Study Demonstrates That Medical Residents Trained in Caring for the Underserved Are More Likely to Practice in Underserved Settings

FOR IMMEDIATE RELEASE: Tuesday, October 29, 2013 

Leslie Champlin 
Senior Public Relations Strategist 
American Academy of Family Physicians 
(800) 274-2237, Ext. 5224 

WASHINGTON — Newly minted physicians who train in underserved health facilities are much more likely to continue practicing in such facilities after completing their residency training, according to research by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care. 

The study, "Do Residents Who Train in Safety Net Settings Return for Practice?"(, found up to half of medical residents who trained in rural health clinics, critical access hospitals and federally qualified health centers — which serve most of the nation's uninsured and underinsured patients — returned to practice in those settings after completing residency training. The study was published in an early release of the December issue of Academic Medicine. 

"Overall, between one-third and one-half of the residents we identified in any of these settings during training were also identified as practicing in these same settings after training," writes Robert Phillips, MD, MSPH, and his co-authors. 

Of the residents who trained in any of these three settings, more than one-third (38 percent) returned to practice in a rural health clinic; 31 percent returned to practice in a FQHC; and 53 percent returned to practice in a critical access hospital. 

By comparison, only 2 percent of all residents practice in safety net facilities. 

“This study demonstrates the importance of preserving the Teaching Health Center program created by the Affordable Care Act and for increasing residency training in settings where the underserved receive care," said Phillips. "It provides additional evidence that a physician’s training site has a significant impact on where he or she will practice. The Institute of Medicine recommended moving training into these settings in 1989, and the Council on Graduate Medical Education repeated that call many times since. But we still train the majority of our residents in hospitals and wonder why they don’t go where they are needed." 

According to the study's authors, medical education policy makers have several options to increase the number of physicians trained in rural and underserved areas: 

  • expand and modify the Teaching Health Center graduate medical education program. The program is designed to build new residency programs in FQHCs and rural health clinics;
  • redistribute unfilled GME positions with the express purpose of building existing safety net training relationships;
  • increase current GME funding with the stipulation that additional funds go to training residents in rural health clinics, critical access hospitals or FQHCs; and
  • Remove indirect medical education payments that go above training expenses and distribute the difference to fund a new performance-based GME program that produces a physician workforce that meets the community's needs.

"We recommend reauthorizing and expanding the Teaching Health Center GME program, increasing the use of cost-based GME reimbursement in critical access hospitals, or expanding training at safety net sites as a condition for receiving additional GME funding," they conclude. 

The study was funded by the Josiah Macy Jr. Foundation. 


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.