Teaching health centers (THCs) are valuable not only as training sites for the next generation of primary care physicians, but also as health facilities for patients in underserved areas.
Yet despite their importance, federal funding for the THC Graduate Medical Education (GME) program is set to expire on Sept. 30, 2017, because Congress extended it for only two years under the Medicare Access and CHIP Reauthorization Act (MACRA). This makes long-term planning difficult, if not impossible.
That's why the AAFP has launched a Speak Out campaign that makes it easy for members to urge legislators to provide a more long-term, consistent funding stream for the program. Participants can send a prewritten message that is delivered directly to their members of Congress.
THCs are now training nearly 700 primary care physicians and dentists at more than 100 different sites. The THCGME program, initially part of the Patient Protection and Affordable Care Act, began in 2011 and received $60 million in annual funding in fiscal years 2016 and 2017.
- An AAFP Speak Out campaign is making it easy for family physicians to ask Congress to provide long-term, consistent funding to the Teaching Health Center Graduate Medical Education (THCGME) program.
- The THCGME program sends funds directly to community-based teaching sites.
- THCs are valuable not only as training sites for the next generation of primary care physicians, but also as health facilities for underserved areas.
Rural and Western states, especially, benefit from the program. A prime example is the Pacific Northwest, where THCs in states involved in the WWAMI Medical Education Program -- which covers Washington, Wyoming, Alaska, Montana and Idaho -- are helping to train physicians to work in rural and underserved parts of the region.
"One of the benefits of the THC program is it provides for training of physicians to work with underserved populations," Suzanne Allen, M.D., M.P.H., vice dean for academic, rural and regional affairs at the University of Washington School of Medicine in Seattle, told AAFP News. "Residents can do their training in locations where we need physicians the most, and then the residents feel comfortable working in those areas when they graduate. We are training people to serve populations where they are needed the most."
The WWAMI program has a network of 29 family medicine residency programs across the five-state region -- seven of them THCs. Many of them offer opportunities for residents to do rotations in rural locations. For instance, residents at the Family Medicine Residency of Idaho in Boise spend two weeks on a rural rotation during their first year and one month on rural rotations during their second and third years.
The THCGME funding that is set to expire in 2017 provides money directly to community-based teaching sites, unlike graduate medical education residency funding that is drawn from the Medicare budget. The Medicare hospital-based funding structure discourages most residencies from sending residents on rotations to rural or underserved areas.
Direct funding of THCs allows residents to do "more training in an outpatient setting," Allen said. "The majority of care we provide as physicians is done in an outpatient setting.
"Medicare funds clinical rotations in a hospital setting, and the dollars flow through the hospital," she continued. "If we were completely dependent on Medicare for funding, then we couldn't send residents to rural areas. From our perspective, THC funds make it possible for residents to do rotations outside of the hospital, including in rural areas."
Because THCGME funding is not permanent, supporters need to continually ask Congress for extensions so the program can maintain its role as a crucial link in building the primary care pipeline.
"For residency programs to be able to recruit, you need to know you have an ongoing source to pay residents' salaries," Allen said. "When funding is year to year, residency program directors hesitate to take on additional residents."
Residency directors could plan more effectively if funding was guaranteed for at least three years, according to Allen.
The THCGME program is addressing the demand for primary care physicians in areas of need. For many communities, THCs allow access to care where few options are available.
"Idaho and Wyoming did not expand Medicaid, so our community health centers and THCs really provide a safety net for patients who don't have health care," Allen said. "They might become even more important in future than they have been."
Related AAFP News Coverage
Robert Graham Center Research
Teaching Health Center Residencies Help Underserved Areas