In addition to its growing funding and support of more than 160 new medical and dental residences developing in rural and underserved areas, the center also recently hosted its annual meeting in Washington, D.C., which included presentations from federal agencies as well as dental and medical accrediting bodies.
The Health Resources and Services Administration (HRSA) through the Rural Residency Planning and Development and Teaching Health Center (THC) Planning and Development Programs provides start-up grants to establish new medical and dental residency programs and funds a UNC School of Medicine-led center that supports successful launching through consultations, advising, education community learning and research that informs policy.
UNC School of Medicine Executive Dean, Cristy Page, MD, MPH, founded this federally-funded national consortium working to expand care in rural and urban underserved communities in 2018 with the Rural Graduate Medical Educator (GME) Center, followed by the Teaching Health Center GME Center in 2021. These centers are collectively providing technical assistance to 166 grant recipients who have received over 100 million dollars in start-up funding to create new programs in 10 specialties across 44 states.
The centers are directed by Emily Hawes, PharmD, professor in the Department of Family Medicine. Page, Hawes, Erin Fraher, PhD, professor of family medicine and director of the Carolina Health Workforce Research Center, and Mark Holmes, PhD, director of the Cecil G. Sheps Center, work in collaboration with HRSA’s Office of Rural Health Policy and Bureau of Health Workforce to lead the cooperative effort. The consortium also includes the University of Washington, University of Wisconsin, NC AHEC and many others.
Rural and Underserved Residency Growth
Physician shortages, poverty and geographic isolation contribute to a lack of access to care and poorer health outcomes for rural Americans. The Carolina-led program supports residency and dental placements in a range of specialties, including internal medicine, family medicine, general surgery, OB/GYN, preventive medicine and psychiatry, and works to create the next generation of health leaders to practice in underserved areas. Currently, about 2% of residency training occurs in rural communities and 3.5% in community health centers.
“A majority of residency training occurs in big academic medical centers near urban and highly populated areas,” Page said. “If you train physicians in rural and underserved settings, then these health care professionals are more likely to stay in these settings and care for underserved populations years after graduation. This work is shifting the distribution of training to more underserved communities, which is key to increasing access to care and sustainable improvements in health.”
HRSA has invested millions to increase residencies across numerous specialties in underserved areas. The UNC School of Medicine’s centers are supporting this national effort that has led to enormous growth, namely the creation of forty-nine accredited programs. During the decade beginning in 2005, it is estimated that just over 400 new rural resident positions were created across the U.S. In under four years, the Rural Residency Planning and Development and Teaching Health Center Planning and Development programs have contributed to the approval of more than 655 additional resident positions.
The UNC team recently secured an additional $2.7 million, bringing total federal funding for the centers to $15.7 million, boosting the organization’s ability to adapt to a growing number of grantees. This collective effort marks a huge federal investment and improvement in availability of care for underserved populations.
The UNC School of Medicine convened a national meeting in Washington D.C. in September that included presentations from numerous federal agencies, including the Centers for Medicare & Medicaid Services, Veterans Health Administration, and Indian Health Service, as well as other key stakeholders like the Accreditation Council for Graduate Medical Education and Commission on Dental Accreditation.
The event brought in a record crowd of nearly 400 people and representatives from 37 partner organizations, including the Association of American Medical Colleges, National Rural Health Association, National Organization of State Offices of Rural Health, and the National Association of Community Health Centers. The purpose of the meeting was to promote connectivity and dissemination of best practices to maximize peer support and facilitate cross-pollination of new and existing rural and underserved residency programs.
In addition to helping health facilities and organizations create new accredited residencies in their respective communities, the centers are conducting important research that helps inform rural and underserved health policy. Cumulatively, the centers have produced, or worked in partnership with others, on 30 published manuscripts.
Examples include publications on topics such as recent legislation and subsequent Centers for Medicare & Medicaid Services rule changes for funding of graduate medical education to support rural programs. Research from the center has outlined the Teaching Health Center Program’s impact and pinpointed considerations for policymakers that may amplify this program to address population health.
“There has been significant progress in rural and underserved GME policy in recent years,” Hawes said. “And our team stays abreast of the micro issues that organizations are facing on the ground in their respective communities and disseminates research to inform broader macro policy changes to grow and sustain rural and underserved GME across the U.S.”