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Over the past decade, Mexico expanded residency positions, with a major increase in physician competition and slots by 2025, driven by efforts to reduce physician shortages and postgraduate training bottlenecks. Despite quantitative gains, major disparities persist in program infrastructure, supervision, and access to tertiary hospitals. Rapid expansion strains accreditation, evaluation, and faculty development, and recent changes to assignment processes improve flexibility but do not fully ensure alignment between applicant profiles and program needs.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/residency-growth-in-mexico-expansion-and-alignment-challenges/415848/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/residency-growth-in-mexico-expansion-and-alignment-challenges/415848.png","ImageObject",300,407,{"name":92,"@type":93},"Putri","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What role does ENARM play in Mexico’s medical residency entry system?","Question",{"text":112,"@type":113},"ENARM is the national examination for medical residency applicants and is administered by CIFRHS. Performance is closely tied to the quality and accreditation of medical schools and to candidates’ geographic and institutional backgrounds.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What changes in residency capacity have occurred in Mexico over recent years?",{"text":117,"@type":113},"Mexico has increased the number of residency positions substantially, especially by 2025, aiming to address physician shortages and the backlog excluding doctors from postgraduate education.",{"name":119,"@type":110,"acceptedAnswer":120},"Why does residency expansion still leave educational inequities unresolved?",{"text":121,"@type":113},"Variability in residency program infrastructure, supervision, and access to teaching hospitals with high-complexity services remains across regions and institutions. Expansion can also dilute competencies when accreditation and quality assurance are not strengthened.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},415848,1791225727,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39,"preview_page_count":4},962085571259,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Comment  \nResidency growth in Mexico: expansion and alignment challenges  \nMauricio Gonzalez-Urquijo  \nTecnologico de Monterrey, School of Medicine and Health Sciences, Av. Batallón de San Patricio 112, Real San Agustín, 66260, San Pedro Garza García, NL, Mexico  \nIn Mexico, entry into medical residency depends on the National Examination for Medical Residency Applicants (ENARM, for its Spanish name: Examen Nacional de Aspirantes a Residencias Médicas), a highly competitive test administered by the Comisión Interinstitucional para la Formación de Recursos Humanos para la Salud (CIFRHS) . Performance on the ENARM is closely linked to the quality, accreditation, and geographic location of medical schools, candidates from private and northwestern institutions often outperform those from public or southern schools, highlighting enduring disparities in medical education and access to postgraduate training.1 At the same time, ENARM has long functioned not only as an entrance examination but also as an informal proxy for medical school quality.1 Admission to residency remains concentrated in major urban teaching hospitals, leaving rural and underserved regions chronically short of specialists.2  \nFrom scarcity to expansion  \nOver the past decade, Mexico’s ENARM, has undergone a remarkable transformation. Once a fiercely competitive high-stakes exam with limited positions, the ENARM has evolved into a central instrument of public health policy and medical education reform. In 2025, 50,635 physicians competed for 18,954 residency positions, a record expansion compared with 7805 positions in 2016 and 3378 in 2001.3 This quantitative growth reflects governmental efforts to address physician shortages and the historical bottleneck in medical training capacity. Yet behind these encouraging numbers lies a complex narrative: while the expansion of residency positions addresses the sheer demand for medical training, persistent disparities in educational quality, unequal access across regions andinstitutions, and the lack of a systematic pairing process between applicants and programs highlight ongoing challenges that threaten the long-term effectiveness and fairness of Mexico’s residency system.  \nMexico has experienced a dramatic expansion of undergraduate medical programs, producing more than 17,500 new graduates each year.4 The ENARM has long functioned as a pressure valve for this educational overproduction. In response, over the past five years,  \nE-mail [address:](address: mauriciogzzu@gmail.com)[ mauriciogzzu@gmail.com](address: mauriciogzzu@gmail.com).  \n© 2025 The Author(s) . Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license ([http://creativecommons](http://creativecommons). org/licenses/by-nc-nd/4.0/) .  \npolicy measures have sought to ease this bottleneck. The Federal Government and the CIFRHS announced an unprecedented growth in residency slots, increasing the number of positions from IMSS-Bienestar, ISSSTE, PEMEX, and state health systems. Between 2019 and 2025, the number of training positions nearly doubled, reflecting a concerted effort to reduce the backlog of doctors excluded from postgraduate education.3  \nQuantitative progress, qualitative tension  \nThis recent expansion, while commendable, raises fundamental questions about capacity and quality. Reports and studies highlight considerable variability in the infrastructure of residency programs, supervision ratios, and access to teaching hospitals with highcomplexity services across different regions and institutions in Mexico.5,6 Despite broader opportunities, the top-performing ENARM applicants continue to cluster within a small group of long-established terciaty level hospitals, while many institutions remain underrepresented among successful candidates.7 The paradox is clear: more residency positions exist than ever before, yet the exam continues to reveal deep educational inequities rather than resolve them.  \nThe Instituto Mexican","cbCailHDchk1gq79","https://ap.wps.com/l/cbCailHDchk1gq79","pdf",130397,"English","# Residency growth in Mexico: expansion and alignment challenges\n## From scarcity to expansion\n## Quantitative progress, qualitative tension\n## Shifting paradigms in residency assignment","[{\"question\":\"What role does ENARM play in Mexico’s medical residency entry system?\",\"answer\":\"ENARM is the national examination for medical residency applicants and is administered by CIFRHS. Performance is closely tied to the quality and accreditation of medical schools and to candidates’ geographic and institutional backgrounds.\"},{\"question\":\"What changes in residency capacity have occurred in Mexico over recent years?\",\"answer\":\"Mexico has increased the number of residency positions substantially, especially by 2025, aiming to address physician shortages and the backlog excluding doctors from postgraduate education.\"},{\"question\":\"Why does residency expansion still leave educational inequities unresolved?\",\"answer\":\"Variability in residency program infrastructure, supervision, and access to teaching hospitals with high-complexity services remains across regions and institutions. Expansion can also dilute competencies when accreditation and quality assurance are not strengthened.\"}]","Residency growth in Mexico - expansion and alignment challenges | PDF",1790603144]