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The use of teaching health centers

From a guest opinion by Ted Epperly, MD, CEO, Family Medicine Residency of Idaho, Boise; Boyd Southwick, President, Idaho Academy of Family Physicians, Idaho Falls, and Neva Santos, Executive Director,
Idaho Academy of Family Physicians
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James needed a sports physical and a vaccine booster in September. In November, he fell from his bike and broke his arm. In February, his parents made appointments for preventive colonoscopies. In March, his younger sister developed an ear infection. In August, his grandmother was diagnosed with high blood pressure and started a long-term treatment plan.

All of them went to the same doctor for their health needs. That doctor, a family physician, was trained in a teaching health center—a community-based residency training program that analysts say is an invaluable tool for increasing primary care physicians and addressing the maldistribution of doctors.

Since their inception in 2010, teaching health centers have been very successful in recruiting medical students into primary care and training them in comprehensive patient care at less cost. Currently, 56 teaching health center residencies are training 728 residents in 23 states and the District of Columbia.
In fact we have a Teaching Health Center (THC ) right here in Boise Idaho. The Family Medicine Residency of Idaho was one of the original 11 THC’s in the United States and has done a lot to help train family medicine physicians for rural and underserved parts of Idaho.

Equally important, they and their graduates have provided much-needed health services to 66.4 % of people in Idaho and nearly 80 million Americans living in health professional shortage areas. Research shows that more than nine out of 10 teaching health center graduates remain in primary care practice and more than three out of four plan to work in underserved communities. Studies also have documented that teaching health center residents are three times more likely than traditionally trained residents to practice primary care in a community-based clinic. Other data show that nearly twice as many residents who trained in teaching health centers went on to practice in underserved settings compared to their counterparts who trained in hospital-based programs.

That’s important because we know that an increase of one primary care physician per 10,000 people reduces deaths by more than 5%. Patients—particularly the elderly—with a usual source of care are healthier and have lower medical costs. They have better care coordination and fewer expensive emergency room visits, unnecessary tests and procedures. In contrast, those without a usual source of care have more problems accessing health services and more often do not receive appropriate medical help when it’s necessary.

Teaching health centers’ continued success now depends on Congressional action. Unless Congress reauthorizes the Teaching Health Center Graduate Medical Education Program, federal support ends on Oct. 1. Ensuring a robust program requires a five-year extension and increased funding that can support new teaching health center programs, particularly in rural and underserved areas. Currently, the Training the Next Generation of Primary Care Doctors Act reflects family medicine’s goals of reauthorizing the THCGME program for five years, authorizing adequate and sustainable funding for existing residency programs, and supporting expansion into more rural and underserved communities.

This is critical. A Robert Graham Center survey of teaching health centers found that more than four out of 10 teaching health center residency programs would be very unlikely and more than two out of 10 would be unlikely to continue supporting residency positions without continued federal funding. Due to funding uncertainty, some programs have slowed their recruiting or closed over the past few years. Congress should pass this legislation immediately to prevent a disruption in the pipeline of primary care physician production.

The current primary care physician shortage and maldistribution remain significant physician workforce challenges. An Annals of Family Medicine study projects that the changing needs of the U.S. population will require an additional 33,000 practicing primary care physicians by 2035. With reauthorization and expansion of the THCGME Program, however, the United States can make significant strides in meeting the challenge.

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