These responses address frequently asked questions and common misconceptions about the ACGME and its roles and responsibilities. They are intended to help the graduate medical education (GME) community and the public better understand the ACGME; they are not intended to provide a comprehensive explanation of the ACGME’s work. For contact information about specific topics and initiatives, visit the Contact Us page. Review the ACGME Glossary for definitions of terms used and the Manual of Policies and Procedures for additional information. This page will be updated regularly and as needed.
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Complaints and Site Visits
Resident and Fellow Employment
Programs and Institutions
Does the ACGME accredit US medical schools?
No. The ACGME only accredits GME programs and the institutions that sponsor them (“Sponsoring Institutions”). The Liaison Committee on Medical Education (LCME) accredits US allopathic medical schools and is sponsored by the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA). US osteopathic medical schools are accredited by the Commission on Osteopathic College Accreditation (COCA) of the American Osteopathic Association (AOA).
Which types of programs does the ACGME accredit?
The ACGME accredits GME (physician residency and fellowship) and certain medically-related post-doctoral fellowship programs and the institutions that sponsor them in the United States. It does not accredit training programs for nurses, advanced practice providers, or other health care professionals.
Are all residency and fellowship programs in the US ACGME-accredited?
No. ACGME accreditation is a voluntary process programs and the institutions that sponsor them choose to complete. There are residency and fellowship programs that are not accredited by the ACGME. In some cases, this is because the ACGME does not yet accredit a particular specialty or subspecialty. In other cases, programs and/or institutions have opted not to apply for accreditation from the ACGME. Residency programs that are not accredited by the ACGME do not receive Medicare funding from CMS for Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME). See Question 22 below.
What happens to residents/fellows if a program or institution loses ACGME accreditation or closes?
If the ACGME withdraws accreditation, or accreditation is voluntarily withdrawn, all residents/fellows who are unable to satisfy requirements for program completion by the effective date of withdrawal must receive assistance in their efforts to continue their education in other ACGME-accredited programs. The ACGME requires that the Sponsoring Institution ensure assistance to the residents/fellows who are displaced by program closures, per Section 19.90 of the ACGME Manual of Policies and Procedures and ACGME Institutional Requirements. Although rare, if a program is reestablished at the institution before the effective date of withdrawal, it is possible the residents/fellows could transfer into that new program at the same institution.
Programs may request temporary complement increases from the ACGME to facilitate the acceptance of residents/fellows transferring from closing programs. The ACGME is not involved in determining funding for displaced resident/fellow positions. Designated institutional officials and program directors may consider seeking advice from Medicare administrative contractors, representatives from their organization’s finance department, and others about Medicare regulations concerning cap adjustments for residents displaced by program or hospital closures.
How does a program’s resident/fellow complement fit within the Match?
The ACGME does not accredit individuals (see Question 2). The ACGME Review Committees approve a complement (maximum number of residents or fellows a program can have) based on an assessment of the program’s resources and ability to provide the required elements for education in the specialty or subspecialty at the time of application for accreditation. The complement is separate and distinct from institutional and program decisions about whether and how many positions to offer through the National Resident Matching Program (NRMP).
Who oversees The Match?
The Match is run by the NRMP. The ACGME is not involved in The Match or the application process. The NRMP Match is the largest, but other matching programs include Military, Urology, and the San Francisco Match.
What is the process for updating the Common Program Requirements and how often are they updated?
Major revisions to the Common Program Requirements occur every 10 years. Interim revisions may be considered at scheduled intervals between major revisions. On rare occasions, upon recommendation of the administration of the ACGME and as directed by the ACGME Board, revisions may be considered between these scheduled intervals.
Pursuant to the ACGME Manual of Policies and Procedures, Policy 11.50, the ACGME Board of Directors has ultimate responsibility for the Common Program Requirements. Revisions to the Common Program Requirements are conducted by a task force convened by the ACGME Board and composed of members of the Board and the Council of Review Committee Chairs. Comments are solicited to inform the revisions from ACGME Member Organizations, Review Committees, nominating organizations, ACGME standing committees and councils, program directors, institutional and program coordinators, and designated institutional officials (DIOs).
The task force drafts proposed revised Common Program Requirements, and the draft is posted on the ACGME website for public comment. All comments are reviewed by the task force and additional revisions to the draft are made if appropriate. The proposed revised Common Program Requirements and a recommended effective date are then submitted to the ACGME Committee on Requirements for consideration. Ultimate approval is made by the Board of Directors.
