I am pleased to share a new analysis my AAMC colleagues and I conducted with researchers from the UNC Cecil G. Sheps Center for Health Services Research on the impact of Section 131 of the Consolidated Appropriations Act, 2021. This provision offered certain hospitals a rare opportunity to establish or expand graduate medical education (GME) programs by resetting low Medicare-funded resident caps and per-resident amounts, a challenge that has disproportionately impacted rural hospitals and those in underserved areas that accepted resident rotators as part of their recruitment strategy.
Our findings show that only 23 of the 219 hospitals (10.5%) eligible under Section 131 have reset their full-time equivalent (FTE) caps so far. For most, the five-year window ending December 26, 2025, has proven too short to benefit under the complex statutory and regulatory policies surrounding new program development and Medicare GME payment.
We included examples of how Section 131 has already made a difference, such as Watauga Medical Center in rural North Carolina, which reset its per resident amount and FTE caps and launched a family medicine residency that now trains 18 residents. Of its first eight graduates, seven have remained in rural practice.
Without an extension, 196 additional hospitals, including 42 in rural areas, may lose the ability to create or expand GME programs, limiting their ability to expand physician training and potentially retain those physicians as they enter practice. Absent Congressional action to extend the policy, hospitals that have not yet taken advantage of Section 131 will lose the ability to do so at the end of December.
If you’re interested in the details, or in how these findings may inform workforce discussions more broadly, I’m happy to answer questions or continue the conversation here.
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Matthew C. Baker, PhD
Director, Policy Research and Analytics
Health Care Affairs
AAMC
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