Calls for greater public accountability for graduate medical education (GME) outcomes continue to come from a broad array of stakeholders. Creation of ways to measure accountability requires a clear understanding of the domains of GME outcomes and the creation of specific measures that are reliable and accurate and do not create an undue measurement burden. Three domains of outcomes are necessary: individual trainee competence, the quality and diversity of the training environment, and workforce factors that address workforce size, specialty mix, diversity, and geographic distribution. The Accreditation Council for Graduate Medical Education has begun to develop measures that have the potential to form the basis of the first two domains, and other data sources exist to measure the quality of the training environment. Little progress, however, has been made to accurately describe institution-specific workforce outcomes. The article by Chen and colleagues in this issue makes a major contribution in the measurement of institution-specific outcomes. Their article creates optimism that a system that incentivizes and rewards specific desirable GME outcomes can be designed. This commentary further defines some practical next steps to achieve this desired GME accountability.