How are Review and Recognition Committee members selected?
Review and Recognition Committees solicit new members for various roles through nominations from the AMA, the American Board of Medical Specialties (ABMS) board for the specialty, the AOA, and professional organizations or societies within a specialty. Some committees, including the Institutional Review Committee and the Transitional Year Review Committee, recruit through public calls for new members when vacancies arise.
The ACGME helps to promote new member solicitations through its e-Communication program to the GME community, as well as on the ACGME website, and through social media. Nominees must submit specific materials, such as letter of recommendation and curriculum vitae, to be considered by the Review or Recognition Committee to which the nominee is applying. Members are selected based on professional qualifications, geographic location, and racial, ethnic, and community diversity and expertise needs of the committee. Once a committee has selected its nominee, the ACGME Board of Directors must approve the nomination.
Is the ACGME’s purview limited to graduate medical education?
The ACGME accredits GME programs and the institutions that sponsor those programs, not the individuals in those programs. While they are in an ACGME-accredited program, residents’ and fellows’ education is under the accreditation purview of the ACGME. Once residents and fellows complete an accredited GME program, however, their educational experience is no longer under the direct purview of the ACGME. Still, the ACGME encourages a lifelong commitment to professionalism through board certification and serving as positive role models for future residents and fellows.
What is needed to set up new GME programs in an institution?
Only ACGME-accredited Sponsoring Institutions may apply for the accreditation of new residency or fellowship programs. To establish an accredited Sponsoring Institution, an organization must first submit an “Intent to Apply for Institutional Accreditation” form before completing the Initial Institutional Application. The institution must meet requirements per the ACGME Institutional Requirements. This includes having a defined structure for educational oversight, including a designated institutional official (DIO) and Graduate Medical Education Committee (GMEC) to oversee the institution and programs and establish a process for carrying out reviewing and reporting responsibilities. The institution must also ensure adequate resources to support program director(s), faculty members, and residents/fellows, appropriate institutional policies and procedures, and safe clinical learning and working environments for GME (details can be found in the Institutional Requirements). After an institution receives Initial Accreditation, sponsored program (specialty or subspecialty) applications may be completed and submitted through the ACGME Accreditation Data System (ADS). There are several resources offered through the ACGME to help with this process, including two web pages outlining the steps for applying for a new Sponsoring Institution or a new program.
How are complaints processed by the ACGME?
Anyone with evidence of a Sponsoring Institution’s or program’s non-compliance with accreditation or recognition requirements may submit a complaint to the ACGME Office of Complaints. Before a complaint is submitted, the complainant should attempt to address the issue locally using all the resources available at the Sponsoring Institution and/or program, unless there is a valid reason for not doing so.
To be investigated by the ACGME, complaint allegations must be related to matters within the ACGME’s educational accreditation scope. The ACGME processes complaints from individuals to determine if an alleged violation potentially goes beyond conduct directed largely at an individual resident/fellow physician or faculty member and is in fact widespread and substantial within the institution or program.
To be investigated by the ACGME, allegations must also fall within the ACGME’s published timeframe. The ACGME accepts complaints of allegations that pertain to the current and preceding academic year. Anything older than that should not be submitted.
More information can be found on the Office of Complaints web page.
What actions can the ACGME take in response to a complaint?
The ACGME investigates alleged non-compliance with accreditation requirements. A complaint could prompt an accreditation site visit and potentially impact the accreditation status of the involved Sponsoring Institution and/or program. If a site visit occurs, the Accreditation Field Representative(s) will write a Site Visit Report that is submitted to a Review or Recognition Committee. The committee can then confer a status decision; issue, extend, or resolve citations; or issue an Area for Improvement.
The ACGME does not adjudicate disputes between individual persons and Sponsoring Institutions or residency/fellowship programs regarding matters of admission, appointment, contract, credit, promotion, or dismissal of faculty members, residents, or fellows.
What information will the ACGME share with a complainant after a complaint is filed?
The ACGME will inform a complainant when the complaint has been filed (i.e., when an allegation letter has been sent to the designated institutional official and/or program director of the Sponsoring Institution and/or program). Complainants are welcome to check the ACGME's public Accreditation Data System (ADS) website to learn if a site visit has been scheduled and if the Sponsoring Institution’s and/or program’s accreditation status has changed.
