To the Editor:
I appreciate the efforts of Dr. Chen and colleagues to examine the sustainability of the Health Resources and Services Administration’s Primary Care Residency Expansion (PCRE) grants. As the former senior advisor to the Bureau of Health Professions at the time of the awards, I am not at all surprised by the bleak outlook for these residency programs, with the authors reporting that nearly half are unlikely to continue their expansion slots after funding expires in 2015, and only a quarter have secured continuation funding from their hospitals.1
In the heady days after the passage of the Affordable Care Act, a future of accountable care with a robust primary care foundation felt like an imminent reality. One of the top priorities was a rapid expansion of primary care in order to care for the newly insured from Medicaid expansion and insurance exchanges. PCRE was a quick avenue to signal the administration’s commitment to primary care and lead the charge in primary care training.
The PCRE grants were never meant to last in perpetuity like Medicare graduate medical education funding. The application guidance was clear that applicants should have sustainability plans after the funding expires. We certainly expected that by 2015, hospitals and health systems would see the value in expanding primary care training and be favorably inclined to support these critical programs.
In reality, change still comes slowly to U.S. health care, and even in a growing milieu of accountable care organizations, primary care training must still fight for its very existence. Time-limited grants are best used to “jump-start” programs but cannot sustain policy efforts. Until hospitals and Medicare redirect their funding to support primary care training, the loss of PCRE may signal a near-term loss of a solution for a long-term problem.
Frederick Chen, MD, MPH
Professor and vice chair for clinical services and director, WWAMI Family Medicine Residency Network, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington; firstname.lastname@example.org.
1. Chen RM, Petterson S, Bazemore A, Grumbach K. Are time-limited grants likely to stimulate sustained growth in primary care residency training? A study of the primary care residency expansion program. Acad Med. 2015;90:12781283.