As of 2020, annual federal and state support for graduate medical education (GME) had grown to nearly $19 billion, which funds 139,848 physician training positions in 1,657 teaching hospitals across the United States. These public subsidies are provided with the understanding that the training institutions will use this governmental funding to meet the health care needs of society, both now and in the future. Decisions about how that funding is further allocated are deferred to individual training sites. This arrangement represents an implicit social contract between teaching hospitals and the American public with the reciprocal responsibilities being sustained government funding that enables GME training programs to produce a workforce that can meet communities’ and the broader society’s needs. 6,7 Surprisingly, this social contract contains little accountability for how that public funding is used.