Teaching Health Center Graduate Medical Education Program: Two Year Update American Association of Medical Colleges th Annual Physician Workforce Research Conference Songhai Barclift, MD, FACOG Branch Chief Bureau of Health Professions/Medicine and Dentistry Health Resources and Services Administration Department of Health and Human Services

Objective Summary of the THCGME program Major Growth Areas and Characteristics of Current THCs Highlight Innovations Next Steps 2

THC model has a long history with several successful THCs dating back to the 1980s (Engebretsen 1989, Zweifler 1993) Increased likelihood of THC graduates choosing to practice in HCs/other underserved settings (Morris 2008, Reiselbach 2010) June 2010 MedPAC report Increase GME time spent in non-hospital settings Community-based care Increase diversity Sec Affordable Care Act “Increasing Teaching Capacity” directed 230 million dollars over 5 years for the THCGME program Components: Section 338C(a), “National Health Service Corps Teaching Capacity” Section 340H (Title III), “Payments to Qualified Teaching Health Centers” BackgroundTHCGME Legislation 3

Eligibility Criteria for THCGME 1 Community-based entity 2 Primary care residency 3 Institutional sponsor 4 New or expanded residency 5 Eligible residents 4

What is a Community- Based Entity? 1. “Community-based ambulatory patient care center” that: Operates a primary care residency program -FQHCs/FQHC Look-Alikes -Community mental health clinics -Rural health clinics -IHS or tribal health centers -Title X clinics OR Has collaborated to form an accredited GME consortium that operates a primary care residency program 1 Community-based entity 5

Institutional Sponsor 3. Institutional sponsorship Must be listed as institutional sponsor by relevant accrediting body (e.g. ACGME, AOA, or CODA) Must be accredited or provisionally accredited at time of application Teaching hospitals/academic institutions holding institutional sponsorship are not eligible for THCGME funding 3 Institutional sponsor 6

Traditional GME Model Community Training Site Teaching Hospital/ Academic Health Center (inpatient) Residency Program (continuity clinic) Medicare GME $ Accreditation 7

THC Model Community Training Sites Hospital/ AHC Medicare GME $ HRSA GME $Accreditation Teaching Health Center Residency CHC 8

THC Consortium Example 9

THCGME Payment Model includes Accountability for Outcome Reporting THCs have to report on outcomes OR Face possible 25% reduction in payment 10

THCGME Growth 11

Teaching Health Center Application Success 12

Approved THC sites HRSA Teaching Health Centers 13

Growth of THCs within FQHCs 74% of THCs have FQHC affiliation 32% of FQHC affiliated THCs are sponsored by Health Centers vs. 8% prior to funding 14

15 Types of Residency Programs Source: HRSA THCGME application data

Difficult to Reach Populations 16 Source: HRSA THCGME application data

Increasing Access 17 Source: HRSA THCGME application data

Teaching Health Center Profile 18 Source: HRSA THCGME application data

Innovations 19

Innovations in Training Wright Center for GME-AT Still University of Health Science’s School of Osteopathic Medicine collaboration “…address national physician workforce shortage by empowering these communities to steward their workforce renewal” Six FQHCs 29 FM positions 20

Innovations in Accreditation Family Medicine “You must be the change you want to see in the world”- Ghandi Mercy Medical Center Graduates currently working at SCHC 21

Spanish Immersion All 8 graduates of the first class will continue in a community based underserved setting “…emphasizes the cultivation of future safety net healthcare leaders” 22

Next Steps 23

Non-CHC vs. CHC trained Residents Working in Underserved Settings 24 Morris et al., Fam Med 2008; 40(4)

Telling the complete THC story George Washington University Evaluation/BHPR Performance Measures THCGME distinguished characteristics Cost of training in a community based settings Long-term Impact on the Workforce 25

Contact Information Songhai Barclift, MD., FACOG Chief, Community Based Training Branch Division of Medicine and Dentistry HRSA/Bureau of Health Professions 26