A high percentage of residents who train in community-based settings, especially those in family medicine, aim to continue practicing in underserved areas, according to a recent study.
The study validates one of the main reasons that teaching health centers (THCs) receive federal funding as policymakers seek to expand access to care and encourage medical residents to work in areas of greatest need.
Data were drawn from surveys of THC residents training in academic years 2013-2014 through 2015-2016 as part of a five-year evaluation of the THC Graduate Medical Education (THCGME) program established under the Patient Protection and Affordable Care Act. The study, "Primary Care Residents in Teaching Health Centers: Their Intentions to Practice in Underserved Settings After Residency Training,"(pdfs.journals.lww.com) was published online ahead of print in Academic Medicine.
Of the 1,153 residents who were invited to participate in the survey, 89 percent -- or 1,031 -- responded. Of that total, 691 were family medicine residents.
Only 24 percent of all residency graduates from 2006-2015 went on to practice in underserved settings, but 55 percent of the THC residents surveyed said they planned to do so. Of those in family medicine THC residency programs, 66 percent said they intend to practice in an underserved area. The odds of intention to practice in an underserved area were three times higher among family medicine residents compared with residents in other specialties.
All THCGME-funded residency programs are in primary care, defined as family medicine, geriatrics, internal medicine, obstetrics-gynecology, pediatrics and psychiatry. Thirty-seven of these programs are in family medicine.
Speak Out to Save Federal Funding
Federal funding for the Teaching Health Center Graduate Medical Education program will expire on Sept. 30 unless Congress takes action. The AAFP's Speak Out campaign makes it easy for you to tell your legislator to protect this program.
"THCs appear to be encouraging their residents to practice in underserved settings after graduation, indicating that primary care training programs sponsored by community-based ambulatory patient care sites represent a promising strategy to improve the health care workforce distribution in the United States," the researchers wrote.
Many residents in THC programs reflect the demographics of the communities they are working in. For example, alhough surveys have indicated that just one-fifth of medical students are from families in the lowest three income brackets, THCs tend to attract individuals from populations with greater needs.
Three out of 10 survey respondents came from a rural background. Forty-six percent said they had an economic or educational disadvantage. Seventeen percent said they represented the first generation in their family to attend college.
The researchers emphasized that having a rural and/or an economically disadvantaged background were significant factors in the intention to practice in an underserved area.
"Residents are more likely to be comfortable and have greater confidence caring for these populations," they wrote.
The THCGME program was created in part because hospital-based GME programs do not offer enough incentive for residents to practice in underserved areas. THCs, on the other hand, train residents to work in community-based ambulatory care settings that are more efficient at providing less-expensive care.
"GME training is recognized as both contributing to the problem and being part of the solution," the authors wrote. "The THCGME experience, if expanded, represents a model of funding residency training that could provide short-term and long-term improvements in access to care."
Related AAFP News Coverage
Leader Voices Blog: Bipartisan Teaching Health Center Bill Is Vital to Workforce