Aligning Expansion of Graduate Medical Education With Recent Recommendations for Reform

Federal funds totaling $16 billion support 120 000 grad-uate medical education (GME) positions (1). However, too few physicians are trained to practice high-quality pri-mary care that can improve outcomes and decrease costs (2). Consistent with recommendations of the Institute of Medicine’s (IOM) recent review of the governance and financing of GME (3), we propose using existing funds to expand primary care positions that target urban and rural areas with shortages of health professionals. We also pro-pose using recently approved Veterans Affairs (VA) fund-ing to expand primary care and mental health residency positions that target VA clinical sites that need more health professionals. Our budget-neutral proposal builds on the existing strength of our nation’s academic medical centers, other teaching hospitals (including VA teaching facilities), com-munity health centers, and rural health clinics. New part-nerships among these participants, targeting areas of demonstrated need, would provide increased access to high-quality, cost-effective care while improving and ex-panding residency training opportunities for growing num-bers of allopathic and osteopathic medical graduates in the United States (4–6). Residents who train in underserved settings are more likely to practice in them (7), and their retention could be further incentivized with debt repay-ment programs sponsored by the National Health Servic