Building the primary care pipeline to bring family physicians where they're most needed will take time and money, and recent research suggests that federal funding of teaching health centers (THCs) is a key part of that support.
Researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care tracked the growth of THCs and found that a recent decline in federal funding brought that growth to a screeching halt. The study(jabfm.org), titled "Funding Instability Reduces the Impact of the Federal Teaching Health Center Graduate Medical Education Program," was published in the May-June issue of the Journal of the American Board of Family Medicine.
The authors detailed how initial funding for THC programs contributed to a steady increase in the number of family medicine residency slots. The THC Graduate Medical Education Program originally was a five-year initiative included in the Patient Protection and Affordable Care Act that was designed to train primary care residents and dentists to work in underserved areas outside of hospital-based residencies. The program contributed to the emergence of 11 new and 14 expanded THC family residency programs.
There are 295 THC family medicine residency slots in 2016-17 compared with 49 in 2011-12. Funding for THCs accounted for 33 percent of the increase of family medicine residency slots between 2011 and 2015, the authors found.
Speak Out for Teaching Health Centers
The AAFP has launched a Speak Out campaign to help members tell Congress how important it is to continue funding the Teaching Health Center Graduate Medical Education program. Family physicians are encouraged to make themselves heard soon because the current funding is set to expire on Sept. 30.
The Medicare Access and CHIP Reauthorization Act of 2015 extended funding for THCs for two years, but funding per resident was reduced by 40 percent, from $150,000 to $90,000. No new THCs were funded since that time. The authors wrote that the short extension period may be one reason behind the lack of new facilities.
The extension is set to expire in September, and the AAFP has urged Congress to continue funding the program. Residency directors have stated that three years of continued funding is the best means of supporting continued growth. The topic will be discussed May 22-23 during the AAFP Family Medicine Advocacy Summit in Washington, D.C.
Continued growth of THCs is not assured, especially given the decreased funding and the annual cycle of uncertain budget negotiations in Congress.
Study authors acknowledged that hospital-based residencies can address primary care shortages, but they cited research that suggests THCs are more effective in encouraging residents to continue practicing in underserved areas once their training is complete.
Residents in THCs have the opportunity to work in outpatient settings, a sharp contrast with most hospital-based residencies. Rural areas in the West that do not have a medical school or a large hospital often rely upon THCs as a vital source of primary care.
Given the caps on graduate medical education funding, changes will have to be made if the nation is to meet the demand for more primary care physicians. Some states are not waiting for action at the federal level. The authors noted that Georgia, for example, plans to train 400 additional residents by 2018 -- a projected 80 of them in family medicine -- through the creation of residencies at new teaching hospitals.
"If policymakers wish to build on community-based training to address projected primary care shortages and maldistribution, THC graduate medical education funding needs to be renewed, stabilized and expanded," the authors concluded.
Related AAFP News Coverage
Robert Graham Center Research
Teaching Health Center Residencies Help Underserved Areas