Funding Instability Plagues Program That Brings Docs to Underserved Areas – KFF Health News

For Diana Perez, a medical resident at the Family Health Center of Harlem, the handwritten thank-you note she receives from a patient is proof she chose the right training path.

Perez helped the patient, a homeless West African immigrant who suffers from HIV and other chronic illnesses, get the medications and care he needed. She documented his medical needs for the nonprofit, which helped him apply for asylum and safe housing.

“I really liked the whole-person care,” said Perez, 31, who has worked at this New York City health center for the past three years. “I wanted to learn and be trained, deal with the day-to-day things I would see as a primary care physician and really immerse myself in the community,” she said.

“I wanted to learn and be trained to deal with the things I would see on a day-to-day basis as a primary care physician and really immerse myself in the community,” says Diana Perez, who is completing her primary care residency at the Family Health Center of Harlem.(Diana Perez)

Very few primary care residents get such extensive community-based outpatient training. Most spend most of their residency in hospitals. But Perez, who is being trained through the Teaching Health Center Graduate Medical Education Program, is among those treating patients in federally qualified health centers and community clinics in medically underserved rural and urban areas across the country. Research has found that after graduation, these residents are more likely than hospital-trained graduates to stay and practice locally, where they are often desperately needed.

Amid a long-term shift from inpatient to outpatient medical care, training primary care doctors in outpatient clinics rather than hospitals is an easier task, according to Robert Schiller, the hospital’s chief academic officer. Institute of Family Healthwho runs the Harlem THC program and operates dozens of other health center sites in New York. He said, “Care is moving into the community,” and the THC program is “creating a community-based training environment, and the community is the classroom.”

However, because the program, established under the Affordable Care Act of 2010, relies on congressional appropriations for funding, it regularly faces financial uncertainty. Despite bipartisan supportIts funds will run out at the end of December unless lawmakers vote to replenish its coffers — no easy task in the current divided Congress, in which passing legislation of any kind has proven difficult. Faced with the prospect of not being able to cover three years of residency training, many of the 82 THC programs across the country have recently paused their residency training programs or are phasing them out.

this is it DePaul Family and Social Medicine Residency Program In New Orleans East, an area that is slowly recovering after Hurricane Katrina in 2005, it did just that. With a startup grant from the federal Health Resources and Services Administration, the community health center hired staff for a residency program and received accreditation last fall. They interviewed more than 50 medical students for residency slots and hoped to enroll their first class of four first-year residents in July. But with funding uncertain, they put the new program on hold this spring, just weeks before “match day,” when residency programs and students are paired.

“It was incredibly disappointing for a number of reasons,” said Coleman Pratt, the residency program director who was hired to launch the initiative two years ago.

We’re “keeping our toes in the water” until we know we’ve got the financing, Pratt said.

“If Congress appropriates new multiyear funds, to have eligible applications on hand, HRSA will release a Notice of Funding Opportunity in late summer for both the new and expanded programs to apply to be funded in FY 2025, subject to the availability of appropriations,” HRSA spokesman Martin Kramer said in an email.

Currently, the Teaching Health Center program has $215 million to spend through 2024.

In contrast, the Centers for Medicare & Medicaid Services paid $18 billion to hospitals to provide residency training for doctors in primary care and other specialties. Unlike THC funding, which must be appropriated by Congress, Medicare graduate medical education funding is guaranteed as a federal entitlement program.

Trying to continue THC’s three-year residency programs in the absence of funding from Congress is taking a toll on the facilities trying to participate. These pressures are now reaching a breaking point.

“The uncertainty of funding is a concern,” Schiller said, noting that the Family Health Institute has put its plans for a new THC in Brooklyn on hold this year.

The imbalance between the health care needs of the American population and the hospital-based medical training most doctors receive is a long-recognized problem. A 2014 report The report, published by the National Academies Press, states that “although the GME system is producing more physicians, it has not increased the proportion of physicians who choose to practice primary care, provide care to disadvantaged populations, or live in rural or other disadvantaged areas.”

Teaching Health Center Program has demonstrated success In these regions, program graduates are more likely to practice in medically underserved areas after graduation. according to a study which analyzed the practice patterns of family medicine graduates from traditional GME training programs compared with those who participated in a THC program, nearly twice as many THC graduates were practicing in underserved areas three years after graduation, 35.2% vs. 18.6%. In addition, THC graduates were significantly more likely to practice in rural areas, 17.9% vs. 11.8%. They were also more likely to provide substance use treatment, behavioral health care, and outpatient gynecological care than graduates from regular GME programs.

But supporters say a lack of reliable, long-term funding is a barrier to the potential of the THC training model. For 2024, the Biden administration proposed three years of mandatory funding, totaling $841 million, to support more than 2,000 residents.

“HRSA is eager to fund new programs and more residents, which is why the President’s budget proposes multi-year increased funding for the Teaching Health Center program,” Kramer said in an email.

Sharon Cohen, a spokesperson for the American Hospital Association, said in an email that the association supports expanding the THC program “to help address common workforce challenges.”

The program attracts residents who are interested in primary and community care in disadvantaged areas.

“There’s definitely a selection bias in who selects these [THC] “This program plays an important role for health care providers,” said Candice Chen, associate professor of health policy and management at George Washington University.

For example, hospital primary care programs, Generally fail to fill their primary care residency on Match Day. But in the THC program, “every single year, all the slots are matched,” said Christine Serrano, executive director of the American Association of Teaching Health Centers. On Match Day in March, more than 19,000 primary care positions were available; about 300 of them were THC positions.

Amanda Fernandez, 30, always wanted to work with medically underserved patients. She did family medicine residency training at a THC in Hendersonville, North Carolina. She liked it so much that after graduating last year, the Miami native took a job in Sylva, about 60 miles away.

Most of her rural patients are accustomed to feeling like a stopover for doctors, who often move on to larger metro areas after a few years. But she and her husband, who works at the nearby Cherokee Indian Hospital, have bought a house and plan to stay put.

“That’s why I like the THC model,” Fernandez said. “You end up practicing in the same community you trained in.”

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