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Do Residents Who Train in Safety Net Settings Return for Practice?

Phillips, Robert L. MD, MSPH; Petterson, Stephen PhD; Bazemore, Andrew MD, MPH

Academic Medicine:
doi: 10.1097/ACM.0000000000000025
Research Reports

Purpose: To examine the relationship between training during residency in a federally qualified health center (FQHC), rural health clinic (RHC), or critical access hospital (CAH) and subsequent practice in these settings.

Method: The authors identified residents who trained in safety net settings from 2001 to 2005 and in 2009 using 100% Medicare Part B claims files for FQHCs, RHCs, and CAHs and 2011 American Medical Association Masterfile residency start and end date histories. They used 2009 Medicare claims data to determine the relationship between this training and subsequent practice in safety net settings.

Results: The authors identified 662 residents who had a Medicare claim filed in their name by an RHC, 975 by an FQHC, and 1,793 by a CAH from 2001 to 2005 and in 2009. By 2009, that number of residents per year had declined for RHCs and FQHCs but increased substantially for CAHs. The percentage of physicians practicing in a safety net setting in 2009 who had trained in a similar setting from 2001 to 2005 was 38.1% (205/538) for RHCs, 31.2% (219/703) for FQHCs, and 52.6% (72/137) for CAHs.

Conclusions: Using Medicare claims data, the authors identified residents who trained in safety net settings and demonstrated that many went on to practice in these settings. They recommend that graduate medical education policy support or expand training in these settings to meet the surge in health care demand that will occur with the enactment of the Affordable Care Act insurance provision in 2014.

Author Information

Dr. Phillips is vice president for research and policy, American Board of Family Medicine, Washington, DC.

Dr. Petterson is research director, Robert Graham Center, Washington, DC.

Dr. Bazemore is director, Robert Graham Center, Washington, DC.

Funding/Support: This study was supported by the Josiah Macy Jr. Foundation (grant #103050226).

Other disclosures: None.

Ethical approval: The institutional review boards of the American Academy of Family Physicians and the George Washington University approved this study.

Previous presentations: Earlier versions of these findings were reported at the Rural Training Track Conclave (Omaha, Nebraska), Association of American Medical Colleges Workforce Research Conference (Washington, DC), Council on Graduate Medical Education (Washington, DC), and AcademyHealth Research Meeting (Orlando, Florida) in 2012.

Supplemental digital content for this article is available at

Correspondence should be addressed to Dr. Phillips, American Board of Family Medicine, 1133 Connecticut Ave., NW, Suite 1100, Washington, DC 20036; telephone: (202) 494-0512; e-mail:

© 2013 by the Association of American Medical Colleges