Teaching hospitals continue to expand the number of resident physicians, exceeding the number of government-funded residency spots, without additional government funding. This is a clear signal that the marginal benefit of employing a resident physician, even in the absence of government funding, clearly exceeds the cost—a narrative at odds with the public advocacy for more federal GME support. We applaud the work done by Dr Royce and others analyzing the distribution of GME funding as it pertains to higher revenue–generating specialties and primary care. It is important to note that there are no nationally coordinated GME performance metrics, and the few that exist are ad hoc and unvalidated. While it is important to collect validated measures of performance for benchmarking programs, they should not be used to justify the GME program, and Congress should use these GME funds, which amount to billions of dollars, for higher priorities.
Grischkan, Justin A., Ari B. Friedman, and Amitabh Chandra. "Financing of US Graduate Medical Education—Reply." JAMA, 325.6, February 2021, 586.