Politicians, practitioners and experts agree that the health care workforce in the United States is inadequate to meet the primary care needs of our nation. There are simply not enough doctors, nurses and other providers to meet the needs of the growing and aging United States population.
Historically, government funding for the training of specialists has been channeled through hospitals with few incentives to target or expand primary care programs. To address this shortfall, the Affordable Care Act established the Teaching Health Center Graduate Medical Education program, which directly funds ambulatory, community-based patient care centers that sponsor primary care residencies. These residency sponsors—known as Teaching Health Centers—provide training in the primary care disciplines and are required to meet the same accreditation requirements as other programs. Teaching Health Centers have no special admissions criteria or curricular requirements but residents care for underserved populations in community-based settings.
As part of the research team from the Department of Health Policy and Management at the Milken Institute School of Public Health that gauged the success of the Teaching Health Center Graduate Medical Education program to improve the primary care workforce we surveyed residents in Teaching Health Centers. Our recent paper describes what we learned about who chooses to train in a Teaching Health Center residency program and these physicians’ plans for practice following their graduation from residency training.
We found that while residents in Teaching Health Centers were similar to their peers nationally in terms of gender, age, race, and ethnicity, Teaching Health Centers seem to attract residents with disadvantaged and rural backgrounds. Nearly half of the residents surveyed reported coming from a disadvantaged background, and nearly a third came from a rural background. Although comparable national data on residents is not available, surveys of medical students indicate that less than 6 percent come from households in the bottom fifth of the U.S. income distribution.
As for career intentions, an impressive 55 percent of Teaching Health Centers residents intended to practice in underserved areas compared to 24 percent of practicing primary care physicians nationwide. If intention is a predictor of practice, then the Teaching Health Centers Graduate Medical Education program has great potential to mitigate the critical shortage of primary care providers in the country.
Zohray Moolani Talib is Associate Professor of Medicine and of Health Policy at the George Washington University (GWU) Medical School in Washington, D.C. Dr. Talib is a clinician and practices Internal Medicine at GWU in addition to conducting research in the field of global health, Dr. Talib’s research focuses on strategies to strengthen health systems in low-resource settings with a focus on the global health workforce. She is a member of the National Academy of Medicine Global Forum of Innovations in Health Professions Education.
Mariellen Malloy Jewers is a Research Scientist in the Milken Institute of Public Health’s Department of Health Policy and Management where she manages the implementation of data collection and data management efforts for the Evaluation and Initial Assessment of HRSA Teaching Health Centers. Ms. Jewers is a PhD candidate at the Trachtenberg School of Public Policy and Public Administration and holds a Master's of International Affairs from Columbia University.