Traditional residency programs are sponsored by hospitals and funded through Medicare payments to the hospitals. Hospital administrators are able to decide what residency positions to offer based on what will provide the greatest benefit for the hospital. As a result, there is in many regions, a shortage of primary care physicians and a surplus of specialty-trained dotors and no formal mechanism for the federal government to direct Medicare dollars to meet the healthcare needs of the community.
In 2010, the Teaching Health Center Graduate Medical Education (THCGME) program was established as a component of the Federal Patient Protection and Affordable Care Act (ACA). This program established a mechanism to fund primary care residency programs through Federally Qualified Healthcare Center and Rural Health Centers. These programs would focus on ambulatory primary care training for residents who would spend more of their time in the clinic setting providing services for underserved communities.
Residents still complete the required inpatient rotations at affiliated hospitals, but there is a primary focus on ambulatory care that is patient centered and community-based. Completion of a THCGME program prepares a resident for private practice or continued service to FQHCs where student loan repayment is often an attractive option.
The THCGME program was an unmitigated success. (See link to article below). Unfortunately, the federal appropriations for the program ran out in 2015 and congress is still debating how to continue funding this excellent program. In the mean-time, state and local funding sources have stepped up their efforts to continue funding residency training at Teaching Health Centers.
The TIGMER Community-Based Family Medicine Resisency Program is made possible through the Texas State GME Expansion Grant Program, a major grant from The Center for Health Care Services and support from CommuniCare and the University of the Incarnate Word School of Osteopathic Medicine.