An Opportunity for Collaboration
Richard Rieselbach, MD, is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program and a professor emeritus and health policy consultant for the University of Wisconsin Medical Foundation.
In the last decade, the nation’s community health centers (CHCs) have doubled their capacity. They now provide care for more than 22 million underserved children and adults in every state. But they’re going to need to do it again. By 2019, some 40 million patients will be in need of care.
The United States does not have enough primary care providers to serve these new patients, and our public investment in health professions education—graduate medical education (GME)—is failing to produce the pipeline we need. Medical students are choosing specialties over primary care at an alarming rate, and a policy vacuum keeps the GME program from being held accountable.
An initiative was launched in 2011 that I think holds great promise: the Teaching Health Center Graduate Medical Education initiative. This five-year, $230 million program was funded by the Affordable Care Act and created to increase the number of primary care graduates trained in community settings.
My colleagues and I have proposed a modified and expanded version of this initiative, called “CHAMP” Teaching Health Centers (CHAMP THCs). Our teaching model would pair CHCs with academic medical centers to develop a THC track that would encourage students to graduate in primary care and practice in urban and rural underserved areas.
Residents in CHAMP THCs would train in all three primary care disciplines concurrently—an undoubtedly helpful training element for their future integrated practice. They would get interdisciplinary education in a multi-disciplinary environment, while also helping CHCs meet the demands of an increasing patient population.
The CHAMP THC program would be high-quality and cost effective because of the existing administrative and accreditation infrastructures. It would also incentivize primary care careers because residents would be serving in communities with limited access to care, which gives them the opportunity for debt repayment through the National Health Service Corps.
We also propose the creation of rural CHAMP THCs, facilitated by a consortium of rural health clinics, rural CHCs, critical access hospitals, and regional teaching hospitals. Rural physician production from GME is now less than 5 percent—an abysmal rate considering nearly 20 percent of the American population lives in rural areas.
Rural CHAMP THCs would not require close proximity to an academic medical center as is necessary for the CHAMP THC model, and would be designed with greater flexibility for faculty and more use of technology to connect participants. By partnering with an already accredited primary care residency program from a regional teaching hospital, there would be no need to create duplicative infrastructures, and the consortium model would allow for sharing resources that provide support and ease the burden for each participant.
We think the CHAMP THC model can help addresses the nation’s shortage of primary care providers, while also aligning GME with national health care needs.
Educating physicians in community settings will produce the kind of physicians we need: those devoted to caring for the underserved. There’s no time to waste.