Graduate Medical Education (GME)

Key facts

Accreditation

ACGME, under a single system for MD and DO programs since 2020

Residency length

Typically 3 to 7 years, plus optional fellowship

Medicare payments

Direct GME (DGME) and Indirect Medical Education (IME)

Medicare resident caps

Set by the Balanced Budget Act of 1997, based on 1996 resident counts

Placement

Mostly through the National Resident Matching Program (NRMP)

What is graduate medical education?

Medical school graduates are not ready for independent practice. In residency, they care for patients under the supervision of attending physicians and take on more responsibility each year until they complete training in a specialty. Fellowships add subspecialty training, such as cardiology after internal medicine.

Programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME). The ACGME and the American Osteopathic Association completed the move to a single accreditation system in 2020, so MD and DO graduates now train in the same accredited programs.

How GME is funded

GME draws on several public funding streams:

• Direct Graduate Medical Education (DGME) payments cover costs such as resident salaries and teaching physician time, under Section 1886(h) of the Social Security Act.
• Indirect Medical Education (IME) payments add to Medicare inpatient payments to reflect the higher costs of teaching hospitals, under Section 1886(d)(5)(B).
• Medicare funding is limited by hospital-specific resident caps dating to the Balanced Budget Act of 1997. The Consolidated Appropriations Acts of 2021 and 2023 added new Medicare-funded residency positions.
• Medicaid, the Department of Veterans Affairs, the HRSA Teaching Health Center GME program and Children's Hospitals GME funding also support training.

Why graduate medical education matters

GME capacity limits physician supply, so it shapes shortages by specialty and region. Many physicians stay near where they complete residency, which makes the location of training positions a factor in rural and underserved access. Congress has repeatedly debated raising the 1997 caps, so GME funding remains a recurring policy issue.

For analysts, teaching status marks academic medical centers that concentrate complex cases, clinical trials and key opinion leaders. Residents receive their own NPIs, so new enumerations in NPPES and physicians finishing training each summer show where the future workforce is forming.