Richard E. Rieselbach, MD; Byron J. Crouse, MD; John G. Frohna, MD, MPH
Rieselbach RE, Crouse BJ, Frohna JG. Teaching Primary Care in Community Health Centers: Addressing the Workforce Crisis for the Underserved. Ann Intern Med. 2010;152:118-122. doi: 10.7326/0003-4819-152-2-201001190-00186
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Published: Ann Intern Med. 2010;152(2):118-122.
Universal coverage and multiple initiatives to improve health care delivery are crucial components of health care reform. However, the missing link has been a plan to rapidly address the primary care workforce crisis for the underserved. The authors propose a link between primary care graduate medical education and care for the underserved in community health centers, where expansion will be necessary for the anticipated increase in Medicaid and insured patients. This can be achieved by establishing primary care teaching health centers in expanded community health centers, which have established a patient-centered medical home practice environment. Residents would receive their final year of training in these centers, and then have the incentive of National Health Service Corps debt repayment if they subsequently practice in an underserved area. Primary care residents being trained in this setting would immediately increase the clinical capacity of community health centers and ultimately expand the primary care physician workforce. This proposal addresses the primary care physician workforce crisis and the associated key problems of limited access for the underserved and suboptimal primary care graduate medical education.
Addresses physician primary care workforce shortage: Replenishes primary care pipeline by attracting residents to a training environment consistent with future practice and providing debt repayment programs through the National Health Service Corps.
Provides access for the underserved: Centers would be located in a certified primary care health professions shortage area and facilitate expansion of community health centers, which face a great increase in demand for patient care.
Improves primary care training in patient-centered medical home environment: Residents could practice in a well-functioning primary care clinic, reflective of their future practice, with close supervision from well-supported teaching faculty who would facilitate development of their team management skills.
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