GME stands for Graduate Medical Education, the training period doctors complete after finishing medical school. It includes residency (specialty training) and fellowship (subspecialty training) and is the phase where medical school graduates develop the hands-on skills needed to practice independently. In the United States, over 41,500 first-year residency positions were offered in 2024 alone, making GME one of the largest structured training pipelines in any profession.
What GME Covers
Medical school gives students a broad foundation in science and clinical skills, but it doesn’t qualify them to practice on their own. GME is where that transition happens. Once you graduate from medical school with an MD or DO degree, you enter a residency program in your chosen specialty. There, you train under experienced physicians while caring for real patients, gradually taking on more responsibility over several years.
If you want to narrow your focus further, you can pursue a fellowship after residency. A cardiologist, for example, first completes a three-year internal medicine residency and then a cardiology fellowship. Fellowships typically add one to three years of training on top of residency.
How Long GME Takes
The length depends entirely on the specialty. Family medicine, internal medicine, and pediatrics each require three years of residency. Surgical fields take longer: general surgery runs five years, orthopedic surgery five years, neurosurgery seven years, and plastic surgery six years. Specialties like dermatology, neurology, and ophthalmology require three years of specialty training plus a preliminary year of broader clinical work beforehand.
Adding a fellowship extends the timeline further. A doctor who completes a three-year internal medicine residency and then a three-year gastroenterology fellowship will spend six years in GME before practicing independently. From start to finish, the path from medical school graduation to fully trained specialist can range from three years to a decade or more.
How Residents Get Placed
Most residency positions in the U.S. are filled through the National Resident Matching Program, commonly called “the Match.” Medical students apply to programs, interview, and then rank their preferred programs in order. Programs do the same with applicants. A computer algorithm pairs them based on mutual preferences, and the results are binding.
In the 2024 Match, 44,853 applicants submitted ranked lists for 41,503 positions across 6,395 programs. Of those positions, 93.8% filled. About 35,984 applicants matched to a first-year spot, the highest number in the program’s 72-year history. The process has three main phases: registration, ranking, and results, with Match Day falling in mid-March each year.
Who Oversees GME Programs
The Accreditation Council for Graduate Medical Education (ACGME) sets standards for and accredits residency and fellowship programs across the country. Programs must meet requirements covering everything from the curriculum and faculty qualifications to resident work hours and supervision. A program that loses ACGME accreditation can no longer train residents, so these standards carry real weight.
For international medical graduates (IMGs), there’s an additional gatekeeper: the Educational Commission for Foreign Medical Graduates (ECFMG). Before entering any ACGME-accredited program, IMGs must earn ECFMG certification, which requires passing Steps 1 and 2 of the U.S. Medical Licensing Examination, meeting English proficiency requirements, and graduating from a qualifying medical school listed in the World Directory of Medical Schools.
How GME Is Funded
Medicare is the single largest funder of GME in the United States. Teaching hospitals receive two types of payments. Direct Medical Education (DGME) payments cover a share of resident salaries, benefits, and teaching costs. Indirect Medical Education (IME) payments compensate hospitals for the higher patient care costs associated with running a training program, since teaching hospitals tend to treat more complex cases and operate less efficiently than non-teaching facilities. In fiscal year 2023, estimated Medicare GME spending totaled roughly $6.1 billion for DGME and $15 billion for IME.
These payments are tied to a cap on how many residents each hospital can count for funding purposes, a limit that was essentially frozen in 1997. Congress has slowly added new slots since then. The Consolidated Appropriations Act of 2023 authorized 200 additional residency positions starting in fiscal year 2026, with priority given to rural hospitals, hospitals already training residents above their cap, hospitals in states with new medical schools, and hospitals serving areas with physician shortages. At least 100 of those new positions must go to psychiatry or psychiatry subspecialty programs, reflecting ongoing shortages in mental health care.
What Residents Earn During GME
Residents are paid a stipend that rises modestly each year. According to a 2025 survey by the Association of American Medical Colleges, the average first-year resident salary is $68,166. That figure climbs to $73,301 by year three, $81,807 by year five, and $94,215 by year eight for those still in extended training or fellowship. While those numbers have been rising, the growth has not kept pace with inflation, meaning residents’ purchasing power has effectively declined in recent years.
Relative to the hours worked, the pay is notably low. Residents routinely work 60 to 80 hours per week, which can bring the effective hourly wage closer to minimum wage in some high-cost cities. This is a well-known tension in medicine: residents are simultaneously trainees and essential members of the hospital workforce, and the compensation reflects the training label more than the workload.
Expanding GME Into Rural Areas
One persistent problem in U.S. healthcare is that doctors tend to settle where they trained, which concentrates physicians in urban academic medical centers. To address rural physician shortages, the Health Resources and Services Administration (HRSA) funds the Rural Residency Planning and Development initiative, which helps organizations create new residency programs in rural communities. These programs must train residents at rural sites for more than half of their residency time and focus on producing physicians who will practice in rural areas.
The ACGME also offers a Rural Track Program designation for residencies that embed significant rural training into their structure. Combined with the new legislatively mandated residency slots prioritizing rural hospitals, these efforts aim to shift at least some of the GME pipeline away from major cities and toward the communities that need physicians most.