Do residents who train in safety net settings return for practice?

Area of Science:

• Health Services Research
• Medical Education
• Health Policy

Background:

• Physician distribution in underserved areas is a persistent challenge.
• Safety net settings like FQHCs, RHCs, and CAHs serve vulnerable populations.
• Understanding residency training's impact on practice location is crucial for workforce planning.

Purpose of the Study:

• To investigate the association between residency training in federally qualified health centers (FQHCs), rural health clinics (RHCs), or critical access hospitals (CAHs) and subsequent practice in these settings.
• To inform graduate medical education policy regarding training in safety net environments.

Main Methods:

• Utilized Medicare Part B claims data (2001-2005, 2009) and American Medical Association Masterfile residency data.
• Identified residents training in FQHCs, RHCs, and CAHs.
• Analyzed 2009 Medicare claims to determine practice locations of these physicians.

Main Results:

• A significant percentage of physicians who trained in safety net settings continued to practice in them: 38.1% for RHCs, 31.2% for FQHCs, and 52.6% for CAHs.
• Physician training numbers in RHCs and FQHCs declined by 2009, while CAH training increased substantially.
• Identified 662 RHC, 975 FQHC, and 1,793 CAH-affiliated residents during the study period.

Conclusions:

• Residency training in safety net settings is a predictor of future practice in these areas.
• Graduate medical education policy should consider expanding training opportunities in FQHCs, RHCs, and CAHs.
• This expansion is vital to address anticipated healthcare demand, particularly with the Affordable Care Act.