Graduate Medical Education in the Changing Environment of Medicine

Abstract

THE US graduate medical education system has been strongly criticized by policymakers and by private and public agencies for not being responsive to the population's health needs. Comments usually focus on the unwillingness of the accreditation and education systems to generate the proper mix of specialties and to influence a more equitable geographical distribution of physicians. No one disputes the inadequacy of the distribution of medical specialties, particularly in the medical care of underserved populations, but to blame solely the graduate medical education and accreditation systems is to ignore the absence of population-based planning for health services—a governmental responsibility—and the important, though lesser, contributions of other medical education components. Education, accreditation, licensure, certification, and practice, although interrelated, are all directed by different organizations. Changes in only one or two of these components will never be sufficient to solve the health manpower problems of the health care delivery system, which would