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482the innovative work by individual family physicians such as Jeff Brenner from Camden, New Jersey, who has demonstrated how health care costs can be cut by finding community "hot spots" where emergency departments are over-utilized. 9 We commend the Association of American Medical Colleges (AAMC) for publishing their report on how academic medical centers of the future must be system-based to survive. 9In a recently published report, the AAMC describes 4 options for academic medical centers to move toward a system identity, from forming a new system, to partnering, to merging, or to facing the reality of shrinking in isolation.10 Within ADFM, we are tracking how departments of family medicine (DFMs) are leading health care transformation within their academic health centers. Many of our DFMs are actively engaged in moving to team-based care, improving delivery of preventive services, and promoting more appropriate use of consultations and referrals. 11 We will continue to collaborate with others who share the goal of using population health management approaches to improve affordable health care for the nation.

Training the next generation of physicians in a system wrought with funding disparities has left many residency program directors wondering if there is hope for change-and what role they might play in bringing about change.The current state of graduate medical education (GME) financing is based on outdated statutory formulas that are focused on cost-based reimbursements in the hospital setting. The consequences of this imbalanced funding are significant: the formula impacts access to care, contributes to physician workforce shortages, and ultimately fails to meet the health care needs in the United States.Between 1998 and 2008, there was an increase in the number of residency slots in specialties known for competitive incomes and appealing lifestyles (radiology, ophthalmology, anesthesia, and dermatology) and a decrease in primary care slots (family medicine, pediatrics, and internal medicine). Despite the increasing need for primary care physicians across the country, research indicates that hospitals largely favor higher revenue-generating specialty training, as there is a direct correlation between specialty income and GME slots offered.