Uncertainty in Teaching Health Center (THC) Funding: Still Crazy After All These Years

Fifty years ago, H. Jack Geiger and Count Gibson recognized an unmet societal need for basic health care services—ironically, near Boston’s renowned academic medical centers—and started the nation’s first community health center (CHC). That same year (1965), at a time when half the physicians in the United States were providing primary care services, Medicare graduate medical education (GME) funding was established to ensure an adequate physician workforce for health care access. Despite $14 billion of taxpayer money invested in GME annually, >65 million Americans currently live in what are officially deemed primary care shortage areas.1 From 1998 to 2006, the number of counties with medically disenfranchised populations—defined as “people with no or inadequate access to a primary care physician due to a local shortage of such physicians”—increased by 52%.2 With no specific incentives nor requirements for teaching hospitals to produce a balanced workforce of primary care physicians and specialists, local profit motives supersede general societal needs. Currently, the Centers for Medicare & Medicaid Services (CMS) GME operates in large part as a subsidy for more financially lucrative, procedure-oriented specialties. Although a proven alternative model currently exists for producing a primary care workforce where it is needed most, the innovative Teaching Health Center (THC) GME program is at risk and continues to face funding uncertainty and damaging instability.

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