Efforts Failed to Up Primary Care, Rural Resident Training

Net growth in primary care training, but outpaced by growth in non-primary care training

FRIDAY, Jan. 18 (HealthDay News) -- The 2005 redistribution of graduate medical education (GME) funds did little to train more residents in primary care and in rural areas, according to a study published in the January issue of Health Affairs.

Candice Chen, M.D., M.P.H., from the National Institute on Minority Health and Health Disparities in Washington, D.C., and colleagues analyzed the outcomes of the 2003 effort to redistribute nearly 3,000 residency positions among the nation's hospitals, in an effort to train more residents in primary care and in rural areas, a system which costs the government nearly $13 billion annually.

The researchers found that only 12 out of 304 hospitals receiving additional positions were rural and that they received only 83 positions, less than 3 percent of all positions redistributed. Although there was net positive growth in primary care training following the redistribution, the relative growth of non-primary care training was twice as large (1,585 primary care positions versus 3,433 non-primary care positions). In addition, after receiving additional positions, 48 hospitals decreased primary care training while increasing specialty training, diverting would-be primary care physicians to subspecialty training.

"Our findings also suggest that future GME reforms must include evaluations of outcomes to create accountability for the results of public investments," the authors write. "More broadly, our findings suggest that an earnest public discussion about what the public should expect for this considerable investment is needed to inform a larger reform of GME funding."

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