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Monday Jan 29, 2018

Congress' Inaction Threatens Family Medicine Training

Roughly half a million American women give birth in rural hospitals each year, but that scenario is steadily becoming less common in our health care system because an alarming number of rural hospitals are shuttering their delivery rooms. An analysis of more than 300 rural hospitals(onlinelibrary.wiley.com) in nine states found that 7.2 percent of such facilities closed their obstetrics units between 2010 to 2014.

[money wrapped in a lock and chain]

My rural Alabama community was ahead of the curve because our 25-bed hospital closed its labor and delivery unit long before that. In one of the most important, vulnerable moments in their lifetimes, expectant mothers in my community were faced with the unenviable choice of traveling 45 minutes northwest to Tuscaloosa or more than an hour northeast to Birmingham.

Then an incredible thing happened. A teaching health center opened in our community.

The Teaching Health Center Graduate Medical Education (THCGME) program, which was created by the Patient Protection and Affordable Care Act in 2010, addresses three key workforce issues: the severe shortage of primary care physicians, their geographic maldistribution and the need for physicians willing to care for patients in medically underserved areas.

The program in my community accepts four interns each year, meaning we have 12 residents per academic year. To complete their broad-scope training in family medicine, the new residency needed to offer obstetrics training, so our labor and delivery unit reopened after being closed for more than a decade. The program delivers about 100 babies a year, which is not insignificant in a county with fewer than 25,000 residents.

That's just one aspect of what the program, which employs about 100 people, has meant to the community. In addition to the clinic in my hometown, branches have opened in four other underserved locations -- both rural and urban. In other words, the program is doing exactly what teaching health centers were intended to do: Train primary care doctors and provide care in areas of need.

These are altruistic young physicians who want to serve the underserved. Unfortunately, Congress has failed these physicians, their programs and our communities. Funding for the THCGME program -- as well as for community health centers and the National Health Service Corps -- expired in September.

These programs, which provide health care for those in need and train the physicians who provide that care, were left to wither while Congress squabbled about tax cuts and border walls. It was a disservice to fourth-year medical students who were considering these programs in the National Resident Matching Program and a disaster for programs that could not guarantee prospective trainees that they will be able to stay open.

Last summer, a teaching health center bill had broad, bipartisan support in the House months before the program's funding expired. Yet here we still are with legislators dragging their feet on a program that funds roughly 750 residency positions.

Congress, after much lobbying from the AAFP and others, recently approved a six-year extension for the Children's Health Insurance Program. That was great news for the nearly 9 million kids and their families who depend on that program for health coverage. But the obvious next step for Congress is to provide stable, long-term funding for other programs that are vital to primary care.

Millions of children are now guaranteed coverage, but without funding for community health centers, teaching health centers and the National Health Service Corps, will children in communities like mine be able to access the care they need?

You can use the AAFP's Speak Out tool to let legislators know how important these programs are in your state.

John Meigs, M.D., is Board chair of the AAFP.

Posted at 01:37PM Jan 29, 2018 by John Meigs, M.D.

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