Graduate Medical Education (GME) Advocacy

What Is GME?

Graduate Medical Education (GME) is the training that medical school graduates receive as residents in more than 1,000 of the nation’s hospitals and health systems. These are called “teaching hospitals,” and they vary in size and specialty focus. GME includes internships, residency, and subspecialty and fellowship programs, and it leads to eligibility for state licensure and board certification.

With the creation of the Medicare program in 1965, a funding stream was established to support the training of medical residents. The federal government spends nearly $16 billion on GME annually through Medicare, Medicaid, the Departments of Defense and Veterans Affairs, and the Children’s Hospital and Teaching Health Center Graduate Medical Education programs.

Medicare remains the single largest payer, with expenditures totaling about $9.5 billion annually, and uses a complex payment formula that includes both direct graduate medical education payments and indirect medical education payments based in part on the number of Medicare patients and residents in training.

Why We Fight

The U.S. faces a critical family physician workforce shortage, compounded by misalignment of resources in medical education, which has led to disparate care access for patients nationwide. Though the current system excels at educating skilled physicians and physician researchers, the primary care physician shortage prevents the U.S. from taking advantage of the better outcomes and lower per capita costs associated with robust primary care systems in other countries.

Effective health care systems have a physician workforce made up of roughly 50% primary care and 50% subspecialty. Today’s U.S. physician workforce is 33% primary care. To achieve the overall goal of 50% primary care, it is imperative that at least 25% of U.S. medical school graduates choose family medicine by 2030.

Evidence indicates that physicians typically practice within 100 miles of their residency program, meaning that the current distribution of trainees in large academic hospitals also leads to physician shortages in medically underserved and rural areas. These shortages result in access barriers and disparities in health outcomes for patients living in rural and underserved communities.

The AAFP supports consistent funding for GME for family medicine to ensure that new residency slots are allocated to address rural and urban imbalances, reduce physician shortages, and focus on medically underserved areas, including funding for programs such as the federal Teaching Health Center GME program.

The THCGME program has a proven track record of achieving its legislative mandate to train the next generation of primary care physicians. Since it began, in 2011, the THCGME program has trained more than 1,148 primary care physicians and dentists, 65% of whom are family physicians. Without permanent federal funding, most of the THCGME programs would be unlikely to maintain residency recruitment and enrollment, threatening the initial program investments and even the viability of the program itself.