Practice Intentions of Family Physicians Trained in Teaching Health Centers: The Value of Community-Based Training

Levin, Zachary; Meyers, Peter; Peterson, Lars E.; Habib, Andy; Bazemore, Andrew

doi:10.3122/jabfm.2019.02.180292

Cited by 5 publications

(7 citation statements)

References 1 publication

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“…1,42 There is evidence that THCGME residency program graduates and others who train in underserved areas are more likely to return to safety net settings to practice. 43,44…”

Section: Discussionmentioning

confidence: 99%

Veterans Affairs Graduate Medical Education Expansion Addresses U.S. Physician Workforce Needs

et al. 2022

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The United States has a well-trained, highly specialized physician workforce yet continues to have care gaps across the nation. Deficiencies in primary care and mental health specialties are most frequently cited, though critical shortages in multiple disciplines exist, particularly in rural areas. Sponsoring institutions of physician graduate medical education (GME) have created rural residency tracks with modest federal funding and minimal incentives, though efforts targeting shortages in these specialties and geographic locations have been limited. In response to access problems in the Veterans Health Administration, Department of Veterans Affairs (VA), the second largest federal funder of GME with the most expansive clinical education platform, Congress passed the Veterans Access, Choice, and Accountability Act of 2014. This act directed the VA and provided funding to establish 1,500 new positions, a 15% expansion of VA-funded positions at the time. Priority for position selection was given to primary care, mental health, and any other specialties the secretary of VA determined appropriate. Importantly, priority was also given to VA facilities with documented physician shortages, those that did not have GME training programs, those in communities with high concentrations of veterans, and those in health profession shortage areas. Many rural facilities match this profile and were targeted for this initiative. At the conclusion of fiscal year 2021, 1,490 positions had been authorized, and 21 of the 22 VA medical centers previously without GME activity had added residents or were planning to soon. Of the authorized positions, 42% are in primary care, 24% in mental health, and 34% in critically needed additional specialties. Targeted GME expansion in the VA, the largest integrated health care system in the nation, has been successful in addressing physician GME training that aligns with physician shortages and may serve as a model to address national physician specialty and geographic workforce needs.

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“…1,42 There is evidence that THCGME residency program graduates and others who train in underserved areas are more likely to return to safety net settings to practice. 43,44…”

Section: Discussionmentioning

confidence: 99%

Veterans Affairs Graduate Medical Education Expansion Addresses U.S. Physician Workforce Needs

et al. 2022

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“…For example, researchers have identified numerous factors associated with important workforce outcomes, yet these results have had little general effect on training. [18][19][20][21][22] Similarly, there is little evidence that training expansion has [23][24][25] Instead, teaching hospitals seem to use public funds to establish training programs within more lucrative clinical services (e.g., cardiology, orthopedics). 26 Furthermore, when additional public funding is provided to support larger societal interests, there is generally little appetite for pursuing those broader goals.…”

Section: Calls For Increased Accountabilitymentioning

confidence: 99%

“…For example, researchers have identified numerous factors associated with important workforce outcomes, yet these results have had little general effect on training. 18–22 Similarly, there is little evidence that training expansion has had any correlation with state workforce needs (e.g., geographic location, specialty type) or community health needs assessments or that redistributions of training slots have met federal intentions (e.g., to establish more rural training programs). 23–25 Instead, teaching hospitals seem to use public funds to establish training programs within more lucrative clinical services (e.g., cardiology, orthopedics).…”

