The UNC School of Medicine convened a national meeting in Washington D.C. in September 2023.
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 technical assistance center (TAC) 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 through the Rural Graduate Medical Educator (GME) Center starting in 2018 during her tenure as chair of the UNC Department of Family Medicine and 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, MD, MPH, Director of the Cecil G. Sheps Center, work in collaboration with HRSA's Office of Rural Health Policy and Bureau of Health Workforce to implement 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 placements in a range of specialties, including internal medicine, family medicine, general surgery 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 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 just four years, the Rural Residency Planning and Development program, has contributed to the approval of more than 500 additional resident positions, with the Teaching Health Center Planning and Development program contributing to another 150 approved slots in just shy of two years since inception.
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 provide technical assistance to a growing number of grantees. Overall, this collective effort marks a huge federal investment and improvement in availability of care for underserved populations.
Annual Meeting
Emily Silberstein, DO, Unity Health Care family medicine resident, Luis Padilla, MD, HRSA associate administrator, Emily Hawes, PharmD, TAC deputy director, Captain Paul Jung, MD, MPH, HRSA director, Division of Medicine and Dentistry.
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 ACGME and Commission on Dental Accreditation.
The event brought in a record crowd of nearly 400 people and representatives from 37 partner organizations, such as organizations like 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.
Research
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.
In May, Page, Hawes, Mark Koday, DDS, previously with the Yakima Valley Farm Workers Clinic, Alyssa Zamierowski, MBA, with the UNC School of Medicine, and Amanda Weidner, MPH, with the University of Washington, published an article in the Journal of Dental Education outlining the effectiveness of community-based postgraduate dental training on workforce outcomes and sharing a roadmap other organizations can follow to create similar programs based in community health centers.
In June, Hawes, Fraher, Candice Chen, MD, MPH, an associate professor at George Washington University, and Jacob Rains, MPH, a former student in the UNC Gillings School of Global Public Health, published a report with the Milbank Memorial Fund, a population health and health equity foundation, outlining the Teaching Health Center Program's impact. The report provides an overview of the program as a model that can be replicated to improve access to high-quality healthcare to meet population needs and pinpoints considerations for policymakers that may amplify this program.
In August, Rains, Holmes, Hawes, and Shweta Pathak, PhD, of the Sheps Center, published an article in the Journal of the American Medical Association that analyzed the distribution of new residency positions made available through recent legislation, the Consolidated Appropriations Act (CAA) of 2021. TAC researchers have described these provisions for rural GME and created numerous online tools to guide rural hospitals and partnering academic medical centers seeking to avail themselves of the opportunities presented by the CAA.
"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."
