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Friday Dec 05, 2014

Penny Wise, Pound Foolish: We Can't Afford to Cut Our Investment in Teaching Health Centers

Not that long ago, Pardee Hospital in Hendersonville, N.C., was considering dropping its family medicine residency. Although such a move would have saved the not-for-profit facility roughly $1 million a year, it would have been a severe blow to primary care and the primary care workforce in the area.

Instead, Blue Ridge Community Health Center, a federally qualified health center (FQHC), joined a collaboration last year that already included Pardee and the Mountain Area Health Education Center of Asheville. The move not only preserved a valuable training program(www.hendersonvillelightning.com), it also gave residents exposure to a second outpatient setting -- an integrated FQHC that offers dental, behavioral health, radiographic and laboratory services; an on-site pharmacy; and interpretive services for a patient panel that includes a large Spanish-speaking population.

Here I am touring the Hendersonville Family Medicine Residency with program director Geoffrey Jones, M.D., (left) and faculty member Magdalena Hayes, M.D. I visited the program Dec. 3 in Hendersonville, N.C.

The changes didn't stop there. After Pardee ceded control of the residency to the FQHC, the program increased its number of residents from three per class to four with funding from the Teaching Health Center Graduate Medical Education (THCGME) program.

That five-year, $230 million initiative provides funds directly to community-based teaching sites with a goal of producing more primary care physicians. One hundred primary care residents have graduated from teaching health centers in the first three years of the program's existence. That's noteworthy because we know that residents who train in underserved areas are more likely to practice in those settings.

I toured the Hendersonville residency Dec. 3 and saw first-hand what a teaching health center is about. I came away impressed by the residents, the faculty and the facilities.

Unfortunately, the Hendersonville program -- and other teaching health centers in 24 states -- face uncertain futures because of funding. Barring a reauthorization by Congress, funding for the THCGME program will end in 2015. That means first-year residents took a giant leap of faith when they entered these programs this summer. Still, residents I talked with this week were focused on their training and optimistic that a solution will be found.

The AAFP is doing its part. The Academy and more than 100 other medical and social service organizations sent a letter to congressional leaders last month, urging that funding for teaching health centers and other important primary care programs be extended.

The second issue facing teaching health centers is that the Health Resources and Services Administration (HRSA) recently announced that it plans to reduce payments for each resident during the 2015-16 school year. The AAFP has responded with letters to HRSA and Congress urging that full funding be restored.

During a recent trip to Capitol Hill, Academy leaders discussed both the need to restore funding for the 2015-16 academic year and the need to extend funding for the program beyond 2015 with congressional leaders and staff. At a time when our nation already faces a dire shortage of primary care physicians, we cannot afford to abandon a program that shows great promise for producing more family physicians.

Robert Wergin, M.D., is president of the AAFP.

Posted at 04:51PM Dec 05, 2014 by Robert Wergin, M.D.

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