Section: The Terms Of the Social Contractmentioning

confidence: 99%

Measuring Graduate Medical Education Outcomes to Honor the Social Contract

et al. 2022

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The graduate medical education (GME) system is heavily subsidized by the public in return for producing physicians who meet society’s needs. Under the terms of this implicit social contract, decisions about how this funding is allocated are deferred to the individual training sites. Institutions receiving public funding face potential conflicts of interest, which have at times prioritized institutional purposes and needs over societal needs, highlighting that there is little public accountability for how such funding is used. The cost and institutional burden of assessing many fundamental GME outcomes, such as specialty, geographic physician distribution, training-imprinted cost behaviors, and populations served, could be mitigated as data sources and methods for assessing GME outcomes and guiding training improvement already exist. This new capacity to assess system-level outcomes could help institutions and policymakers strategically address the greatest public needs. Measurement of educational outcomes can also be used to guide training improvement at every level of the educational system (i.e., the individual trainee, individual teaching institution, and collective GME system levels). There are good examples of institutions, states, and training consortia that are already assessing and using GME outcomes in these ways. The ultimate outcome could be a GME system that better meets the needs of society and better honors what is now only an implicit social contract.

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“…These experiences also could help to shape future practice choices. For example, the HRSA-funded Teaching Health Centers medical residency training program is associated with significantly increasing the likelihood that residents will choose primary care practice in underserved settings . Complementing this training support, albeit with considerably less funding, is the HRSA’s Advanced Nurse Education Workforce Program that prioritizes nurse practitioner residency training in health centers.…”

Section: Expanding the Primary Care Workforcementioning

confidence: 99%

Federally Qualified Health Centers and Related Primary Care Workforce Issues

Wakefield

2021

JAMA

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Since the Affordable Care Act (ACA) was enacted in 2010, provisions that increase access to insurance coverage have generated widespread policy attention and contentious public debate. By contrast, other important provisions of the ACA, such as the expansion of the National Health Service Corps and federally qualified health centers (hereafter referred to as health centers), generated almost no conflict. Federally qualified health centers are community-based health care organizations that, with federal funding, provide primary care in underserved areas. Through these programs, ACA funding increased the number of primary care locations, services, and clinicians available to medically underserved rural and urban communities. This expansion was particularly important given research linking primary care to improved health outcomes and increased health equity. 1 Federally Qualified Health Centers: Background While significant funding increases are a recent phenomenon, health centers have a long history of federal support dating back to the first $51 million appropriation from Congress in 1967. In 1990, federal legislation augmented health center reimbursement from Medicare and Medicaid. Following a $2 billion investment in health centers through the American Recovery and Reinvestment Act of 2009 (ARRA), the ACA infused an additional $11 billion over 5 years (2011-2015). By2020,1400federallyqualifiedhealthcenterswere operating 14 500 health care sites, with locations in every state, US territory, and the District of Columbia, 2 with an enacted federal appropriation of approximately $5.6 billion. Today, approximately 16% of health center revenue comes from competitive federal grants awarded by the Health Resources and Services Administration (HRSA). This funding largely benefits individuals insured through Medicaid and Medicaid expansion, as well as individuals whoareuninsured.Anadditional43%ofhealthcenterrevenue is derived from Medicaid reimbursement and 8% from Medicare. 3 Foundation and state funds, as well as private insurance, supply most of the other revenue. Prior to enactment of ARRA and the ACA, federally qualified health centers were providing care for an estimated 18.8 million patients. By 2020, an estimated 30 million people received primary care services in these centers, including 9 million children. 2 Overall, health centers have more than tripled the number of patients served since 2000. At federally qualified health centers, primary care is defined broadly. An array of services, often available onsite, includes behavioral health and medical and dental care. Transportation to and from the health center is often available, reducing missed appointments. Some centers also include food banks, em-VIEWPOINT

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Practice Intentions of Family Physicians Trained in Teaching Health Centers: The Value of Community-Based Training

Cited by 5 publications

References 1 publication

Veterans Affairs Graduate Medical Education Expansion Addresses U.S. Physician Workforce Needs

Veterans Affairs Graduate Medical Education Expansion Addresses U.S. Physician Workforce Needs

Measuring Graduate Medical Education Outcomes to Honor the Social Contract

Federally Qualified Health Centers and Related Primary Care Workforce Issues

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