Teaching Health Centers address medical education reform — and the primary care shortage

Teaching Health Centers address medical education reform — and the primary care shortage

There’s little doubt that modern medicine needs an overhaul. From how clinicians train to how patients fare, our current system is unwieldy, expensive, and fragmented.

Yet rarely in the debate on healthcare do we focus on what’s going well.

This March, a report was released by the Milken Institute School of Public Health at the George Washington University that examined the cost effectiveness of America’s Teaching Health Centers (THCs). The report indicates that the THC program could produce nearly $2 billion in public program savings (Medicaid and Medicare) over the next five years.

That’s news we can all get behind.

Indeed, THCs are one of the highest-yield secrets in healthcare today, adeptly addressing three of the biggest stressors on the system: a primary care shortage amid an aging population, lack of access to care in rural and underserved communities, and the greatest threat to the healthcare workforce: burnout.

Much has been discussed in recent years about the looming (and in many parts of the country, pervasive) primary care shortage. The Association of American Medical Colleges suggests that the country could see a shortage of up to 120,000 physicians by 2030. Further, according to the Health Resources and Services Administration, two-thirds of states already had shortages of primary care physicians in 2013.

While there are a number of measures being taken to catch up with demand, it’s not as easy as simply hiring more clinicians. We have to train them. And to train them, we have to have residency positions that ensure our future workforce is equipped to care for our future patient populations.

Currently, however, of the roughly 30,000 residency slots available each year across all specialties, family medicine — where we see the greatest need, has the greatest impact on health outcomes, and reduces overall healthcare spending — accounts for just 3,500 of those positions, or about 12% of all residents.

That’s problem enough to inspire organizations like the American Academy of Family Physicians to launch a national campaign to increase residency positions for primary care from 12% to 25% by 2030. That’s important, to be sure; it’s still not enough to meet demand — and certainly not in the neediest regions of the country.

Some argue that the underlying issue isn’t a lack of clinicians, but rather poor distribution of clinicians.

That brings us to the issue of access.

More and more medical deserts are cropping up nationwide — locations primarily (though not exclusively) in rural America. The National Rural Health Association reports that 77% of rural counties are deemed Primary Care Health Professional Shortage Areas, and around 10% have no physicians at all. In fact, half of all rural counties lack an obstetrician. This is especially problematic given the high health disparities among these populations. The Rural Health Information Hub reports that rural communities experience lower life expectancy and higher rates of diabetes, chronic disease, and obesity.

So we have these national challenges on the one hand. On the other, we have a workforce in crisis.

According to the latest data from the Physicians Foundation, nearly four out of five physicians report the symptoms of burnout. What’s more, physicians have higher rates of depression and the highest rates of suicide among any industry in the nation. Less than 30% would recommend a career in medicine to their own children.

When we evaluate the drivers for burnout, we observe again and again clinicians justifiably bemoaning aspects of their work that decrease time with patients — the rise of technology, administrative burdens and bureaucracy, rapid and unsustainable transformation.

But we also observe that clinicians who feel connected to their patients and a greater sense of agency to effect change report lower rates of professional disengagement .

THCs are uniquely positioned to address all three challenges — with a cost, scalability, and impact that few programs can similarly achieve.

Established through the Affordable Care Act and numbering just under 60 in total, THCs are part of community health centers and scattered across the country in underserved regions where primary care is critically needed. They’re lower cost residency programs, funded by the government, that get more clinicians embedded in more communities, earlier in their training, with the resources and time to address more of the social determinants of health than their urban counterparts.

And importantly, 63% of THC graduates specialize in family medicine, and three out of four remain in medically underserved areas.

A blog post by the AAFP says it best: “It is hard to identify a public policy that has been more successful during the past decade than the THC program. In its first eight years, the program grew from supporting 63 residency positions to more than 700 residency positions… [and] has done all of this at a fraction of the cost of the legacy hospital-based residency programs.”

What’s more, THCs care for patients and providers.

During a yearlong look at America’s graduate medical education system, I had the privilege of being embedded with residents across the country — suburban Seattle, Native American reservations in Arizona, rural clinics in Appalachia, prisons in Massachusetts, and dozens more.

The most powerful experiences were those in the clinics of The Wright Center for Community Health — the largest administer of THCs in the country.

It’s in these THCs that a focus on caring for communities meets an emphasis on teaching the future workforce of healers — and the values of equity and inclusion meet the ingenuity necessary to care for diverse, underserved populations.

Where I expected to hear grievances from trainees about electronic medical records or sleepless nights or the bureaucratic malaise that often arise in conversations with healthcare professionals, I heard a kind of zeal for the work that is rare in today’s climate.

As we continue to transition to new models of care, we must also transition to new models of training — where clinicians are embedded in the communities that need them most, and in settings where they’re provided more time and resources to develop the relationships that are proven to result in better health outcomes for patients and better access to care for communities.

America’s changing. If we’re going to invest in a workforce that’s treating a changing America, shouldn’t the way we train the workforce change, too?

Teaching Health Centers address medical education reform — and the primary care shortage

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