Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) changes in medical residency slots, focusing on: (1) VA's goals in realigning its residency program and the goals accomplished so far; (2) the reasons for changes in the number of graduate medical education residency slots; and (3) the views of VA facility and medical school officials on the effect of the changes on resident training and on the potential to train residents at VA community-based outpatient clinics.

GAO noted that: (1) the changing health care environment has resulted in less demand for specialty physicians and more demand for primary care physicians; (2) this shift influenced the changes in residency slots at VA; (3) over the last three academic years, VA realigned its graduate medical education program and achieved its goal to train 48 percent of its residents in primary care; (4) VA's strategy eliminated 251 residency slots in specialty care and converted 714 specialty residency slots to primary care slots; (5) these changes reduced the number of residency slots from 8,910 to 8,659; (6) the major reasons for the changes in residency slots were: (a) VA's decision to increase primary care residency slots and decrease specialty slots; and (b) medical school decisions to restructure their programs to meet changing demands for physicians or accreditation requirements; (7) VA initiated the majority of changes in the residency slots at the six facilities GAO visited, but these changes were consistent with the medical schools' own initiatives to meet changing demands; (8) VA and medical school officials characterized the changes as generally mutually beneficial because they were consistent with current health care practices nationally; (9) changes in residency slots have not been disruptive to training, according to VA and medical school officials at the six facilities GAO visited; (10) when VA reduced the number of residency slots, for the most part those residency slots reappeared at other hospitals affiliated with the medical schools; (11) in addition, VA and medical school officials said that some training opportunities exist at VA's community-based outpatient clinics; and (12) however, VA is not pursuing establishment of such slots because: (a) sufficient opportunities exist for primary care training in outpatient clinics located at VA hospitals; (b) remote community-based clinics present a commuting problem for the residents; and (c) the physicians who would be required to supervise and train residents at remote clinics might not be able to obtain faculty status at the medical schools.