Graduate medical education (GME) in the United States is under siege. The status quo is not sustainable and the way it was in the past will not be the way it will be in the future. The purpose of the paper is not to relive the history of GME in the United States, but to assess the current status and propose an alternative solution which might affect not only the Center for Medicare and Medicaid Services (CMS) and the American Board of Medical Specialists, but also the Accrediting Council for Graduate Medical Education (ACGME) and the various boards that certify individual practitioners. In the earliest beginnings of specializations, various guilds of physicians broke off to create new specialties. The fields of ophthalmology and otolaryngology (ear, nose, and throat and surgery—ENT) established themselves with the boards and ultimately, a board certification. Other specialties in surgery and in medicine sequentially followed. There was no control over the educational process that led to becoming qualified to sit for the boards and there were no funding sources other than the hospitals to compensate trainees during the training period. Compensation usually consisted of a fresh uniform weekly, meals within the hospital confines, and access to a call room. In rare cases, certain less desirable institutions entered into elaborate arrangements where the individual in training actually received a tiny stipend. When Medicare was created in 1965, things began to change radically. By this time, a National Resident Matching Plan had been established (1952) and much of the chaos that surrounded a medical student’s foray into GME had subsided. The federal government, through the Medicare program, established a payment system whereby residents in training could expect to receive a reasonable stipend, though considerably less than what their colleagues in other walks of life might expect to receive at this point in their career. In addition to the direct payments (direct medical expense) of a salary to the residents, with its