Training health care professionals including physicians1 is part of the VA’s statutory mission. It does so to provide an adequate supply of health professionals overall and for the VA’s health system. This mission began in 1946, when the VA began entering into affiliations with medical schools as one strategy to increase capacity. Some trainees in particular, those in the later years of training may provide direct care to patients, thereby increasing provider capacity and patient access. In the long term, training physicians at the VA creates a pipeline for recruiting physicians as VA employees. In 2014, the Veterans Access, Choice, and Accountability Act of 2014 (VACAA, P.L. 113 46, as amended) initiated an expansion of the VA’s medical training by requiring the VA to increase the number of graduate medical education positions at VA medical facilities by 1,500 positions over a five year period beginning July 1, 2015, through 2019.5 P.L. 114 315 extended this time period to 10 years (i.e., through FY2024).