In addition to allowing current federal Graduate Medical Education program training dollars to be spent in community-based sites, there should be additional funding provided to expand these sites. To support reform of health professions education, new federal funding should provide grants and loans for start-up costs associated with developing community-based training activities in underserved communities and populations. This will help balance urban, hospital, and tertiary care training venues with community-based, rural, ambulatory, and interdisciplinary team training and can be administered through HRSA.
Teaching Health Centers—nonhospital community settings that would develop and operate an accredited primary care residency program—are one way to increase community-based training for medical residents. There are different proposals circulating in Congress on how to accomplish this.
In the House bill there is a new grant program through HRSA for the establishment and operation of community-based residency training programs that includes Teaching Health Centers. In the Senate, the proposal goes further and would expand flexibility of the payments and the ultimate capacity of community-based training. In this model, federal funding would go directly to community-based sites. Both of these proposals would reward teaching hospitals that contract with entities such as federally qualified community health centers and rural clinics for community-based resident and nursing education, and create an infrastructure to train doctors, nurses, and others to provide both service and learning to provide coordinated care and increase primary care capacity in underserved rural and inner-city urban venues.
Allowing the federal financing of Graduate Medical Education to flow directly to these community-based sites is a significant change that would restore balance to health professions education between hospital, outpatient, and ambulatory training, and redirect the pipeline to areas of need in health professions shortage areas.
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