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Are Time-Limited Grants Likely to Stimulate Sustained Growth in Primary Care Residency Training? A Study of the Primary Care Residency Expansion Program

Chen, Rossan Melissa MD, MSc; Petterson, Stephen PhD; Bazemore, Andrew MD, MPH; Grumbach, Kevin MD

doi: 10.1097/ACM.0000000000000805
Research Reports

Purpose: To examine the perceived likelihood of sustaining new residency positions funded by five-year (2010–2015) Primary Care Residency Expansion (PCRE) grants from the Health Resources and Services Administration, which aimed to increase training output to address primary care workforce issues.

Method: During September–December 2013, the authors administered an online or telephone survey to program directors whose residency programs received PCRE grants. The main outcome measure was perceived likelihood of sustaining the expanded residency positions beyond the expiration of the grant, in the outlying years of 2016 and 2017 (when the positions will be partially supported) and after 2017 (when the positions will be unsupported).

Results: Of 78 eligible program directors, 62 responded (response rate = 79.5%). Twenty-eight (45.1%; 95% CI 32.9%–57.9%) reported that their programs were unlikely to, very unlikely to, or not planning to continue the expanded positions after the PCRE grant expires. Overall, 14 (22.5%) reported having secured full funding to support the expanded positions beyond 2017. Family medicine and pediatrics program directors were significantly less likely than internal medicine program directors to report having secured funding for the outlying years (P = .02).

Conclusions: This study suggests that an approach to primary care residency training expansion that relies on time-limited grants is unlikely to produce sustainable growth of the primary care pipeline. Policy makers should instead implement systemic reform of graduate medical education (GME) financing and designate reliable sources of funding, such as Medicare and Medicaid GME funds, for new primary care residency positions.

R.M. Chen is associate physician, Family Medicine, Kaiser Permanente Napa Solano, Vallejo, California. She is a graduate of the University of California, San Francisco Family and Community Medicine residency program.

S. Petterson is research director, Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington, DC.

A. Bazemore is director, Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington, DC.

K. Grumbach is professor and chair, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California.

Funding/Support: None reported.

Other disclosures: R.M. Chen: Former resident physician in a residency program that received a Primary Care Residency Expansion grant. K. Grumbach: Faculty member in a residency program that received a Primary Care Residency Expansion grant. S. Petterson and A. Bazemore: No conflicts of interest reported.

Ethical approval: This study was reviewed and deemed exempt by the University of California, San Francisco Institutional Review Board.

Previous presentations: Portions of this report were presented at the North American Primary Care Research Group Annual Meeting, New York, New York, November 23, 2014.

Correspondence should be addressed to Rossan Melissa Chen, Kaiser Permanente Napa Solano, 975 Sereno Dr., Vallejo, CA 94589; telephone: (650) 542-9935; e-mail: rossan.m.chen@kp.org.

© 2015 by the Association of American Medical Colleges