Commentary: the teaching community health center: an idea whose time has come

The community health center (CHC), or neighborhood health center as it was originally known, was an innovation developed under President Lyndon Johnson's War on Poverty to address the needs of poor urban and rural Americans. The ranks of CHCs have grown from 8 pilot health centers in 1965 to more than 1,100 health centers serving over 19 million Americans in 2012. The capacity of CHCs is limited by the availability of primary care clinicians (physicians, nurse practitioners, and physician assistants) who are trained to work in these settings. Primary care residency program faculties have long recognized the value and importance of educating physicians in CHCs, but productivity pressures over the past decade forced the dissolution of many CHC-medical school and residency program partnerships. Advocacy and research conducted in the 1990s and 2000s laid the groundwork for the Teaching Health Center Graduate Medical Education (THCGME) program, funded under the 2010 Patient Protection and Affordable Care Act, which enables funding for residency training to flow directly to CHCs. This new federal initiative aligns the graduate medical education (GME) mission of preparing competent professionals with the CHC mission of providing quality and comprehensive care; it also helps address health care reform and the need for more primary care clinicians. Of the first 21 THCGME grants, 15 (71%) were awarded for family medicine residency training. As Chen and colleagues suggest in this issue of Academic Medicine, the THCGME program is an important step in reform of GME financing and training.