WASHINGTON--The George Washington University School of Public Health and Health Services (SPHHS) recently received a $2.3 million contract to assess the baseline characteristics and outcomes of training medical residents in community-based settings, often located in regions struggling with a severe shortage of health care providers. These so-called Teaching Health Centers were created by the landmark Affordable Care Act in order to strengthen the primary care workforce, particularly for people living in underserved neighborhoods.
"This is an exciting opportunity to evaluate the Teaching Health Center Program and the goal of boosting access to primary care," said Marsha Regenstein, PhD, MCP, a principal investigator on the project and a professor of health policy at SPHHS. "With this five-year contract our team will conduct an in-depth study of nine Teaching Health Centers located in underserved communities across the country." Candice Chen, MD, MPH, an assistant research professor at SPHHS will act as the co-principal investigator and manager of the project.
Under the Affordable Care Act the Teaching Health Center Graduate Medical Education Program was established to boost the number of primary care training programs for newly graduated doctors entering a residency program. The program aims to increase the number of primary care providers practicing in underserved neighborhoods, places that often struggle with high rates of poverty, a lack of health insurance and other issues.
"The hope is that doctors trained in these settings will go back and work in the same community or in other underserved neighborhoods," Chen said, adding that many doctors today train to be specialists and end up in big cities or suburban areas. "There's a shortfall of physicians trained in family medicine or other aspects of primary care—and that shortage is especially acute in lower-income urban or rural areas."
Currently Medicare provides nearly $10 billion per year to teaching hospitals, typically large academic medical centers where residents have traditionally trained for independent practice. However, hospital-based programs often focus on specialty care and may not adequately prepare doctors for practicing medicine in places where people are poor and suffer from many chronic health problems, Regenstein said.
The Teaching Health Center program was set up to remedy that lack of access by allowing community-based ambulatory health centers, including Community Health Centers, to begin to train residents in family medicine and other aspects of primary care. With the new contract, SPHHS researchers will evaluate nine Teaching Health Centers and their ability to provide medical residents with high-caliber training in remote or underserved locations, Regenstein said.
The contract also stipulates that SPHHS evaluate how many residents actually circle back after they finish the program and care for the underserved. There is some evidence that they do but this study could help solidify that link or identify barriers that still keep residents away from underserved locations.
The SPHHS researchers will also be able to evaluate the cost of training residents in the Teaching Health Centers. Such information is important for policymakers who must evaluate the program and want to see that funds going toward such training result in a payoff—namely an expansion in primary care doctors who are practicing in community clinics.
Finally, Regenstein and her colleagues will also develop a toolkit so that these teaching centers can be evaluated in the future for quality, cost, and outcome measures.
The nine Teaching Health Centers included in this evaluation are: Valley Consortium for Medical Education in Modesto, Calif.; Family Residency of Idaho in Boise; Northwestern McGaw Erie Family Health Center in Chicago, Ill.; Greater Lawrence Family Health Center in Massachusetts; Montana Family Medicine Residency in Billings; Institute for Family Health in New York; Wright Center for Graduate Medical Education in Scranton, Penn; Community Health of Central Washington in Yakima and Community Health Systems in Beckley, W. Va.
About the George Washington University School of Public Health and Health Services:
Established in July 1997, the School of Public Health and Health Services brought together three longstanding university programs in the schools of medicine, business, and education and is now the only school of public health in the nation's capital. Today, more than 1,100 students from nearly every U.S. state and more than 40 nations pursue undergraduate, graduate, and doctoral-level degrees in public health. http://sphhs.gwu.edu/
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