Yet Another Task For Congress In September: Renew Rural Doctor Training Program

Aug 30, 2017

Credit churl / Flickr

Rural areas of the country need more doctors, and there's a federal program that seems to have made progress on that. But with the mountain of work that Congress has to do in September, it may fall by the wayside.

Training at a Teaching Health Center

After medical school, newly-minted doctors do a residency, where they train under established docs. Alexandre Le did his residency at the Wright Center, a primary care clinic northeast of Scranton, Pennsylvania.

The Wright Center, a non-profit, and has over 150 residents doing primary care. It's one of almost 60 Teaching Health Centers (THCs) around the country. THCs get federal money to pay for residencies in underserved rural and urban areas.

"I'm not gonna say we run the show," Le said, but residents "provide an additional layer of care that patients wouldn't have if we weren't here."

Progress with THCs

A survey of graduates of the program showed they were much more likely to go on to practice in those areas than residents in general. 

Paul George, a professor of medicine at Brown University, said the program also creates more of the primary care doctors the country needs. That matters, George said, because "primary care will likely form the foundation of just about any health care system that the U.S. ultimately comes to agreement on."

Renewal for THCs

So here you have a program that experts say works. And it has bipartisan support (there are standalone THC proposals in both the House and Senate). But between now and the end of September, there are a gajillion other things that Congress needs to do, like raise the debt ceiling, pass a budget, and reauthorize CHIP (the health insurance program for poor children).

That means it's possible the Teaching Health Center funding could fall through the cracks or get traded for something else.

Negotiations could play out any number of ways, according to Rodney Whitlock, a former Congressional staffer and now a lobbyist at ML Strategies.

"How many different subject matters will you put into one bill? Will you put the concept of CHIP in a bill with VA in a bill with The Wall?" he asked, referring to President Trump's proposed border wall. "It's unclear what process we have and what pieces will go within which bills."

And then, there's paying for the program. Teaching Health Centers want to make up for a cut they took in 2015. They're looking for an increase to $157,000 per medical resident. At current enrollment levels, that's a total of $116 million annually.

"In the grand scheme of the dollars that your government throws around, Teaching Health Centers is not very expensive," Whitlock said. But he went on: "paying for anything in this environment is very, very hard."

Planning for Life Without THCs

The Wright Center has a contingency plan if the funding isn't extended. They'll use reserves to see their new round of residents - onboarded in July - through to the end of their three-year training. But an end to the program's funding would mean the staff would have to shrink. Other centers could face a similar decision.

Despite continued uncertainty from Washington, the Wright Center's CEO, Linda Thomas-Hemak, believes deeply that the process will put out something she can work with.

"The beauty of America and the way our democracy works," she said, "is that it will come out with collective legislation, around a vision, that all the parts don't recognize they're a part of."