Teaching Health Center Graduates Go On to Practice in Underserved Settings
Study Shows Continued THC Funding is Vital to Meeting Urban, Rural Americans’ Health Needs
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WASHINGTON, DC — Teaching health center residency programs are more effective than hospital-based programs in graduating family physicians who go on to care for underserved populations, according to research in the current issue of American Family Physician.
The research found that nearly twice as many residents who trained in teaching health centers went on to practice in underserved settings as did their counterparts who trained in hospital-based programs. The findings were summarized in a one-pager Graduates of Teaching Health Center Programs Are More Likely to Practice in the Primary Care Safety Net.
Researcher Andrew Bazemore, MD, MPH, director of the Robert Graham Center, and his colleagues examined data from the 2014 American Board of Family Medicine census data of family medicine residents who had registered for board certification examinations three months before they graduated. One of the registration questions asked residents about their plans for future practice.
Bazemore and his colleagues found that, among graduates who named a practice location, one in three who trained in a teaching health center planned to continue practicing with underserved populations in community health centers, rural health centers, the Indian Health Service or the U.S. Public Health Service. Of those trained in hospital-based settings, fewer than one in five planned to practice in such settings.
“The research supports earlier studies that show residents who train in safety net settings are more likely to return to those settings to continue their careers,” said Bazemore. He pointed to an earlier report, Do Residents Who Train in Safety Net Settings Return for Practice?(www.ncbi.nlm.nih.gov), which found up to half of medical residents who trained in rural health clinics, critical access hospitals and federally qualified health centers returned to practice in those settings after completing residency training. By comparison, only 2 percent of all residents practice in safety net facilities.
“These strengthen the case for teaching health centers as pathways to practicing in underserved areas for family physicians,” Bazemore said.
Authorized by the Affordable Care Act, the Teaching Health Center Graduate Medical Education Program has grown from 11 programs and 63 residents in 2011 to 60 programs that have trained more than 550 residents in primary care. To date, more than 90 percent of teaching health center graduates reported their intentions of working in primary care, and more than 75 percent planned to practice in underserved areas.
Despite its success, the THCGME program barely survived. Authorized by the Affordable Care Act, the program was funded through October 2015. In March, the Medicare Access and CHIP Reauthorization Act extended the THCGME program through fiscal year 2017, when efforts to preserve authorization and funding will need to be revived.
“Funding to expand primary care residency training in teaching health centers was extended only through 2017, and our previous survey of THCGME program directors suggests that these training positions will not continue without more durable funding,” Bazemore wrote in the one-pager. “Congressional action to extend funding for the THCGME program by two years was important, but the program’s long-term viability and the production of safety-net physicians are in jeopardy without broader graduate medical education reform.”
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.