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Efforts to Bolster Rural Primary Care Residencies Fall Short

John Commins, for HealthLeaders Media, January 16, 2013

If the measure of success is intent and outcomes then the federal government's efforts under the Medicare Modernization Act of 2003 to train more physicians in primary care and to practice in rural areas have been a failure.

A study published this month in Health Affairs looked back on the mandate in the legislation to redistribute nearly 3,000 residency slots among the nation's hospitals. The researchers found that only 12 of the 304 hospitals that had received additional positions starting in 2005 were considered rural, and received only 3% of all positions redistributed.

And while primary care training had positive net growth after the redistribution, the growth of subspecialty training was twice as large and diverted would-be primary care physicians into subspecialty training.

Only 3% of rural hospitals got additional slots
"The really concerning thing is that the legislation specifically prioritized rural training so you would expect that the intent would be to significantly increase rural training. Only 12 rural hospitals received additional slots and that was only 3% of the total additional slots redistributed. Most of us would agree that that probably didn't meet the legislative intent," says Candice Chen, lead author of the study and an assistant research professor at the George Washington University School of Public Health and Health Services.

"The primary care issue is a little more complicated," Chen says. "We found that coming up to the redistribution a lot of the hospitals that got slots had been likely converting their primary care to non-primary care slots."

"Many of them increased their primary care training so in those hospitals where you had lost some primary care training you did manage to gain some back. But we saw a significantly larger increase in non-primary care training slots. And there was a subset of hospitals that received additional primary care slots and continued to convert them into non-primary care slots."

Chen says outcomes demonstrate the need for more coordination of medical workforce development on a national level.

"Each one of those GME programs is out there for individual organizations meeting their hospitals' and communities' needs and when you cobble them all together we are not getting what we need over all the country," she says.

"We need some more analyses and planning on a national level so we can start asking 'how can we get what we need out of this system as a whole? How do we build those requirements into the system so that in another 10 or 15 years, or even sooner than that,  people aren't scrambling to find a primary care provider.'"

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2 comments on "Efforts to Bolster Rural Primary Care Residencies Fall Short"


Robert Weltzien MD PhD (1/18/2013 at 2:23 PM)
I agree. I am a medical school graduate who is looking for a Family Medicine residency spot here in West Virginia and have only had two interviews this season, in spite of USMLE scores in the mid 90s, repeated commendations on bedside manner and a PhD in biomedical sciences. In addition to hiring foreigners on visas, age discrimination is widely practiced, as I am 53 years old. My plan is to practice in one of the underserved counties in this state in return for the government paying off my federal loans. I don't think that is selfish or money grubbing (like my specialist friends) but my chances are looking slimmer and slimmer. I could still give 20 years of service to the underserved; my father is 86 years old and just started a new company. I know money from Medicare has been frozen at 1996 levels to fund new spots but what are we getting ourselves into?

Jennifer Metivier (1/17/2013 at 7:50 AM)
Not only is it important to increase the number of residency slots in rural areas, the GME system needs to focus on recruiting more physicians FROM rural areas to begin with. If programs would increase the number of slots for physicicans that are FROM rural areas and trained them in rural areas, the chances of them desiring a practice in a rural area are much greater. I believe SUNY Upstate may have a program like this.