**Abstract**

The recent restructuring of the healthcare reimbursement system has led to financial pressure on all aspects of healthcare delivery. Naturally, this financial pressure will also trickle down to graduate medical education, resulting in mergers of residency programs. Historical examples of residency mergers will be presented and discussed in this chapter. Guidelines for merging residencies will be suggested for those programs undertaking this difficult process. These guidelines will address aspects of organization and leadership, educational philosophies and environment, program goals, culture, interpersonal relationships, communication, day-to-day operations, and finances. Special considerations for program mergers will also be discussed, including cultural differences, medical students, and surgical programs. The chapter concludes with a discussion on the relevancy of this information and important key concepts.

**Keywords:** graduate medical education (GME), merger, leadership, communication, culture, guidelines
