Amid all the anguish in the medical community over changes to come from the implementation of the Affordable Care Act, perhaps this is the most daunting: the expected doubling in size of the patient load.
The national problem of too few primary care physicians is only going to get worse. And for rural areas, where there are one-fourth fewer doctors per person than urban areas, the right word to use is "crisis." In fact, 68% of the communities with federally designated doctor shortages are rural.
But a report published by the National Association of Community Health Centers lays out the strengths of the community health center system and proposes that CHCs have an important role to play in training future primary care docs.
While hospitals across the country are jockeying for position by gobbling each other up in complicated financial transactions, the nation's Community Health Centers are quietly making preparations of their own.
With nearly $1 billion in federal funding announced this month alone, and much of that earmarked specifically to increase access to preventive and primary healthcare, CHCs are in a position to make wide-reaching and long-term impact on healthcare.
Here's how they can do it:
Training: The ACA authorizes a program called Teaching Health Center (THC) that provides payments to eligible “teaching health centers” to cover the direct and indirect costs of primary care residency training. NACHC's report calls CHC residency training programs "extremely effective tools for the recruitment and retention of family practice physicians into community-based practice."
Retention: "Large proportions of graduates" either stay where they trained or migrate to other CHCs, the report says. The report adds that well-run training programs can be a draw for specialty physicians. It spotlights four health centers that have built successful physician residency training programs in Worcester, MA; Waco, TX; Santa Fe, NM; and Yakima, WA.
But even with the HHS cash spigot wide open —$11 billion more is slated for CHCs over the next five years — there are challenges. Balancing patient care with teaching responsibilities is one. Accreditation is lagging; NHCHC advocates for an expedited process of residency program accreditation.
One way NHCHC could help move physician training forward would be to in a triage-like manner, identify CHCs that meet the requirements for physician training and focus resources in those places.
By the way, the challenges of practicing medicine in rural areas of the U.S. are documented nowhere better than here, in a series of stories, photos, and videos published by the Wisconsin State Journal. The series is funded in part by from the nonprofit, nonpartisan Kaiser Family Health Foundation.