Fairness and Integrity in (Medical) Residency Act, The FAIR Act

Problem

- Residents are underpaid and unprotected. National average pay ≈ $64,000/year despite graduate‑level clinical responsibility. 

- Workload inequality:  Residents routinely exceed 60–80 hours/week with no overtime eligibility. 

- Labor gap: Advanced Practice Providers (APPs) enter the workforce at $88k–$100k with FLSA coverage; residents lack those rights. 

- Economic impact: High burnout and attrition rates threaten the future physician pipeline and patient safety.

 

Solution: The FAIR Act Framework

 

| Category | Provision | Goal |

|-----------|------------|------|

| Fair Pay | $80,000 base salary, inflation‑indexed + regional COLA | Ensure parity with APP entry‑level salaries |

| Labor Protection | FLSA extension to all residents | Guarantee overtime, rest, and whistleblower protections|

| Transparency | Annual HHS reporting on compensation and burnout | Accountability and data‑driven reform|

| Incentives | Federal grants for supportive programs | Reward innovation in resident welfare |

| Enforcement | Loss of GME funds for non‑compliance | Tie federal funding to compliance |

 

Benefits

- Stabilizes the physician workforce

- Enhances patient care continuity 

- Improves morale, mental health, and retention

- Promotes fiscal responsibility through transparent GME fund usage 

 

Cost & Funding

- Estimated cost: ≈ $2.1 billion annually (incremental). 

- Offset mechanisms: Reallocation of indirect GME funds, decreased reliance on locums or contract staff, and lower attrition costs.

 

Policy Alignment

- Complements the Medicare Patient Access and Practice Stabilization Act by focusing on the trainee workforce. 

- Advances national goals of workforce equity, physician retention, and healthcare infrastructure sustainability.

 

Endorsement Rationale

Training America’s doctors should not mean financial hardship. FAIR honors those delivering frontline patient care by establishing fair wages, federal protections, and transparency—ensuring a stable, equitable future physician workforce.

 

(Prepared October for legislative review. Contact [lancewatson@live.com] for public distribution or coalition endorsement.)

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The Draft Bill:

119th CONGRESS  

1st Session  

H. R. _____  

 

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A BILL  

 

To promote fair compensation, labor protections, and transparency for medical residents; to strengthen the U.S. healthcare workforce; and for other purposes.  

 

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IN THE HOUSE OF REPRESENTATIVES  

 

Mr./Ms. [Name] (for himself/herself and others) introduced the following bill; which was referred to the Committee on Education and the Workforce, and in addition to the Committee on Energy and Commerce.  

 

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A BILL  

 

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,  

 

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SECTION 1. SHORT TITLE. 

 

This Act may be cited as the “Fairness and Integrity in Residency Act” or the “FAIR Act”.  

 

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SEC. 2. FINDINGS AND PURPOSE.  

 

(a) Findings.—Congress finds that—  

(1) Medical residents form the backbone of U.S. hospital care and are vital to the education, supervision, and continuity of clinical services nationwide.  

(2) Despite their qualifications and contributions, residents receive limited compensation and lack standard labor protections compared to other healthcare professionals. 

(3) The average compensation for an Advanced Practice Provider (APP) at entry level exceeds $88,000 annually, whereas the mean salary for a resident physician remains below $65,000, despite residents having completed four years of medical school and carrying an average educational debt exceeding $200,000.¹  

(4) Residents are frequently subject to extended shifts—averaging 60 to 80 hours weekly—without eligibility for overtime pay, rest periods, or collective bargaining rights under current federal law.²  

(5) The United States invests more than $20 billion annually in Graduate Medical Education (GME) through Medicare and Medicaid, yet these funds are directed primarily to teaching hospitals rather than directly to resident compensation, resulting in a misalignment between federal investment and resident welfare.  

(6) Prior reforms aimed at indirect physician reimbursement have not demonstrably improved resident well-being, financial stability, or workforce retention.  

(7) The United States faces a projected shortage of up to 124,000 physicians by 2034, according to the Association of American Medical Colleges, and inadequate compensation and protections for residents threaten to exacerbate this shortage by discouraging entry into and retention within the physician workforce.  

(8) International comparisons demonstrate that the United States lags behind peer nations in both physician-to-population ratios and resident compensation standards, undermining global competitiveness in healthcare workforce development.  

(9) Resident burnout and attrition, driven in part by financial strain and excessive work hours, contribute to increased reliance on costly locum tenens coverage and threaten patient safety through higher rates of fatigue-related medical errors.  

(10) Establishing a fair wage floor, codified labor protections, and transparent federal oversight will strengthen the physician pipeline, reduce attrition, promote equitable healthcare delivery, and ensure that federal GME investments directly support the individuals providing essential patient care.  

