Editor's note: This story has
been updated to provide correct information about the amount of money dispensed
to the Teaching Health Center Graduate Medical Education program. The
information the Health Resources and Services Administration initially provided
to Stateline was
incorrect.
In nearly two years as a medical
resident in Meridian, Mississippi, Dr. John Thames has treated car-wreck
victims, people with chest pains and malnourished infants. Patients have
arrived with lacerations, with burns, or in a disoriented fog after
discontinuing their psychiatric medications.
Thames, a small-town
Mississippi native, said the East Central Mississippi HealthNet
Rural Family Medicine Residency Program has been “exactly what I was
looking for.”
Unlike the vast majority of
doctors, Thames sought a residency in a rural clinic instead of in a teaching
hospital because his ambition is to practice in the sort of place where he grew
up, where doctors are scarce. He wants to be able to handle anything that comes
through the door, from infections to gunshot wounds to a woman who might
deliver a baby any second.
But budget decisions in faraway
Washington, D.C., may make it more difficult for Thames and other doctors who
want to practice in small towns or underserved cities.
Under the Teaching Health
Center Graduate Medical Education program, which is part of the Affordable Care
Act, the federal government dispenses grants to community health centers to
train medical residents. The goal of the program is to address the shortage of
primary care physicians in rural and poor urban areas.
But under current law, the
federal government will stop funding the program, which serves nearly 750
primary care residents in 27 states and Washington, D.C., at the end of
September. Without congressional action, it might be shut down.
“The program is absolutely
doing what it is designed to do, which is to put doctors in underserved areas
like ours,” said Darrick Nelson, the director of Hidalgo Medical Services’
teaching health center program, which is training six residents in Lordsburg,
New Mexico.
The teaching health centers
have received bipartisan support in the past. But supporters worry that because
the program is new, relatively small, and not as well-known as other federally
funded doctor training programs, it might fall through the federal budgetary
cracks.
“The greatest threat to the
teaching health centers is the dysfunction in Washington,” said Dan Hawkins, a
vice president at the National Association of Community Health Centers, a
research and advocacy group.
Earlier Cuts
Bipartisan support didn’t
protect the program from earlier cuts. In 2010, Congress allocated $230 million
over five years. When it approved a two-year extension in 2015, it provided $60
million a year which, because of growth in the program, resulted in a reduction
in the level of support per resident. That reduction was enough to cause some
of the teaching health centers to train fewer residents. Some have closed.
Studies have found that
most physicians
end up practicing close to where they did their residencies. But most teaching hospitals
are located in urban centers, far from rural regions with acute doctor
shortages. Poor urban neighborhoods also have difficulty attracting physicians.
The American Association of
Teaching Health Centers, a nonprofit advocacy group, said the ACA residency
program is having the intended result. According to the organization, 55
percent of teaching health center graduates practice in underserved areas, compared to 26 percent of
those who graduate from hospital-based residencies.
“The program is doing exactly
what we wanted it to do,” said John Sealey, director of medical education for
Authority Health in Detroit. More than 60 percent of residents who graduated
from teaching health centers in Detroit go on to practice in medically
underserved areas, many of them in Michigan, he said.
Progress in Montana
RiverStone Health, a health
care provider in Billings, Montana, was a teaching health center even before
the federal program began. RiverStone started training residents in 1998, after
partnering with two local hospitals.
“The state was completely
reliant on recruiting from other areas, which was clearly not working as well
as it should,” said Roxanne Fahrenwald, a RiverStone vice president. Fifty-one
out of 56 Montana counties have shortages of primary care doctors,
according to the federal government.
With the federal money awarded
to it under the ACA, RiverStone has been able to add one medical resident a
year to its program, bringing its number of residents to 24. About 70 percent
of RiverStone graduates have remained in the state.
Supporters also argue that
teaching health centers expose residents to the types of ailments and health
disparities, such as higher rates of obesity, diabetes and heart disease, that
they are likely to encounter if they practice primary care in underserved
areas.
“In a community health center,
most of the patients are going to present with conditions or ailments more
common to a primary care practice, whereas those in the hospital will be
sicker, with more acute needs,” said Shawn Martin, a vice president at the
American Academy of Family Physicians.
The residents in teaching
health centers do spend some of their time training in hospitals. They must
complete hospital rotations in surgery, inpatient care, obstetrics and
gynecology.
But health center residents
also see what many hospital residents never do. In Washington, D.C., for
example, medical residents at Unity Health Care Inc. often work in jails,
homeless shelters and HIV/AIDS clinics.
Those receiving care at such
sites would bear the brunt of the impact if federal money for the health center
residency program disappears.
“I’m very nervous,” said Eleni
O’Donovan, director of the teaching health center program at Unity. “The
program is not sustainable without that funding.”
