Impact of Increasing Obligated Service for Graduate Medical Education

This study estimates the impact of increasing the active duty obligation (ADO) for graduate medical education (GME). We found that the amount by which accession requirements could decrease depends on the size of the GME program. Specifically, accession requirements and costs are less if the GME program were optimized than if it were fixed at current levels. If GME is fixed, many accessions are needed, not to fill billets, but simply to support the GME program. We find that marginal increases—1-year increases—in the GME ADO are supportable. We based this finding largely on GME program directors’ perceptions and the willingness of current residents and fellows to consider and accept GME with a longer ADO. Because of the concurrent payback of the GME obligation with any prior obligation, there are many ways to structure a marginal increase in the ADO. How DoD should structure an increase depends on which specialties it wants to impact. We find that increasing the GME ADO more than marginally is not warranted because the applicant pool for accessions will not support it.