The document discusses the history and current state of Teaching Health Centers (THCs), which provide primary care medical residency training in community and rural health centers. Key points: - THCs were established in 2010 under the ACA to expand GME outside of hospitals. There are now 44 THC programs across 21 states. - THCs receive funding through 2015 from HRSA's Teaching Health Center Graduate Medical Education program. This funding is set to expire without reauthorization. - Legislation has been introduced to extend THC funding for another 5 years, but future funding is uncertain beyond short-term solutions. - THCs aim to increase primary care physicians working in underserved communities through

1. Fitzhugh Mullan, MD
Murdock Head Professor of
Medicine and Health Policy
George Washington University

2. Number of MD and DO Medical School
Graduates from 1970 - 2013
Year
NumberofGraduates
0
5000
10000
15000
20000
25000
MD DO Total

3. Academic Year MD Graduates DO Graduates Total Graduates
1980-1981 15,632 1,151 16,783
1990-1991 15,427 1,534 16,961
2000-2001 15,796 2,510 18,306
2001-2002 15,676 2,536 18,212
2002-2003 15,531 2,607 18,138
2003-2004 15,829 2,713 18,542
2004-2005 15,760 2,756 18,516
2005-2006 15,927 2,708 18,635
2006-2007 16,140 3,000 19,140
2007-2008 16,168 3,364 19,532
2008-2009 16,467 3,588 20,055
2009-2010 16,836 3,631 20,467
2010-2011 17,362 4,159 21,521
2011-2012 17,343 4,458 21,801
2012-2013 18,156 4,726 22,882
Number of MD and DO Medical
School Graduates from 1980 - 2013
Sources: AAMC and ACCOM

4. 1st Year MD and DO Enrollment In
2003 Compared With Projected 2017
Enrollment Figures
2003 2017 # and % Increase
MD 16,541 21,434 4,893 29.6%
DO 3,308 6,675 3,367 101.8%
_______________________________________________
Combined 19,849 28,109 8,260 41.2%
Sources: AAMC Results of the 2012 Medical School Enrollment Survey, May 2013;
AAMC Enrollment Data 2008 https://www.aamc.org/download/60740/data/enrollmentdata2008.pdf
AACOM – Trends in Osteopathic Medical School Applicants, Enrollment and Graduates

5. Graduates and Projected Number of US
MD and DO Graduates from 2008-2021
0
5000
10000
15000
20000
25000
30000
MD DO Total
NumberofGraduates
Year
| Extrapolated | | Projected |

6. Academic
Graduation Year
MD Graduates DO Graduates Total Graduates
2008-2009 16,467 3,588 20,055
2009-2010 16,836 3,631 20,467
2010-2011 17,362 4,159 21,521
2011-2012 17,343 4,458 21,801
2012-2013 18,156 4,726 22,882
2013-2014* 18,665 5,428 24,093
2014-2015* 19,230 5,788 25,018
2015-2016* 19,517 5,986 25,503
2016-2017* 20,055 6,449 26,504
2017-2018** 20,654 6271 26,925
2018-2019** 21,053 6,222 27,275
2019-2020** 21,255 6,179 27,434
2020-2021** 21,434 6,675 28,109
MD and DO Medical School Graduation
Projections from 2008 - 2021
Sources: AAMC and ACCOM
*Notes extrapolated data
**Notes projected data

7. New Entrants into GME: Entrants into
GME Without Prior GME 2010-2013
Sources: NCHWA analysis of data from AAMC and AACOM, April 2012; Number for 2011 is provisional; Number for 2013 is from NRMP and AOA
25,105 25,151
25,384 25,617 25,574
25,959 26,084 26,220
26,692
27,198
27,489
28,450
28,871
29,292
20,000
21,000
22,000
23,000
24,000
25,000
26,000
27,000
28,000
29,000
30,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Entrants
Year

8. Projected US MD and DO Medical School
Graduates (with 3% Attrition Rate) and 1st
Year Entrants into GME (2009-2021)
Year
2014-2021 data are based on a 1% annual increase in entrants into GME
15,000
17,000
19,000
21,000
23,000
25,000
27,000
29,000
31,000
33,000
2009 2010 2011 2012 2013 2014* 2015* 2016* 2017* 2018** 2019** 2020** 2021**
1st Year Entrants into GME US Medical School Graduates with 3% Attrition Rate

