The health care environment in the United States is witnessing major changes. The Halstedian model has produced surgeons who joined the workforce for over a century. While the Halstedian model will continue to be of benefit, we need to be proactive and develop innovative models of graduate medical education that meet the needs of the 21st century. The history of graduate medical education is punctuated by surgical leaders that made great contributions. The time is ripe again for the surgical community to develop innovative models of graduate medical education that will continue to sustain the surgical workforce of the future.