Graduate medical education

Graduate medical education (GME) refers to any type of formal medical education, usually hospital-sponsored or hospital-based training, pursued after receipt of the M.D. or D.O. degree in the United States. This education includes internship, residency, subspecialty and fellowship programs, and leads to state licensure and board certification. Physicians must complete GME training before they can practice medicine independently. Graduate medical education is part of what's known as the continuum of medical education, following undergraduate medical education (UME)—the training that leads to the M.D. or D.O. degree—and preceding continuing medical education (CME).

The federal government significantly invests in GME, primarily through Medicare payments administered by the Centers for Medicare & Medicaid Services (CMS). The federal government also supports physician GME training through the Medicaid program, the children's hospital GME program, the teaching health center GME program, the Department of Defense, and the Department of Veterans Affairs. Total federal GME funding was about $15 billion per year as of 2012 and 2018. The Balanced Budget Act of 1997 capped payments because of an anticipation of a surplus of physicians and a concern that the IME adjustment overpaid hospitals relative to their additional teaching costs.