Community Health Center Residency Training: Improving Staffing, Service, and Quality

Abstract

Background and Objectives: Community-based residency programs are an important strategy to address rural and underserved primary care shortages, however, health centers report both benefits and challenges to training. This study aims to understand the impact of new Teaching Health Center (THC) residency programs on health center staffing, patient service, quality of care, and provider productivity. Methods: Using the Uniform Data System, we used inverse propensity score weighting to create a balanced sample of new THC and non-THC health centers in 2010. Using 2018 data, we applied propensity score weighted regressions to examine changes in staffing, service, quality of care, and productivity in THC versus non-THC health centers. Results: In 2018, health centers with new THC programs were associated with increased physician (16.40, P<.01) staffing, yet decreased physician visits per full-time equivalent (-425.3, P<.01) relative to non-THC centers. New THC centers had increased delivery visits (231.0, P<.05), and had a greater rate of early entry into prenatal care (4.90%, P<.01). Conclusions: New residency programs are associated with increased provider recruitment, expanded patient service, and some improved health outcomes, but also with potential decreased provider productivity in health centers.

The Workforce Needed to Address Population Health

“…Another study found that although nearly two‐thirds of all medical schools offer rural clinical training, less than a quarter offer rural didactic curricula to prepare students to care for rural populations 65 . These strategies prepare and encourage students and residents to practice in areas of high need, pointing to the importance of place of training in career outcomes 66 …”

“…65 These strategies prepare and encourage students and residents to practice in areas of high need, pointing to the importance of place of training in career outcomes. 66…”