ACGME Answers: Explaining GME Position Allotment

30 August 2022

This post is part of an ongoing “ACGME Answers” series, expanding on frequently asked questions the ACGME often receives or sees online. To learn more about the ACGME and graduate medical education (GME), review the ACGME FAQs on our website.

As the academic year moves into the fall and new residents and fellows are settling into the next phase of their education and career, it is important, and hopefully helpful, to understand the origins and limitations of position caps and the resident/fellow complement. This post aims to clarify the role of the ACGME in the GME position allotment structure and explain residency numbers, caps, and funding.

There are several factors at play here:

  • First, the United States Congress set the cap on CMS-funded residency/fellowship positions in 1997.
  • Congress updated the cap in 2020 to include 1,000 additional positions.
  • Alternative sources of funding are available, such as states’ Medicaid programs, and public and private sources, including the institutions themselves.
  • The ACGME has no role in funding.

The role of the ACGME is to ensure learning environments are set up properly to educate and support residents/fellows. When a program applies for accreditation, the relevant ACGME Review Committee, made up of a diverse set of volunteers from the field of the associated specialty/subspecialty, approves 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 as described in the application materials. If an existing accredited program would like to expand its current approved complement, it must submit a formal request through the ACGME’s Accreditation Data System; most Review Committees provide detailed instructions for what to include in such requests on the applicable specialty’s page on the ACGME website.

The only resident cap set by the ACGME is by institution, based on Review Committee approval. Review Committees and the ACGME do not set limits by specialty or nationally, and the ACGME is not involved in The Match, which is run by the National Resident Matching Program for medical students entering residency. While the ACGME sets the eligibility requirements for appointment to an ACGME-accredited program, it does not oversee the process of residency selection of medical students, nor does it accredit medical schools. 

To maintain accreditation by the ACGME, an institution that sponsors GME programs must meet the published ACGME Institutional Requirements. This includes having the proper physical and staffing/faculty structure in place, including a designated institutional official and Graduate Medical Education Committee to oversee the institution and programs and establish a process for carrying out reviewing and reporting responsibilities. The institution must also have adequate designated supervision time for the program director(s) of its sponsored GME programs and financial support for educational resources for the residents/fellows, as well as meet all requirements ensuring a proper resident/fellow learning and working environment. All these factors will be considered when setting the approved complement or reviewing a request for expansion of it.

We hope this post helps clarify the role of the ACGME within the medical education continuum regarding limits on residency spots in GME. To learn more about other organizations involved, Question 1 of our general Frequently Asked Questions page is a good place to start.

Please continue to look for other posts in this series. If you have questions or potential topics you’d like to see explained in more detail in a future post, email