• Speak Out for Teaching Health Centers Today

    This is a plea to members of the AAFP.

    Please urge your congressional representatives and senators to support the Teaching Health Center Graduate Medical Education program. I know you're busy and THCGME funding is a perennial issue, but we are pushing for a long-term reauthorization that could mean real program expansion. Temporary funding for the program is set to expire Nov. 21, so the Academy is working not only to ensure its renewal, but also to secure enough resources to allow for lasting growth in new communities.

    The proposed legislation that is pending in Congress would extend the program for at least four years. Last week, I was on Capitol Hill along with other Academy leaders to make the case for additional funding, but we need more voices now!

    The teaching health center program offers a path to increase the number of primary care residency positions beyond the traditional Medicare support for GME training positions, which has been capped for more than 20 years. The Patient Protection and Affordable Care Act of 2010 created the program. Since 2011, it has supported the training of more than 880 new primary care physicians and dentists who have graduated and entered practice. During the 2018-19 academic year, the program supported the training of 728 residents in 56 primary care residency programs in 23 states. However, uncertainty about funding threatens the viability of these training programs.

    I recently attended the WONCA World Rural Health Conference in Albuquerque, N.M., where one of the presenters made the case that an investment of $1 billion in the THCGME program would solve our workforce problems and address the uneven distribution of physicians across our country.

    Unfortunately, we are not investing in the workforce that we need. Specifically, we are not graduating enough primary care physicians, and the physicians we are training are not dispersed across the country in an equitable manner.

    We know that the majority of family medicine residency graduates practice within 100 miles of where they complete their training. In fact, nearly 40% of FPs practice within 25 miles of their residency program. When the majority of Medicare-funded programs are located in large urban areas, the result is medical deserts in many parts of the country that struggle with increased risks for maternal and infant mortality, poorly controlled chronic disease and decreased life expectancy (especially in rural areas).

    Studies have shown that THCGME graduates are much more likely than graduates of traditional residency programs to practice in underserved areas, so teaching health centers can and should be located in rural and urban underserved communities.

    Responding to the projected undersupply of physicians, medical schools have increased class sizes and several new medical schools have opened in recent years. Yet the number of residency slots has grown only modestly. The total number of residency applicants has outpaced the number of residency positions, heightening medical student anxiety and, consequently, encumbering programs with larger numbers of applications.

    The AAFP and our sister organizations have set an audacious goal of having 25% of U.S. medical school graduates choosing family medicine by 2030, which will require increasing the number of family medicine residency positions. This will not happen without GME reform, of which THCGMEs could be the most important component.

    As mentioned earlier, a $1 billion investment in the THCGME program would resolve many of our country's health inequities by improving access in underserved areas. This seems like a large number, but it turns out that if all residency programs were capped at the same per-resident, per-year Medicare payment rate as THCGMEs, our country would save more than a billion dollars -- some of which could be invested in teaching health centers.

    The United States is facing a primary care physician deficit, and we have a maldistribution of physicians, resulting in poor outcomes. Research has shown that appropriate investment in primary care can lower costs and improve outcomes. We can accomplish this by expanding the THCGME program.

    So, here is my plea. Go to the AAFP Speak Out tool and contact your representatives and senators.

    It is quick and easy, and it is critical for our health system and our specialty.

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


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