During this era of market-driven medicine with very little revenue being channeled into shrinking financial coffers of the medical institutions and with much of the physicians efforts being directed toward revenue generation, graduate medical education has, overall, suffered a severe setback. In addition, the limitations of graduate medical education funding, sex and racial disparities, a 20% attrition rate in general surgery residency programs, new Accreditation Council for Graduate Medical Education (ACGME) requirements, and other regulatory mandates (eg, Health Insurance Portability and Accountability Act of 1996) have placed surgical training in a vulnerable state. In fact, there has never been a time (post-Halstedian) in which there have been so many major challenges to the core missions of graduate medical education in surgery. From 1997 through 2004, general surgery surfaced from a period of specialty apathy when there were unprecedented vacancy numbers in categorical positions in general surgery training programs. During this period the unfilled National Residency Match Program vacancies by US medical school seniors were as follows: 6 in 1997, 24 in 1998, 38 in 1999, 19 in 2000, 68 in 2001, 58 in 2002, 11 in 2003, and 2 in 2004.