Teaching health centers vital to solving physician shortage

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Ensuring Americans have access to a primary care physician remains one of the foremost challenges in U.S. health care policy. The maldistribution and shortage of physicians in our rural and underserved areas are stubborn problems, and they must be solved.

Iowa has worked hard to train family physicians to live and work here. The AAFP conducts an annual study on the percentage of graduates of allopathic and osteopathic medical schools who entered family medicine residency programs as first-year residents in the previous year. The University of Iowa Roy J. and Lucille A. Carver School of Medicine has ranked among the top 20 schools in the nation for the percentage of medical students who chose family medicine residency training. In its 35th national study, published in the October 2016 edition of Family Medicine, the academy pointed to the DMU College of Osteopathic Medicine “as having both the most graduates of any of the U.S. medical schools and the largest percentage of graduates entering family medicine.”

But that effort alone is not enough. By 2030, Iowa will need to add 119 more primary care physicians to meet residents’ health care needs.

Despite that escalating need, the most successful solution — the Teaching Health Center Graduate Medical Education Program — could close Sept. 30 without immediate congressional action to reauthorize and appropriately fund it.

Currently, 59 teaching health centers — including Primary Health Care in Des Moines — are training 742 residents across 27 states and the District of Columbia. According to research, the THCGME program is graduating the primary care physicians it was designed to deliver. Nine of 10 teaching health center graduates say they intend to work in primary care, and more than three in four want to work in underserved communities. The Health Resources and Services Administration data confirm that residents who train in community-based settings such as teaching health centers are three times more likely than traditionally trained residents to practice primary care in an underserved setting.

In addition, research demonstrates that most family physicians ultimately practice within 100 miles of their residency program, so the THC’s decentralized training model serves to help remedy the uneven distribution of physicians. Clearly, the program has been successful in increasing access for people who are geographically isolated and economically or medically vulnerable.

Demand for the program is high; in fact, centers receive about 100 applications for every open residency position.

Teaching health centers are key to meeting the demand for primary medical care among the 664,587 Iowans living in health professions shortage areas.

Congress must reauthorize the Teaching Health Center GME program at a funding level that provides the $157,000 per resident — the cost of salaries and benefits of residents, faculty and support staff to train each primary care physician.

The “Teaching Health Centers Graduate Medical Education Extension Act of 2017,” bipartisan legislation introduced in the U.S. House and Senate, reauthorizes the program, provides enhanced funding and lays a pathway for growth in the number of residents trained. Most of all, the legislation will help build the primary care physician pipeline necessary to reduce costs, improve patient care, and support underserved rural and urban communities. Congress should act quickly to pass this legislation before this vital program expires.

• Jenny Butler, M.D., is Iowa Academy of Family Physicians president. Scott Bohner, D.O., is Iowa Academy of Family Physicians president-elect.

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