 

(b) Purpose.—This Act is intended to—  

(1) ensure fair and equitable compensation for medical residents;  

(2) extend essential labor protections to residents under federal law;  

(3) increase transparency and accountability in federally funded Graduate Medical Education (GME) programs;  

(4) promote physician workforce sustainability and retention, particularly in rural and underserved areas;  

(5) improve patient safety by reducing fatigue-related medical errors; and  

(6) align federal GME investments with national healthcare priorities and fiscal accountability.  

 

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SEC. 3. DEFINITIONS. 

 

For purposes of this Act: 

(1) Resident.—The term “resident” means any physician participating in an accredited Graduate Medical Education (GME) training program under Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).  

(2) GME Program.—The term “GME program” refers to any residency or fellowship program receiving federal funds through the Centers for Medicare & Medicaid Services (CMS) or the Department of Health and Human Services (HHS).  

(3) Department.—The term “Department” means the U.S. Department of Health and Human Services (HHS). 

(4) Cost-of-Living Adjustment (COLA).—The term “COLA” means regional cost adjustments based on the Bureau of Economic Analysis Regional Price Parities index or an equivalent measure.  

 

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SEC. 4. COMPENSATION STANDARDS.  

 

(a) Establishment of National Base Salary.—  

(1) Beginning in Fiscal Year 2026, every federally funded GME program shall provide a minimum annual base salary of $80,000 for each resident.³  

(2) The base salary shall be indexed annually to inflation using the Consumer Price Index for All Urban Consumers (CPI–U).  

(3) Regional cost-of-living adjustments (COLAs) shall be applied to this base rate for programs in higher-cost geographic areas.  

 

(b) Public Disclosure.—All GME programs shall publicly report annual resident salary data on their institutional websites and to HHS for publication in a centralized federal database.  

 

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SEC. 5. EXTENSION OF FAIR LABOR STANDARDS ACT PROTECTIONS.  

 

(a) Coverage.—Residents shall be classified as covered employees for purposes of the Fair Labor Standards Act of 1938 (29 U.S.C. 201 et seq.).  

 

(b) Application.—Residents shall be entitled to—  

(1) federal minimum wage protections;  

(2) overtime pay for hours worked in excess of forty (40) per week;  

(3) mandated rest and meal breaks; and  

(4) whistleblower and workplace safety protections under section 15(a)(3) of the Act (29 U.S.C. 215(a)(3)).  

 

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SEC. 6. TRANSPARENCY, ACCOUNTABILITY, AND REPORTING.  

 

(a) Required Reporting.—Each GME program receiving federal funds shall submit annual data to the Department, including—  

(1) resident compensation and non-salary benefits;  

(2) attrition, burnout, and financial hardship metrics;  

(3) resident debt burden and moonlighting policies;  

(4) documentation of compliance with this Act.  

 

(b) Publication.—The Department shall publish an annual National Resident Workforce Report, summarizing national and regional resident compensation trends, program compliance status, and recommendations for continued improvement.  

 

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SEC. 7. RESIDENT SUPPORT INCENTIVE PROGRAM.  

 

(a) Establishment.—The Secretary of HHS shall create a Resident Support Excellence Grant Program to incentivize institutions that exceed baseline standards established by this Act.  

 

(b) Grants may be awarded for—  

(1) above-minimum resident compensation;  

(2) housing stipends and transportation assistance;  

(3) mental health, wellness, and counseling services;  

(4) structured protected time off for personal or educational development.  

 

(c) Funding.—Funds shall be derived from existing GME allocations or newly appropriated funds authorized by Congress.  

 

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SEC. 8. ENFORCEMENT AND PENALTIES.  

 

(a) Compliance.—Any GME program found non-compliant shall be subject to corrective action plans and, if unresolved, withholding of federal funds until compliance is achieved. 

 

(b) Resident Protections.—Residents shall have the right to file complaints of non-compliance with the Department of Labor or HHS Office of the Inspector General, and shall be protected from retaliation for such reporting.  

 

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SEC. 9. IMPLEMENTATION AND TIMELINE.  

 

(a) Rulemaking.—The Department shall promulgate regulations necessary to implement this Act not later than 12 months after enactment.  

 

(b) Compliance Window.—All GME programs shall achieve compliance within two fiscal years of the Act’s effective date.  

 

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SEC. 10. SEVERABILITY. 

 

If any provision of this Act is held invalid, the remainder of the Act and its application shall remain unaffected.  

 

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FOOTNOTES:  

1. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, 2024.  

2. Accreditation Council for Graduate Medical Education (ACGME) duty hour standards report, 2023. 

3. Comparable to the 2024 national average salary for entry-level Advanced Practice Providers. 

 

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COST ESTIMATE (Preliminary):  

Based on approximately 140,000 active residents nationwide, salary standardization at $80,000 (adjusted for current averages) would require an estimated incremental increase of $2.1 billion annually, offset in part by reallocated GME funding and institutional savings from reduced resident attrition, improved retention, and decreased reliance on costly locum coverage. This represents less than 0.01 percent of total U.S. healthcare spending.