In its broadest sense, this Article examines the complex relationship between population booms, doctor shortages, and United States government financing of graduate medical education (GME). More specifically, this Article argues that current rules governing the calculation of Medicare payments to teaching hospitals for the costs of GME are based on cost, population, and other data that are no longer relevant. As applied, these formulas discriminate in favor of the nation’s oldest teaching hospitals, located in New England and the Middle Atlantic, and against current and future teaching hospitals located in growing population centers, especially regions in the South and West. To remedy these inequities, this Article proposes a new structure for calculating Medicare payments to teaching hospitals that takes into account current GME costs, population data, and geographic imbalances in physician and resident supply and distribution. These proposals are designed to boost residency training in physician shortage areas and in growing population centers and improve access to generalist and specialist physicians across the United States.



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