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F A L L 2 0 1 3
showed that family physicians who train
in health centers are nearly three times
more likely to practice in underserved
settings upon graduation than residents
who never worked in CHCs. Among the
22 THCs created to date, 39 different
sites nationwide are being funded in the
amount of $150,000 per resident.
Further, while many advocates of
more primary care providers focus on
the expansion of GME to train more
doctors and dentists, others believe the
scope of the problem is too big to ad-
dress with physicians alone. They argue
that Medicare and even Medicaid-GME
funding should be expanded to cover the
training of graduate Nurse Practitioners
(NPs) employed not just in hospitals, but
also in different types of health centers.
To this end, Section 5316 of the Afford-
able Care Act created a Family Nurse
Practitioner Residency Training Pro-
gram (NPRTP) in 15 to 20 FQHCs and
Nurse-Managed Health Clinics (NMHCs)
nationwide. To date, the program has
helped establish NP residency training
programs most affiliated with universi-
ties in California, Connecticut, Maine,
Massachusetts, Pennsylvania, Texas and
Washington. With additional funding,
more NPRTP locations will be estab-
lished in Alaska, Ohio, Mississippi, New
Jersey, New York and North Carolina.
U.S. medical schools argue that they
are working to solve the crisis by enroll-
ing 30% more doctors by 2016. However,
they have not yet seen a proportionate in-
crease in the number of residents trained
at teaching hospitals because the afore-
mentioned residency cap froze Medicare-
GME funded training slots at 1996
levels. Community health advocates go
further and argue that GME funding
must be expanded to cover physician
training in both hospitals and health
centers. Yet others argue, again, that
federal funds should support training not
only for doctors, but also other providers
such as Nurse Practitioners in hospitals,
health centers, Nurse-Managed Health
Clinics and others. Clearly, pressure to
address the problems outlined above is
growing. Without changes to existing law,
the fundamental goal of increased acces-
sibility to affordable healthcare will not
be realized.
Get Involved
How can hospitals, medical and health
centers, and U.S. institutions of higher
learning, including both medical and
nursing schools, increase the number of
heathcare providers needed? They can
work to support legislative initiatives to
address the workforce shortage:
The Resident Physician Shortage
Reduction Act (S. 577/H.R. 1180),
introduced by Senators Bill Nelson
(D-FL), Harry Reid (D-NV) and
Charles Schumer (D-NY) in the upper
chamber and by Reps. Joe Crowley
(D-NY) and Michael Grimm (R-NY)
in the House of Representatives,
would expand the residency cap and
create 15,000 new GME slots (3,000/
year) over five years.
The Training Tomorrows Doctors
Today Act (S. 577/H.R. 1201), in-
troduced by Reps. Allyson Schwartz
(D-PA) and Aaron Schock (R-Ill),
would also create 15,000 new GME
slots over five years but would reserve
one-third of the new residency slots
for teaching hospitals that seek to
train over their Medicare cap. This
bill would also give first preference
to funding of hospitals in states with
new medical colleges.
The Primary Care Workforce Ac-
cess Improvement Act (H.R. 487),
introduced by Reps. Mike Thompson
(D-CA) and Cathy McMorris Rodg-
ers (R-WA) would establish pilot
projects that permit a portion of GME
payments to go directly to commu-
nity-based primary care physician
residency programs; not just hospi-
tals. Under the bill, supported by
the American Association of Family
Practitioners (AAFP), community-
based facilities would collaborate
with local hospitals, which would
still provide residents with necessary
in-patient training. Four models are
identified for testing under the bill,
which include:
a community-based entity working
with two or more hospitals;
two hospitals working together to
develop a primary care program;
a hospital subsidiary or indepen-
dent corporation working with
the community to further primary
care; and
a medical school or university in
collaboration with a hospital.
Legislation is also being drafted
by several members of Congress to
reauthorize Sec. 5508, the Teach-
ing Health Center Graduate Medical
Education (THCGME) program, in
response to support from the newly-
established American Association of
Teaching Health Centers (AATHC).
Hospitals, schools of medicine and
nursing, and FQHCs/CHCs all have a
stake in whether these legislative propos-
als become law. If you wish to affect the
outcome of these congressional delibera-
tions, please contact me.