affordable Care Act's Medicaid expansion, which took effect in January 2014, has been established to significantly increase healthcare utilization rates. However, there is limited evidence connecting this increased demand to growth in residency programs, particularly in states that adopted the Medicaid expansion. 

This paper addresses this gap by estimating the causal impact of the ACA’s Medicaid expansion on the availability of medical residency positions, using match residency data from the National Resident Matching Program for years 2010 to 2019 and a difference-in-differences (DD) technique. We exploit the staggered implementation of the program and compare the outcomes between expansion and non-expansion states using recent developments in the DD literature. We find that the ACA’s Medicaid expansion led to an increase in the number of physician residency slots offered in states that expanded Medicaid post-implementation of the policy. Moreover, heterogeneous effects across different medical specialties were observed, pointing to the nuanced impacts of the Medicaid expansion on residency program availability.