Due to confidentiality agreements with the Sponsoring Institutions the ACGME accredits, the ACGME is unable to share any citations resulting from a complaint, specifics regarding accreditation decisions, or correspondence between the ACGME and the Sponsoring Institution and/or program. Because a complaint is processed in the context of the accreditation status of the Sponsoring Institution and/or program, the complaint outcome is solely between the ACGME and the Sponsoring Institution and/or program.
Does the ACGME issue statements or comment on complaints or allegations involving accredited Sponsoring Institutions and programs?
No. The ACGME does not issue public statements related to concerns or complaints involving specific Sponsoring Institutions or programs. Reasons behind accreditation decisions are confidential between the ACGME and accredited institutions and programs.
Does the ACGME release information regarding Sponsoring Institutions’ and programs’ accreditation status?
All current and past Sponsoring Institution and program accreditation statuses, as well as all publicly available information regarding accredited institutions and programs, can be found on the public ADS site. Additional information and data can be found in the annual published ACGME Data Resource Book, available on the ACGME website.
How often are accreditation and recognition site visits conducted?
There are several reasons for a site visit to be scheduled, and they can occur at various times during the academic year. See the Site Visit FAQs for more information.
What happens after an accreditation or recognition site visit?
After an accreditation or recognition site visit, the Field Representative(s) write(s) a Site Visit Report that is submitted to the Review or Recognition Committee to be considered as a part of the committee’s review of the Sponsoring Institution or program. The committee can then confer an accreditation or recognition status decision; issue, extend, or resolve citations; or issue Area(s) for Improvement. The committee can also request another site visit or additional information from the Sponsoring Institution or program, or take another action, as appropriate to the circumstances.
Can a Sponsoring Institution or program appeal an accreditation or recognition decision?
Yes. A written request for such an appeals hearing must be received by the President and Chief Executive Officer of the ACGME within 30 days following the Sponsoring Institution’s or program’s receipt of the Letter of Notification of the adverse accreditation/recognition action. More information can be found in the ACGME Manual of Policies and Procedures, Policy 20.30 for Appeals of Adverse Accreditation Actions and Policy 23.30 for Appeals of Adverse Recognition Action.
For adverse accreditation decisions made by the ACGME Board of Directors following an egregious event there is a slightly different reconsideration process. Details can be found in Policy 24.10.
What are the possible accreditation actions resulting from accreditation site visits?
Several actions are possible following an accreditation site visit, including issuance of status decisions for Continued Accreditation, Probationary Accreditation, or Withdrawal of Accreditation. See the ACGME Manual of Policies and Procedures, Section 19.00 Accreditation and Administrative Actions for details.
Does the ACGME have any role in managing exams or assessing residents and fellows?
The ACGME is not involved in administering exams or conducting individual physicians’ assessments. The ACGME accredits residency and fellowship programs and the institutions that sponsor those programs in the United States, not individuals. Exams, such as the USMLE or COMLEX-USA, are managed by other organizations.
Does the ACGME review or set requirements for resident/fellow board exam scores?
The ACGME does have requirements for the evaluation of programs regarding board pass rates of residents and fellows (see Section V of the Common Program Requirements). The ACGME does look at aggregate board pass rates of a program’s residents/fellows in its evaluation of program effectiveness. The ACGME does not receive any information on board performance of individual residents or fellows.
Where do Sponsoring Institutions and programs get funding for residents/fellows?
The ACGME does not control and has no involvement with GME funding. GME funding is derived from a variety of public and private sources, including the institutions themselves. The federal government is by far the largest contributor to GME. Federal investments in GME occur through various programs that support physician workforce development. These programs are managed by agencies within the Department of Health and Human Services, Department of Veterans Affairs, and Department of Defense. Residency and fellowship programs can also receive funding from their respective states’ Medicaid programs, private entities, and additional public sources. Read more about federal GME funding.
How does the ACGME address conflicts of interest in medical education, research, and physician practice related to financial support for education?
The ACGME has a set of guiding principles, and general physician competencies, for sponsoring institutions and programs in helping to form residents and fellows as physicians who exemplify professionalism by serving the best interests of patients in a consistently ethical manner. The ACGME recognizes the conflict between professional responsibilities and business objectives but the interest of patients must be paramount. Read more about the guiding principles. (Note: These principles constitute guidance; they are not accreditation standards.)
What is the ACGME’s position on GME funding?
