The Council on Graduate Medical Education (COGME) was authorized by Congress in 1986 to provide an ongoing assessment of physician workforce trends, training issues, and financing policies and to recommend appropriate Federal and private-sector efforts to address identified needs. The legislation calls for COGME to advise and make recommendations to the Secretary of the Department of Health and Human Services (DHHS); the Senate Committee on Health, Education, Labor, and Pensions; and the House of Representatives Committee on Commerce. Section 219 of the Departments of Labor, Health and Human Services, and Education and Related Agencies’ Appropriations Act, 2004, Public Law 102-394, 106 Stat. 1825, resulted in the Secretary of DHHS extending COGME through September 30, 2004.

The legislation specifies 17 members for the Council. Appointed individuals are to include representatives of practicing primary care physicians, national and specialty physician organizations, international medical graduates, medical student and house staff associations, schools of medicine and osteopathy, public and private teaching hospitals, health insurers, business, and labor. Federal representation includes the Assistant Secretary for Health, DHHS; the Administrator of the Health Care Financing Administration, DHHS; and the Chief Medical Director of the Veterans Administration.

Charge to the Council

The charge to COGME is broader than the name would imply. Title VII of the Public Health Service Act, as amended, requires COGME to provide advice and recommendations to the Secretary of DHHS and Congress on the following issues:

1. The supply and distribution of physicians in the United States;
2. Current and future shortages or excesses of physicians in medical and surgical specialties and subspecialties;
3. Issues relating to international medical school graduates;
4. Appropriate Federal policies with respect to the matters specified in items 1–3, including policies concerning changes in the financing of undergraduate and graduate medical education (GME) programs and changes in the types of medical education training in GME programs;
5. Appropriate efforts to be carried out by hospitals, schools of medicine, schools of osteopathy, and accrediting bodies with respect to the matters specified in items 1–3, including efforts for changes in undergraduate and GME programs; and
6. Deficiencies and needs for improvement in databases concerning the supply and distribution of, and postgraduate training programs for, physicians in the United States and steps that should be taken to eliminate those deficiencies.

In addition, the Council is to encourage entities providing GME to conduct activities to achieve voluntarily the recommendations of the Council specified in item 5.

COGME Publications

Since its establishment, COGME has submitted the following reports to the Secretary of DHHS and Congress:

Reports

• First Report of the Council (1988);
• Second Report: The Financial Status of Teaching Hospitals and the Underrepresentation of Minorities in Medicine (1990);
• Third Report: Improving Access to Health Care Through Physician Workforce Reform: Directions for the 21st Century (1992);
• Fourth Report: Recommendations to Improve Access to Health Care Through Physician Workforce Reform (1994);
• Fifth Report: Women and Medicine (1995);
• Sixth Report: Managed Health Care: Implications for the Physician Workforce and Medical Education (1995);
• Seventh Report: Physician Workforce Funding Recommendations for Department of Health and Human Services’ Programs (1995);
• Eighth Report: Patient Care Physician Supply and Requirements: Testing COGME Recommendations (1996);
• Ninth Report: Graduate Medical Education Consortia: Changing the Governance of Graduate Medical Education to Achieve Physician Workforce Objectives (1997);
• Tenth Report: Physician Distribution and Health Care Challenges in Rural and InnerCity Areas (1998);
• Eleventh Report: International Medical Graduates, The Physician Workforce and GME Payment Reform (1998);
• Twelfth Report: Minorities in Medicine (1998);
• Thirteenth Report: Physician Education for a Changing Health Care Environment (1999);
• Fourteenth Report: COGME Physician Workforce Policies: Recent Developments and Remaining Challenges in Meeting National Goals (1999); and
• Fifteenth Report: Financing Graduate Medical Education in a Changing Health Care Environment (2000).

Other COGME Publications

2002 Summary Report (2002)

COGME Resource Papers

Preparing Learners for Practice in a Managed Care Environment (1997);

International Medical Graduates: Immigration Law and Policy and the U.S. Physician Workforce (1998); Update on the Physician Workforce (2000);

Evaluation of Specialty Physician Workforce Methodologies (2000);

Scholar in Residence Report: Reform in Medical Education and Medical Education in the Ambulatory Setting (1991);

Process by which International Medical Graduates are Licensed to Practice in the United States (September 1995);

Council on Graduate Medical Education & National Advisory Council on Nurse Education and Practice: Collaborative Education to Ensure Patient Safety (February 2001);

Proceeding of the GME Financing Stakeholders Meeting (April 11, 2001), Bethesda, Maryland, Public Response to COGME’s Fifteenth Report (September 2001);

The Effects of the Balanced Budget Act of 1997 on Graduate Medical Education (2000); and

Council on Graduate Medical Education: What is it? What has it done? Where is it going? 2nd Edition (2001).