Research: Efforts to Build Primary Care, Care for the Underserved Undermined by Unstable Funding for Teaching Health Centers
FOR IMMEDIATE RELEASE: Wednesday, May 10, 2017
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WASHINGTON, DC — Financial malnourishment and an unstable environment are stunting the growth of a highly successful primary care medical training program, according to research in the May-June Journal of the American Board of Family Medicine.
The training program – the Teaching Health Center Graduate Medical Education Program also known as THCGME – was established by the Affordable Care Act in 2010. The law authorized and funded community-based teaching health centers with the goal of graduating primary care physicians who will practice in underserved areas. Since then, teaching health center residency training has grown from 63 positions to more than 400 in family medicine specifically and 700 in primary care overall in the 2016-2017 academic year.
Despite early growth, teaching health centers’ contributions to increased family medicine positions have plummeted due to unstable funding, according to research by Troy Kurz, a Larry Green Visiting Scholar at the Robert Graham Center. His analysis, “Funding Instability Reduces the Impact of Teaching Health Center Graduate Medical Education Program(www.jabfm.org),” found that between 2011 and 2015, family medicine residency positions grew by 735 positions. Of that, teaching health center expansion accounted for one-third of the growth. Since then, however, teaching health centers’ contribution to increased family medicine positions fell to 7 percent.
The trend highlights the ongoing link between funding instability and teaching health centers’ ability to recruit medical school graduates into family medicine. That, in turn, signals future trouble for efforts to build the primary care physician workforce and address the maldistribution of doctors.
Data show more than 90 percent of graduates indicate they intend to work in primary care and more than three out of four in underserved communities(publichealth.gwu.edu). Other data show that training in underserved communities increases the likelihood these residents will practice in similar settings upon graduation. Graduates of THCs are more likely to work in safety net clinics than residents who did not train in these centers. Research also demonstrates that family physicians usually practice within 100 miles of their residency program(www.stfm.org), so the THC’s decentralized training model helps remedy the uneven distribution of physicians.
“THCGME provides an innovative vehicle for addressing primary care workforce needs and maldistribution,” Kurz writes. “However, given funding instability and decline, THCGME leaders have raised concerns about the program’s viability, particularly since the amount received falls short of the THC per-resident net cost, estimated to be over $150,000.”
Kurz is referring to the 2015 reauthorization of the THCGME program. In 2015, the Medicare Access and CHIP Reauthorization Act renewed the THCGME program for two years but cut per-resident funding – which pays for each resident’s salary and employment benefits, faculty and support staff, curriculum development, and medical liability – by 40 percent, from $150,000 to $95,000.
The teaching health center program will fold Sept. 30 without another reauthorization and funding appropriation. The American Academy of Family Physicians has strongly supported permanent funding for the program. Previous research demonstrated that teaching health centers are likely to close without continued federal funding.
“If policymakers wish to build on community-based training to address projected primary care shortages and maldistribution, THCGME funding needs to be renewed, stabilized, and expanded,” Kurz concludes.
About the Robert Graham Center
The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.
Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.