Graduate Medical Education Reform Report
Mar 23, 2026
Graduate Medical Education (GME) is the training that medical school graduates receive in more than 1,000 of the nation’s hospitals and health systems. GME includes internships, residency, and subspecialty and fellowship programs, and it leads to eligibility for state licensure and board certification. Federal funding of GME plays a major role in supporting physician training, yet its financing and governance structures remain largely unchanged from the model developed more than 60 years ago. As a result, GME continues to reinforce historical training patterns rather than adapting to current health delivery needs, contributing to shortages in primary care and other essential fields, geographic imbalances, and inequitable access to care.
In 2014, the Institute of Medicine (now the National Academy of Medicine) published
“Graduate Medical Education That Meets the Nation’s Health Needs,” calling for strategic, accountable medical workforce planning. More than ten years ago, this report recommended major structural reform for GME financing and governance.
The Farley Center is publishing a report summarizing research they conducted on this critical topic, “Reforming Graduate Medical Education to Create the Physician Workforce America Needs: 21 Billion Reasons Not to Change.”
To improve GME, the report makes three primary policy recommendations:
- Fund a National Health Care Workforce Commission (NHWC) with a GME-focused subcommittee.
- Establish equitable, cost-based, national per-resident payments (PRPs) that are paid directly to Sponsoring Institutions (SIs).
- Implement strategic payment reform for indirect medical education (IME) funds.
Read the Executive Summary and Full Report.