A ccess to health care is, in part, determined by the supply of physicians available to provide treatment. Policymakers have demonstrated a long-standing interest in access to care (in general and for specific populations). In addition to these programs and policies, the federal government provides support for medical residency training (a.k.a., graduate medical education [GME]). Some federal programs use GME to support training for non-physician health providers; however, this report focuses only on the training of physicians. In FY2012, the last year of data available for all federal sources of GME payments, the federal government spent an estimated $15 billion on GME, which was the largest federal investment in the health care workforce. The federal government supports GME
through payments made by the Medicare and Medicaid programs, both administered by the Centers for Medicare & Medicaid Services (CMS) located in HHS; by training medical residents at Department of Veterans Affairs (VA) and Department of Defense (DOD) facilities; and by funding programs administered by HHS's Health Resources and Services Administration (HRSA) that support primary care training in outpatient facilities, rural GME program development, and training in children's hospitals. The relative cost to a hospital for operating a residency program may also vary by a number of factors, such as the size of the residency program, the specialty of the program, the total number of residency programs that the hospital operates, and the availability and cost of alternative providers who would be needed to replace the resident's labor.
Access to health care is, in part, determined by the availability of physicians, a function of the physician supply. Policymakers have demonstrated a long-standing interest in access to care, both in general and for specific populations. Moreover, federal support for medical residency training (a.k.a., graduate medical education [GME]) is the largest source of federal support for the health care workforce. Although the health workforce includes a number of professions, the size of the federal investment in GME—estimated at $16 billion in 2015—makes it a policy lever often considered to alter the health care workforce and impact health care access. This report describes federal programs that provide GME support. Although these programs may also support training for other health professions, this report focuses on training for physicians, who receive the bulk of GME support. The report examines GME support in Medicare, Medicaid, the Department of Veterans Affairs, the Department of Defense, and programs administered by the Health Resources and Services Administration, such as the Children's Hospital and Teaching Health Center GME payment programs. The report details the mechanisms that various federal programs use to support GME and provides data, when available, on funding and the number of trainees. As noted in the table below, the data available vary by program.