High-quality GME is responsible for providing a well-educated physician workforce and, hence, for safeguarding access, quality, and safety of health care for future generations. GME’s value to the public demands that its funding be predictable, sustainable, and sufficient—sufficient to support both individual resident/fellow physicians and the clinical learning environments that provide safe, high-quality patient care, as well as to maintain quality educational experiences. GME programs must be transparently accountable for the use of public funds and must be able to demonstrate how they serve the public’s interest.
The ACGME does not lobby for additional funding to support GME and does not advise or assist Sponsoring Institutions and programs in securing funding for current or future GME.
Who is responsible for limiting the number of CMS-funded resident/fellow positions?
The United States Congress set the cap on CMS-funded residency/fellowship positions in 1997 and updated the cap in 2020 to include 1,000 additional positions. However, certain qualifying residency and fellowship programs, such as programs serving rural and underserved areas, are eligible for funding from alternate federal programs, including the Teaching Health Center GME Program and the Children’s Hospital GME Training Program.
Is the ACGME a part of the US government?
No. The ACGME is a private, 501(c)(3), not-for-profit organization that sets standards for US GME, which includes education after medical school, such as residency and fellowship programs in more than 180 specialties and subspecialties.
Does the ACGME lobby Congress?
No. The ACGME does not lobby on behalf of any individual, group, or organization. The ACGME does serve as a resource to legislators and regulators for objective, fact-based information pertaining to GME.
Who should individuals contact regarding residency interviews?
Interview questions should be directed to the AAMC, American Association of Colleges of Osteopathic Medicine (AACOM), and the NRMP. Medical school students can also contact leadership at their current institutions.
What is the ACGME’s role relative to resident and fellow salaries and benefits?
The ACGME does not set resident and fellow salaries and benefits. The ACGME does require, however, that Sponsoring Institutions provide all residents/fellows with financial support and benefits as a part of their contract to ensure they are able to fulfill the responsibilities of their ACGME-accredited program(s) (see Institutional Requirement II.D.). A Sponsoring Institution’s Graduate Medical Education Committee (GMEC) is also required to approve annual recommendations to institutional administration concerning resident/fellow salaries and benefits (see Institutional Requirement I.B.4.b).(3)), and financial support must be specified in the resident/fellow contract (Institutional Requirement IV.C.2.c)).
Can the ACGME require/regulate hazard pay?
While the ACGME requires that residents and fellows have contracts, the ACGME is not involved in setting salaries. However, there is nothing in any ACGME Requirements that prohibits additional payments to residents and fellows for the work they are performing. Note that any additional work hours must be counted toward the clinical and educational work hour limits.
Does the ACGME require Sponsoring Institutions or programs to provide residents/fellows with well-being support and leave? (e.g., mental health services, time off for medical appointments)?
Yes. The ACGME Common Program Requirements mandate that programs must ensure residents and fellows can attend medical, mental health, and dental appointments, including those scheduled during their working hours (see Common Program Requirements VI.C.1.d).(1), VI.C.1.e).(2), and VI.C.1.e).(3)).
The Common Program Requirements also set limits on the maximum weekly hours of clinical and educational work and consecutive hours and days of clinical work and require certain time off after 24 hours of in-house call (Common Program Requirement VI.F.), and one day free in seven. The particulars of an individual’s contracted vacation, sick, or paid time off, etc., are the purview of the employer (the institution, hospital, etc.); vacation or sick day benefits are the purview of the individual program and Sponsoring Institution.
What are the current ACGME limits on clinical and educational work hours for residents/fellows, and how were they developed?
In 2017, the ACGME released revisions to Section VI , The Learning and Working Environment, of the Common Program Requirements following a comprehensive 18-month review process based on evidence, research, expert opinion from medical educators, specialty organizations, and residents, and a 45-day public comment period during which over 600 individuals from the public contributed feedback.
The ACGME does not set work hours, only the maximum allowable. The revised requirements retained a maximum of 80 clinical and educational work hours per week, averaged over four weeks., and returned first-year residents to the same schedule as other residents and fellows, re-establishing the commitment to team-based care and seamless continuity of care. The cap for first-year residents returned to 24 hours, a cap that had been in place nationwide for all other residents and fellows, plus up to four hours to manage necessary care transitions. The clinical and educational work hour limit is inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting. ACGME-accredited programs must adhere to this absolute maximum, outside of extenuating circumstances set forth in Section VI.F.4.a., while training residents and fellows under appropriate supervision.
Must institutions provide residents and fellows with parental, medical, or caregiver leave?
