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Many prospective clients frequently begin their inquiries with questions regarding GME reimbursement, Medical School and ACGME accreditation, and overall feasibility. Our ACA consultants have compiled a list of the most frequently asked questions. It is important to note that GME is a multifaceted specialty with a range of diverse outcomes.
​We encourage you to browse through our FAQs and contact one of our consultants for an answer tailored to your specific organization.
Q- Our hospital is too small to start GME independently, and we have a limited budget. Is there a way we can work with regional partners to develop GME?
A- Establishing a GME consortium in select systems or geographies can improve economics by streamlining administrative oversight requirements and sharing FTEs, such as program directors, faculty, and coordinators.
Q- Do my FM residents still need to meet the 1650 continuity clinic visit to graduate?
I cannot find it in the 2025 ACGME FM program requirements.
A- The ACGME eliminated the 1650 patient visit requirement with the 2023 Family Medicine standards. It has been replaced with a more complex formula that assures that residents fulfill the “continuity” reasoning for the clinic.
Q- We are in our CAP building period but have not decided on which programs will be part of our strategic plan. How can I preserve my cap?
A- When in the cap building period, new programs can leverage Transitional Year (TY) programs to expand the cap and provide future flexibility.
Q- Our hospital is a Critical Access Hospital in a rural designated area. Recruiting providers to our hospital/community is difficult and expensive. If we were to start residency programs to assist with recruiting, what could be some of my accreditation concerns?
A- Residents are an exceptional source of provider assistance and a portal to future provider recruitment. However, you should look to specialty programs that have the least number of inpatient rotations or partner with an acute care hospital to support the gaps due to the small bed count and patient volume.
Q- What are the benefits to GME if my organization goes through Rural Reclassification?
A- GME will receive a 30% increase in IME cap that can be used to cover any current CAP shortage or increase current residency programs and will be able to start new programs and build new IME cap, but not additional DME.
Q- If I start a Rural Training Program (RPT), can I get an additional cap without undergoing a rural reclassification?
A- Starting a Rural Training Program where 51% of the training takes place in a rural location can be developed, and a separate cap will be created just for the rural program, generating both DME and IME. Note, a track that only serves to increase the complement of an existing program does not fall under this rule.
Q- My hospital is interested in establishing a family medicine residency program.
What state and federal support is available through Medicaid?
A-Medicaid is one of the few ways states can receive federal matching funds to help pay for hospital residency training. However, there is no set federal rule requiring states to fund GME through Medicaid – it is state-optional. States must request Medicaid GME funding in their Medicaid State Plan, and as of 2024, 44 states and the District of Columbia provide Medicaid GME support.
Q- How are State Medicaid funds distributed to GME in support of residency programs?
A- Most states have different approaches and do not treat all residency programs the same when distributing Medicaid GME funding. In many states, Medicaid GME funding is often directed, either wholly or in part, toward primary care residency programs, especially Family Medicine, as a way to address healthcare access and workforce shortages in underserved areas.
Q- As a newly proposed medical school, what are the steps in securing core clinical rotation sites for third- and fourth-year students?
A- Your dean and clinical associate dean should proactively develop clinical partnerships with your region's hospitals, health systems, and community clinics. Given the competitive landscape for clinical rotations, your team must prioritize formal affiliation agreements that define educational roles, capacity commitments, and student support expectations at the medical school and clinical training site.
Q- Why has COCA recently revised Standard 10.2 in the New and Developing Medical School Standard, making it more challenging to achieve Pre-Accreditation?
A- The Commission on Osteopathic College Accreditation (COCA) revised Standard 10.2 to strengthen the role of Colleges of Osteopathic Medicine in developing Graduate Medical Education opportunities for their graduates. This change reflects COCA's commitment to ensuring that COMs actively contribute to expanding and supporting residency programs, addressing the growing need for GME positions with the growth of osteopathic medicine.
Q- Has there been a recent change in medical school applications?
A- Yes, both MD and DO medical schools in the United States have experienced a modest decline in applications for the 2024–2025 academic year.​ However, the decline in applications for both MD and DO programs suggests a normalization following the surge during the COVID-19 pandemic. Despite fewer applicants, the number of matriculants has risen, leading to higher acceptance rates.
Q- What are two of the most significant factors discouraging medical school graduates’ decisions to forgo a career in primary care?
A- Primary care specialties typically offer lower salaries compared to procedural or subspecialty fields, which may deter graduates from managing high educational debt. Additionally, primary care physicians are often faced with high patient volumes and administrative duties, leading to burnout and early attrition.
Q- We are starting a Family Medicine residency program and want to avoid the expense of building an FM Continuity Clinic. What is a good alternative?
A- FQHCs can be ideal continuity clinic training partners. They provide an existing patient panel with co-morbidities for strong resident training. The FQHC can benefit from an increasing throughput and improved clinical economics.
Q- My Family Medicine residency clinic is in the red. I know they see a lot of patients. What strategy can I use to improve the bottom line?
A- Predictive scheduling is one option to improve program economics and more effectively manage no-shows. With appropriate scheduling, a single preceptor can increase productivity if the teaching and private practice FTE time is managed appropriately.
Q- We have a utilization rate of 50%, with many hospital beds not staffed due to the decreasing patient volume. What are the implications for GME reimbursement?
A- Beds available for patient use are a critical component for calculating IME reimbursement. Beds available should reflect those beds available to be used for patient care within a short period of time, versus licensed beds.
Q- We are applying to become a Sponsoring Institution. When do I need to start my GMEC committee? Can I wait until the residency program is accredited?
A- No, you cannot wait for an approved program. At least 1 set of committee meeting minutes must be provided with the application. ​Typically, the IRC likes to see 4 GMEC meetings taking place before the application is submitted, primarily because the application requires the approval of SI policies, whose dates of approval by GMEC must be noted in the application.​
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