Future directions in graduate medical education

Public perception that the challenges of meeting medical manpower and facility needs and of providing access to complex medical care have been met, coupled with concerns over mounting costs of medical care, will significantly reduce commitment to funding of graduate medical education. There will be reduced funding for longer educational programs and subspecialties and for foreign medical graduates, but not for primary care specialties and US medical graduates. The medical care system must ensure that each US medical graduate has access to the postgraduate education necessary as preparation for practice. The system will be challenged to develop necessary techniques for funding that education. An all-payor's system based on health insurance premiums, funds from the faculty practice plans, and sponsored programs carrying obligations of future service are reasonable possibilities for meeting funding needs.