Efforts to Bolster Rural Primary Care Residencies Fall Short
Legislators lack "granular knowledge" of GME
Perry A. Pugno, MD, vice president for education with the American Academy of Family Physicians, says he is not surprised that the goals of the 2003 legislation were not attained.
"When this first came out we contacted the people who were putting forward this legislation and said you really should have talked to us beforehand and we could have helped you write it so there were fewer loopholes that would allow the outcome that you got to occur," he says.
"The people who write this legislation see the problem, they are trying to make a difference, but they don't have the granular knowledge of the nuances for how GME functions and how trainees go through their training in enough detail to plug the holes from which these kinds of distributions occur."
"We knew small rural hospitals were probably not going to jump through all the hoops necessary to try to get some additional physicians and that the larger academic centers that train lots of specialists would eventually get their hands on many of these positions, which is exactly what happened."
Pugno says some of the shortcomings in the 2003 legislation could be alleviated under the Patient Protection and Affordable Care Act.
"There are provisions in the[PPACA] that are trying to direct funding and support toward addressing rural training and the care of disenfranchised populations and things like that," he says.
Don't blame hospitals
"The conversation about redirecting money towards outcomes of training programs is probably the most effective. The caveat is that they need to be looking at the outcomes from people who are at least two years out from their residency training. One of the problems with these programs is there is a lot of talk about 'we are doing primary care training because we have all of these residents in internal medicine and pediatric residency programs.' But half of the pediatrics go into subspecialties and 90% of the internal medicine residents go into subspecialties."
Chen says it's not fair to lay all the blame on hospitals for skirting the intent of the legislation.
"People want to make hospitals the bad guys, but it's not as simple as that. Most hospitals are trying to meet a community need, particularly the smaller community hospitals," she says.
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