Teaching Health Center Graduate Medical Education
TEACHING HEALTH CENTERS GRADUATE MEDICAL EDUCATION (THCGME) REAUTHORIZATION LEGISLATION
Unless Congress enacts new legislation, the THCGME program will expire on September 30, 2023.
AATHC ultimately seeks a permanent extension of THCGME, known as the “DOC Act,” that would be the equivalent of what the Medicare-funded GME program enjoys. However, given the divided Congress and current fiscal climate, we and other stakeholders are seeking an extension of a minimum of three years (Fiscal Years 2024-26). This reauthorization needs to both accommodate the growth in the number of programs that has occurred (now at 72) and the expected additional programs HRSA will designate this Spring and next year based on the Notice of Funding Opportunities that closed last October. In addition, we have asked Congress to increase the per resident allocation (PRA) from the current $160,000 to $210,000, as justified by a recent HRSA-commissioned study.
Our proposal calls for higher funding that accommodates the projections by HRSA as to the number of medical residents it expects will be trained in FY24-26. HRSA’s recent FY24 Budget Request included a robust projected increase in the number of residents from 969 to 1105 next year to 2,094 by FY26. This reflects the number of organizations about to start as THCs this July 1 and next July 1.
It is essential that the next legislative vehicle include a minimum of a three-year extension, just like the most recent three-year reauthorization, since past extensions of a few weeks or months disrupted successful training programs significantly. At present, only three months of the 2023-2024 academic year are guaranteed funding, making it difficult for nonprofit THCs to plan and budget.
Updated March 2023
1. The THC program started about 10 years ago and is the only federal program that invests in the training of future physicians in a community setting as opposed to hospitals. As a result, it has been reauthorized several times with strong bipartisan support.
2. In the current academic year that started on July 1, there are 72 Teaching Health Center programs in 24 states and the District of Columbia with 969 medical residents handling more than an estimated one million patient visits annually in rural and urban communities.
3. THCs play a vital role in training the next generation of primary care physicians, with residents handling an estimated one million patient visits annually in rural and urban communities. THCs are responding to the crisis-level shortage of primary care physicians by delivering doctors to communities where they are needed most.
4. The uncertainty regarding the program’s expiration in September and future funding levels impedes planning and recruiting for future residency programs. Meanwhile, many THCs have over 100 applicants for every residency slot.
5. The threat of expiration of the program or a lower PRA causes THC residency programs to make difficult budgetary decisions that will adversely impact patient care and jeopardize the sustainability of future programs. Some centers have exited the THCGME program because they could not afford to continue to participate while others have cut their budgets and changed their program curricula and services, which include telemedicine, behavioral health, wellness programs and other key components that make these programs exceptional in producing a primary care workforce.
6. Funding for the THCGME program is well spent, with each dollar used for residency training in community-based settings. Based upon results of a recent survey:
82% percent of THC graduates remain in primary care practice, compared to 23 percent of traditional GME graduates.
55% percent of THC graduates practice in underserved communities, compared to 26 percent of traditional GME graduates.
20% percent of THC graduates practice in rural America, compared to 8 percent of traditional GME graduates.
7. Our recommendation also includes an increase in the per resident allocation each THC receives from HRSA annually. The current PRA is $160,000, which covers salary and benefits for a resident along with the necessary overhead, including faculty time, curriculum development, program director costs, etc.. A 2022 survey of THCs commissioned by HRSA and conducted by researchers at the objective George Washington University found that the national median of true training costs are roughly $210,000. If Congress fails to include this kind of increase in the THCGME reauthorization bill, some programs won’t be able to continue because a $160,000 PRA is unsustainable. Further, many of the organizations seeking to start their residency programs this July or next July won’t start their training because they are counting on a higher federal investment and, as local nonprofits, don’t have the ability to contribute more to the ongoing costs of training.
8. As the program gets to nearly 2,100 residents, it means that each year our nation will add seven hundred new physicians in rural and urban underserved areas, making an important long-term impact on the physician shortage.
9. Reauthorization of THCGME is also supported by our coalition partners: National Association of Community Health Centers, American Academy of Family Physicians, American Association of Colleges of Osteopathic Medicine, Council of Academic Family Medicine, American College of Obstetricians and Gynecologists, American Osteopathic Association, and Society of General Internal Medicine.
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