The work of the first 11 teaching health centers to receive graduate medical education (GME) funding through a program established by the Patient Protection and Affordable Care Act "has implications for primary care training, the GME system, and future policies and legislation aimed at strengthening the health care workforce," according to an article(journals.lww.com) about the centers recently published in Academic Medicine.
The five-year, $230 million Teaching Health Center Graduate Medical Education (THCGME) program(bhpr.hrsa.gov) is designed to boost the number of primary care residents trained in teaching health centers (THCs), which are community-based ambulatory care centers that operate a primary care residency program.
Unlike Medicare GME funding, which goes mostly to hospitals, THCGME funding goes directly to community-based sites. The funding is tied to specific health care workforce goals, and THCs must report annually on the types of primary care training programs offered, the number of resident positions, and the number of residency graduates who care for vulnerable populations in underserved areas.
"The work being done by these centers is exciting," said Candice Chen, M.D., M.P.H., lead author of the article and assistant research professor in the Department of Health Policy at the George Washington University School of Public Health and Health Services in Washington.
- An article in the December 2012 Academic Medicine looks at the work of the first class of teaching health centers (THCs) to receive funding through the Teaching Health Center Graduate Medical Education (THCGME) program.
- Since THCGME funding is tied to health care workforce goals, grant recipients must report annually on the types of primary care training programs offered, the number of resident positions, and the number of graduates who care for vulnerable populations in underserved areas.
- The first 11 THCs "show great promise," according to the article, and "further study of their efforts and outcomes has the potential to shape primary care training and the GME system at large."
"The THCGME program may be small, but its inclusion in the Affordable Care Act sends a message to the medical community," said Chen. "It shows that there's national interest in primary care and community-based training. The program gives funding directly to community-based sites because those are the people who should drive the focus and mission of primary care residency programs, and the funding gives those sites more leverage in partnering with hospitals."
The Academic Medicine article presents a number of specifics about the inaugural THCs. For example, a THC's community-based training site must be the accredited institutional sponsor of the residency program, or it must be a central partner in a sponsoring GME consortium. Residencies at five of the 11 THCs are directly sponsored by a health center; the other six are sponsored by a consortium.
All of the THCs have partnerships with federally qualified health centers (FQHCs) or FQHC "look-alikes," which are like FQHCs but don't receive federal funding. All of the THCs also have affiliations with at least one university or medical school, and each one partners with a teaching hospital or academic medical center to provide residents with training in the inpatient setting.
In addition, all of the THCs have implemented EHR systems at their training sites, and all use interdisciplinary health care teams. The educational curricula of the THCs include initiatives in community medicine, cultural competency, rural training, geriatrics training and primary care mental health training.
"These inaugural THCs are taking their mission seriously," said Chen. "They're pushing the boundaries on regulatory issues. For example, one osteopathic program convinced the American Osteopathic Association to change its residency sponsorship requirements to allow osteopathic postdoctoral training institutions that partner with community-based health care facilities to sponsor residency programs. The THCs are answering the question of how you put together an FQHC and a residency program to complement each other.
"The THCs are addressing the issues they face, or at least delineating the issues so they can start conversations with the right people to resolve them. Their work will help every THC that comes after them."
One area of concern, however, is the funding uncertainty for the future of the program, according to Chen. The THCGME program is funded only through 2015, which creates a challenge for the THCs, she said. Unless Congress provides additional funding for 2016 and beyond, THCs may have residents in the middle of their training without THCGME payments to support them.
Despite this, programs have applied in all three of the grant application cycles thus far, said Chen. "This signals to Congress that the medical community is willing to back the THCGME program, but it needs more stable funding."
The federal budget sequestration also creates uncertainty for the THCGME program. It's unclear how sequestration will affect the THCs.
Although the THCGME program is small, faces funding challenges and has yet to have its outcomes evaluated in the long term, the first THCs in the program "show great promise," according to the Academic Medicine article. "Further study of their efforts and outcomes has the potential to shape primary care training and the GME system at large."
Academic Medicine: "Commentary: The Teaching Community Health Center: An Idea Whose Time Has Come"(journals.lww.com)
Academic Medicine: "Commentary: Teaching Health Centers and the Path to Graduate Medical Education Reform"(journals.lww.com)