9. Match
Year
1st Year Entrants
into GME
US MD and DO
Medical School
Graduates
(3% Attrition Rate)
Difference
2009 27,198 20,055 7,143
2010 27,489 20,467 7,022
2011 28,450 21,521 6,929
2012 28,871 21,801 7,070
2013 29,292 22,882 6,410
2014* 29,585 23,370 6,215
2015* 29,881 24,267 5,613
2016* 30,180 24,738 5,442
2017* 30,481 25,709 4,772
2018** 30,786 26,117 4,669
2019** 31,094 26,457 4,637
2020** 31,405 26,611 4,794
2021** 31,719 27,266 4,453
Projected US MD and DO Medical School Graduates (with 3%
Attrition Rate) and 1st Year Entrants into GME (2009-2021)
*Notes extrapolated data
**Notes projected data
2014-2021 data are based on a 1% annual increase in entrants into GME

10. Teaching Health Centers
and THCGME

11. White K. et al, The Ecology of Medical Care, NEJM, 1961

12. L. Green et al., The Ecology of Medical Care Revisited, NEJM, 2001

13. • GME History
• Teaching in Health Centers
• The ACA opportunity
• Section 5508 of the ACA established the
Teaching Health Center Graduate
Medical Education (THCGME) program
Teaching Health Centers

14. • The program is funded at $230 million from
FY2011 to FY2015, a five year initiative.
• Administered by the Health Resources and
Services Administration (HRSA).
• Under the jurisdiction of the Senate Health
Education Labor and Pension (HELP)
Committee, and the House Energy and
Commerce Committee.
THCGME Program

15. • There are 44 THCs in 21 states across the
country.
– 3 states (Colorado, Florida and Tennessee) will be
added in the 2014 THC cohort.
• THCs are located in underserved communities
in rural and inner city areas.
• Each year new THCs are added to the program.
– In 2011 - 11 total THCs
– In 2012 - 22 total THCs
– In 2013 - 44 total THCs
Current THCs

17. THC Residency Numbers
2011 2012 2013
Number of THC
Programs
11 22 44
PGY-1 THC
Residents
44 154 273
# of residents
per year in
steady state
132 462 819

18. Specialty Number of THCs
Dental 2
Family Medicine 29
Internal Medicine 5
OB/GYN 2
Pediatrics 3
Psychiatry 3
THC Residency Specialties

19. THC Accreditation
THC Year ACGME AOA ACGME/AOA CODA N/A
2011 5 1 4 1 0
2012 0 9 1 1 0
2013 8 11 2 0 1
Total 13 21 7 2 1

20. • GW was awarded the Evaluation and Initial
Assessment of HRSA Teaching Health Centers
contract.
• This is a five year contract to better understand
this model of community-based residency
training, including an examination of the:
– costs of training in THCs
– contributions to the primary care workforce,
particularly in underserved communities.
THC Evaluation Project

21. • THC funding will end in 2015.
• THC classes that began in July 2013 do not have
funding for the last 9 months of their training.
• Future classes will have even less time funded.
• THC programs may only be able provide partial
training to residents, and are hesitate to recruit
or continue to expand their training programs.
Challenges for Teaching Health Centers

22. • On November 23, 2013 Senator Bernie Sanders (I-VT)
introduced Senate Bill 1759, Teaching Health Center
Reauthorization Act, which provides $800 million in
funding to reauthorize the THCGME program for an
additional five years.
• House staffers are examining a short-term funding
patch. This patch will provide approximately $90 million
to allow THCs to maintain full funding for all residents
in their programs for academic year 2015-2016.
Options to Extend Funding for THCs

23. • The President’s FY 2015 Budget increases
funding for primary care residency positions.
• THCGME program is not specifically sustained
within any new targeted support for GME in the
FY 2015 Budget.
FY 2015 President’s Budget

24. THCs are:
• Dedicated primary care education centers
• De-institutionalized medical training
• A means of increasing residency training without
“feeding the monster”
• Transformative and revolutionary: you pick!
Message for the Hill