Defense Health Care: DOD's Proposed Plan for Oversight of Graduate Medical Education Programs

GAO-19-338 Published: Mar 28, 2019. Publicly Released: Mar 28, 2019.
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Fast Facts

The Defense Department's graduate medical education programs provide specialty training to medical school graduates who agree to active duty service. These programs prepare physicians for service at military hospitals and on deployment.

Congress wants to ensure that these programs produce a medical force that is ready to carry out military operations. It instructed DOD to routinely review the programs to ensure a focus on readiness, among other things.

We found DOD has developed a plan to oversee graduate medical education programs, which includes the measures Congress required. DOD has not yet begun implementing the plan.


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What GAO Found

The National Defense Authorization Act for Fiscal Year 2017 (NDAA 2017) directed the Secretary of Defense to establish and implement a process to oversee military graduate medical education (GME). The goal was to ensure GME programs fully supported operational medical force readiness, and the NDAA 2017 included several requirements for the process. In July 2018, the Department of Defense (DOD) provided a report to Congress outlining its proposed GME oversight process, and GAO found that the proposed process addressed each of the NDAA 2017 requirements. (See table.) The process formalized practices that were already in place within the military services, while also establishing two new oversight entities—the Oversight Advisory Council and the Integration Advisory Board. These entities were chartered in late 2018 and report to the director of DOD's Defense Health Agency.

Comparison of NDAA 2017 Graduate Medical Education (GME) Oversight Requirements with Department of Defense's Proposed Oversight Process

NDAA 2017 oversight requirement

Department of Defense's proposed oversight process

(1a) Review GME programs to ensure, to the extent practicable, that such programs are conducted jointly among the military departments.

  • The Oversight Advisory Council (OAC) will review the services' annual training plans to ensure GME programs are conducted jointly.
  • The Integration Advisory Board (IAB) will improve and formalize communication and collaboration, collect best practices, and make recommendations to maximize joint conduct of GME programs.

(1b) Review GME programs to ensure, to the extent practicable, that such programs are focused on, and related to, operational medical force readiness requirements.

  • The OAC will assist the Defense Health Agency with optimizing military GME programs to improve readiness.
  • The IAB will review the services' annual training plans to ensure GME programs support readiness.

(2) Minimize duplicative programs.

  • The IAB will assess GME programs for unwarranted duplication and identify areas for efficiencies.

(3a) Ensure that assignments of faculty, support staff, and students are coordinated among the military departments.

  • The IAB will review annual reports on faculty and staff assignments and coordinate student placement through the existing Joint Services GME Selection Board process.

(3b) Ensure that military treatment facilities are used as training platforms when and where most appropriate.

  • The IAB will ensure military treatment facilities remain the primary training platform for GME programs.

(4) Review and, if necessary, restructure or realign programs to sustain and improve operational medical force readiness.

  • The IAB will review programs and performance data annually and will offer recommendations to restructure programs if necessary to improve readiness.

Source: GAO analysis of National Defense Authorization Act for Fiscal Year 2017 (NDAA 2017) and Department of Defense information. The numbering of the NDAA 2017 oversight requirements is for reporting purposes and does not reflect the full numbering in the NDAA 2017. | GAO-19-338

At the time of GAO's review, DOD had not developed plans for implementing the GME oversight process. DOD officials stated that they began their planning efforts in late January 2019 but were unsure how long this process would take.

Why GAO Did This Study

DOD's health care system prepares medical personnel for wartime or humanitarian missions while providing health care to servicemembers and other eligible beneficiaries. It is responsible for ensuring that military servicemembers are physically and mentally fit to perform their missions and that it has an adequate number of medical personnel with the requisite skills and training to meet DOD's mission needs (operational medical force readiness). DOD uses GME programs to recruit and retain military physicians by providing specialized medical training through physician residencies and fellowships in exchange for active duty service obligations.

The NDAA 2017 included a provision for GAO to review DOD's GME oversight process, as detailed in DOD's July 2018 report to Congress. GAO assessed to what extent DOD's proposed oversight process, as outlined in its report to Congress, addressed each of the NDAA 2017 requirements. GAO compared DOD's process with the NDAA 2017 requirements; reviewed relevant documentation, such as minutes from planning meetings and charters for two new oversight entities; and interviewed DOD officials.

In commenting on a draft of this report, DOD did not fully agree with GAO's finding that the department had not developed plans to implement its new GME oversight process, citing as a basis certain preliminary steps it had taken. Based on the preliminary nature of these steps and other reasons explained in the report, GAO stands by its finding.

For more information, contact Debra A. Draper at (202) 512-7114 or

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