One million patients could lose primary care if residency training in underserved regions is eliminated
The shortage of primary care doctors could worsen if funding for the Teaching Health Centers (THC), a program to train medical residents in underserved areas, is eliminated. Loss of funding - which has already been drastically reduced - could disrupt the training of 550 current medical residents and cut off the pipeline of future primary care residents, says a new report conducted by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University (GW).
"An estimated 50 million Americans have trouble accessing timely medical care—even if they have health insurance—because they live in rural, urban or suburban parts of the country without enough primary care doctors," says Leighton Ku, PhD, MPH, lead author of the report and a professor of health policy at Milken Institute SPH. "Without continued support, the Teaching Health Centers program will not be able to train the doctors needed to deliver primary care to millions of needy Americans."
The Teaching Health Center program was started in 2011 to increase the number of primary care residents and dentists trained in community-based settings, and to fill gaps left by the current system of graduate medical education (GME). The traditional GME system has rewarded hospital-based residency programs, which often produce specialists who are not trained to provide primary care in neighborhood clinics. In contrast, the THC program, based in clinical training sites that include community health centers and other community-based sites, trains medical residents to practice in underserved communities serving people who are geographically isolated, and economically or medically vulnerable.
Congress has not yet appropriated new funding for the THC program for Fiscal Year 2015. The lack of new funding has already disrupted the 60 THC programs operating in 27 states and the District of Columbia—in communities where people have to travel long distances or wait for long periods of time to get the care they need to avert serious medical problems. If medical residents in these programs can complete their training, they are expected to provide much-needed primary care to an estimated one million patients per year.
According to the report, almost 91 percent of THC graduates remain in primary care practice compared to less than 25 percent of residents who graduate from traditional residency programs. In addition, about 76 percent of THC residents practice in underserved regions of the country as compared to 8 percent of residents trained in traditional GME programs.
"The current GME system does not promote community-based primary care training opportunities, despite the enduring national need for physicians in these settings," says Fitzhugh Mullan, MD, a co-author of the report and the Murdock Head Professor of Health Policy and Medicine at Milken Institute SPH and Professor of Pediatrics at the GW School of Medicine & Health Sciences. "The THC programs do just that and it would be a huge loss to stop funding them now—just as they start to graduate physicians ready to practice primary care in shortage areas."
If Congress steps in and extends funding, the current crop of THC residents can continue to train and provide care to half a million patients in 27 states and the District of Columbia. Once this group of residents graduate they are expected to remain in underserved regions and continue providing care to about one million people every year—a projection that would go a long way to providing a solution to the primary care shortfall.
"The THC program helps provide primary care in areas that need it most, and creates a pipeline for sustainable capacity in underserved communities," says Feygele Jacobs, president and CEO of the RCHN Community Health Foundation. "Without continued support, the Teaching Health Center program will be derailed and that could reduce primary care services in struggling neighborhoods for years to come."