New GME model strives to keep doctors in underserved areas

A new model of federal funding for graduate medical education is training more residents in community-based health centers with the goal of reducing primary care physician shortages in medically underserved areas.

The Teaching Health Center Graduate Medical Education Program was established as part of the Affordable Care Act and provides $230 million in funding over five years. It represents a significant shift from the traditional GME model.

Instead of funneling federal funds through large academic medical centers by Medicare, the program provides funding directly to ambulatory, community-based centers through the Health Resources and Services Administration.

Residency programs at 22 facilities received funding through the program in 2012, and it is being expanded to additional teaching health centers in 2013, said Kathleen Klink, MD, director of the Division of Medicine and Dentistry in HRSA's Bureau of Health Professions.

The goal is to get more young physicians to practice primary care in communities that otherwise might have difficulty attracting them, she said. “Physicians who train in underserved communities will stay in underserved communities.”

A review of the first 11 centers funded in 2011 by the THCGME program found that they are providing valuable training for residents in areas such as use of electronic health records, working as a health care team and quality improvement, according to a study in the December 2012 issue of Academic Medicine

Teaching health centers and academic medical centers offer different educational experiences, but both models are valuable, depending on the type of medicine one hopes to practice, said Boyd R. Buser, DO, a trustee with the American Osteopathic Assn.

“I don't think one is a replacement for the other,” he said. “The teaching health center model is responsive to certain needs in the work force, and it is focused on primary care physicians, which are the largest projected shortage area.”

Nationwide physician shortages are expected to reach 91,500 by 2020, including 45,400 primary care physicians, according to the Assn. of American Medical Colleges Center for Workforce Studies.

Studies have shown that physicians who provide primary care in community-based centers as residents are about three times as likely as other residents to practice primary care long-term, said Cynthia D. Smith, MD, the American College of Physicians' senior medical associate for content development.

A team approach to care

The teaching health center model offers residents the chance to practice primary care as part of an interprofessional team. Residents have the benefit of working closely with health professionals and learn how to treat a range of patients with a variety of conditions, she said.

The THCGME program encompasses geriatrics, obstetrics and gynecology, pediatrics, internal medicine, family medicine, psychiatry, and general and pediatric dentistry. Eligible facilities are community-based ambulatory patient care centers that operate a primary care residency program, such as federally qualified health centers, community mental health centers and health centers operated by the Indian Health Service.

Dr. Klink emphasized that residency programs funded by THCGME must be accredited and meet the same rigorous requirements of hospital-based programs.

The concept of teaching health centers is not new.

Many allopathic and osteopathic programs have offered community-based residency training for decades. For example, osteopathic medical graduates have had the opportunity to complete GME training in health centers for more than 20 years, but such programs were not eligible for federal GME funding until now, Dr. Buser said.

“What's really new about [teaching health centers] and what's really bringing them to the forefront is that the ACA provided funding,” he said. “It's reflective of the federal government's recognition that the access issues for patients are greatest in the rural and underserved areas, and this allows programs to be set up in those areas.”