Yes. The ACGME Institutional Requirements were revised in 2021 to specify that institutions must provide residents and fellows with a minimum of six weeks of approved medical, parental, and caregiver leave(s) of absence, at least once during their residency or fellowship program. The Sponsoring Institution must also provide residents/fellows with at least one week of paid time off reserved for use outside of the first six weeks of such approved leave(s) of absence. Residents and fellows must be provided with at least the equivalent of 100 percent of their salary for the first six weeks of the approved leave(s) of absence, and health and disability benefits must continue during that time (see Institutional Requirement IV.H.1.).
This new requirement is now in effect as of July 1, 2022, with enforcement of the requirement beginning July 1, 2023 to allow institutions time to update their policies to become compliant.
Does the ACGME set educational curricula?
No, the ACGME does not set specific curricula for any program. A program’s curriculum is established by the local program within the framework of the ACGME’s Common and specialty- or subspecialty-specific Program Requirements. Curricular components must also meet the requirements of the relevant specialty board, which are informed by the current standard of practice determined by the applicable specialty society. As stated in the Common Program Requirements, the curriculum must also reflect the mission of the Sponsoring Institution and the needs of the community the institution and program serve.
Does the ACGME allow health professionals other than physicians to teach residents and fellows?
It is appropriate, at the physician faculty’s discretion and supervision, for an appropriately licensed and credentialed non-physician to teach and/or assist in clinical care and serve as a supplement for resident and fellow learning. ACGME Review and Recognition Committees are authorized to specify when such non-physician participation in the educational experience of residents and fellows is appropriate. It is also appropriate, at the discretion of the program director, to delegate supervision of specific educational experiences to a non-physician (with the required credentials and licensure as applicable) who is part of a physician-led team.
Does the ACGME allow health professionals other than physicians to supervise residents and fellows?
Physicians are accountable for resident and fellow education in most programs.* Effective Sponsoring Institutions and programs have a clearly defined and communicated chain of responsibility and accountability as relates to the supervision of all patient care. Attending physicians are responsible for supervising the educational experience of and clinical care provided by residents and fellows. As such, it is appropriate for health professional faculty members other than physicians to supervise residents/fellows, as approved by the individual Review Committee, with the supervision of physician faculty members.
*Post-doctoral specialties allow non-physicians to serve in such leadership positions as program director.
Are there requirements for the minimum amount of time a program director or faculty member should devote to supervision and education of residents and fellows?
While there is no predefined amount of time, the program director must spend sufficient time supervising and teaching residents/fellows to ensure the quality of didactic and clinical education at all sites that participate in the program. Find more information about requirements for program directors and faculty members in Section II of the Common Program Requirements. See Common Program Requirement VI.A.2. for more information on supervision requirements. Refer to the ACGME Data Resource Book for the average times faculty members in each specialty spend in activities related to GME as reported by ACGME-accredited programs.
Does the ACGME allow health professionals other than physicians to be called “residents” or “fellows”?
The ACGME’s definitions of residents or fellows participating in ACGME-accredited programs can be found in the ACGME Glossary of Terms.
It is not the ACGME’s role, however, to define what other professions choose to call their educational and training programs or the individuals in those programs. The terms “resident” and “fellow” can refer to multiple types of learners within a health care institution. Examples of health care professionals whose professions offer residency or fellowship programs include pharmacists, advanced practice nurses, optometrists, physician assistants, podiatrists, and psychologists. Individuals participating in academic research programs are also commonly referred to as fellows.
That said, the presence of multiple types of residents and fellows can be confusing to patients, health care administrators, and others, who deserve to understand the qualifications of the members of their health care team. In the interest of transparency and alleviating confusion, individuals participating in a residency or fellowship program should clearly and accurately state their professional credentials when interacting with patients and caregivers. For residents and fellows in ACGME-accredited programs, this transparency is a core element of the Common Program Requirements. Residents/fellows and faculty members must inform each patient of their respective roles when providing direct patient care.
What are the Milestones and how are they used in education and accreditation?
The Milestones provide a framework to support the professional development and assessment of the resident/fellow in the six essential physician competencies (the ACGME “Core Competencies”) in a specialty or subspecialty. The Milestones are criterion-referenced based on the best educational and clinical evidence and not based on the post-graduate level of a resident or fellow. While all residents and fellows in ACGME-accredited programs must be assessed on the Milestones every six months, individual resident/fellow Milestone evaluations are not considered during annual program accreditation review nor are they used to determine individuals’ eligibility for board certification.