Letters to the Editor
We thank Dr. Walsh for his thoughtful comments on our review of the inaugural Teaching Health Centers (THC) programs. We agree that the educational reforms undertaken by these programs are recent examples of a wider movement to make health professions education more relevant and socially accountable.1 However, the Teaching Health Centers Graduate Medical Education (THCGME) Payment Program is unique for its redirection of funding to the community-based health center. The key innovation of the THCGME program is having a national policy to place the ownership of a training program in the community-based site rather than in the hospital.
The requirement for outcomes evaluation for the THCGME program is also significant, given the lack of equivalent requirements in the larger Medicare GME payment program. In this context, the unique nature of this evaluation requirement should not been seen as an excuse to “go easy” on the THCs (and this was not suggested by Dr. Walsh). Rather, the onus to undergo a rigorous evaluation is increased, as this evaluation may be held as a foundation to build accountability into the larger GME system. Inherent in Dr. Walsh’s suggestion of “looking at the utility of alternatives” is the need to match the outcomes of GME programs to the health care needs of the country.
Finally, Dr. Walsh briefly mentions an issue that deserves greater attention—the lack of stable funding for the THCGME program beyond fiscal year 2015. Medicare GME payments exist as part of an entitlement program, ensuring ongoing annual payments to hospital-based residency programs. In sharp contrast, the THCGME program received only five years of guaranteed funding and will require congressional action to continue funding. This funding model creates a special problem for primary care residency programs that require, on average, three years of training. A funding cliff places programs and residents at risk for starting programs without guaranteed funding to complete training. The THCGME program has awarded increasing numbers of primary care programs in each of the three years since the program was established and has been successful in achieving its goal of increasing primary care training. Lack of stable funding places this innovative program at risk.
Candice Chen, MD, MPH
Assistant research professor, Department of Health Policy, School of Public Health and Health Services, George Washington University, Washington, DC; firstname.lastname@example.org.
Frederick Chen, MD, MPH
Associate professor, Department of Family Medicine, University of Washington, Seattle, Washington.
Fitzhugh Mullan, MD
Murdock Head Professor of Medicine and Health Policy, Department of Health Policy, School of Public Health and Health Services, George Washington University, Washington, DC.
1. Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376:1923–1958