Dear Chairman Fitzgerald, Ranking Member Nadler, and Members of the Subcommittee:

My name is Jeffrey A. Singer. I am a Senior Fellow in Health Policy Studies at the Cato Institute. I am also a medical doctor specializing in general surgery and have been practicing that specialty in Phoenix, Arizona, for over 40 years. The Cato Institute is a 501(c)(3) non-partisan, non-profit, tax-exempt educational foundation dedicated to the principles of individual liberty, limited government, free markets, and peace. Cato scholars conduct independent research on a wide range of policy issues. To maintain its independence, the Cato Institute accepts no government funding. Cato receives approximately 80 percent of its funding through tax-deductible contributions from individuals. The remainder of its support comes from foundations, corporations, and the sale of books and other publications. The Cato Institute does not take positions on legislation.

I appreciate the opportunity to share with the subcommittee my thoughts on how the monopoly over accrediting medical postgraduate training programs (residency programs), granted by state licensing boards and supported by the Centers for Medicare and Medicaid Services (CMS), creates a bottleneck in residency positions. This bottleneck affects the production of new licensed physicians and limits patients’ access to care.

States will only grant medical school graduates a license to practice medicine if they complete at least one year of an accredited postgraduate education (residency). States recognize one US-based independent third-party residency accrediting organization, the Accreditation Council on Graduate Medical Education (ACGME). States permit physicians to treat patients provided they have attended an ACGME-accredited program. However, in recent years, most states have also permitted physicians who have attended residency programs accredited by the Royal College of Physicians and Surgeons of Canada to treat patients. The Centers for Medicare and Medicaid Services (CMS) only subsidizes residency programs that are ACGME-accredited.

Yet the number of medical school graduates exceeds the number of accredited postgraduate residency positions. In 2025, 6.9 percent of medical school graduates could not find a residency position during the annual “Match Week” of the National Residency Matching Program (NRMP).