Opinion

Teaching Health Centers on the COVID-19 Front Lines Need Our Support

Residents at the nation’s 56 Teaching Health Centers (THCs) have been critical in the fight to combat COVID-19 and now they need our support. Why? The Teaching Health Center Graduate Medical Education (THCGME) program – which Congress created more than 10 years ago to help expand the primary care physician workforce in medically underserved areas – is due to expire on Nov. 30. 

How can we help? By calling on policymakers to extend the program. The stellar performance of the nation’s THC medical residents during their COVID-19 baptism by fire should convince Congress to include the multiyear extension for the THCGME program in the COVID-19 emergency response bill Members are negotiating this month.

Since the pandemic began, THCs have been caring for thousands of patients with respiratory illness and keeping them out of already overcrowded emergency rooms and hospitals, screening and testing patients at their community health care centers and adopting telehealth for countless individuals with chronic diseases as well as acute complaints. 

The heroic efforts of these residents continue to validate the THCGME program. And the outsized return in access to care and the increase in primary care physicians demonstrate why policymakers must swiftly extend the program.  

Reauthorization of the THCGME program is particularly time sensitive given the financial hardship faced by community health centers due to the COVID-19 crisis. The five-year extension and increased funding contained in bipartisan reauthorization bills introduced by Sens. Susan Collins (R-Maine) and Jon Tester (D-Mont.) and Reps. Raul Ruiz (D-Calif.) and Rep. Cathy McMorris Rodgers (R-Wash.) are critically needed to cover increased residency costs, add residents in existing programs and provide for growth of the program to new communities.

America has a shortage of primary care physicians and dentists and needs medical residents like those at THCs, who train for three years in community clinics before opening up their own practices or joining the health care workforce of community health centers. THCs provide an alternative to traditional hospital-based graduate medical residency programs and are sponsored by community-based clinical organizations. So far, more than 1,100 THC graduates have completed their residency, and the vast majority have continued practicing primary care.  Many have become doctors in underserved communities.

A recent study published by the George Washington University Milken Institute School of Public Health, “An Unexpected Education: Teaching Health Center Training in a Global Pandemic,” by Marsha Regenstein, Ph.D., et al. provides excellent insight on the critical role played by THC residents as the clinics pivoted to new ways of providing medical care during the COVID-19 crisis. For example: 

  • In March, the Ozark Center, a THC psychiatry residency program located in Joplin, Mo., moved to telemedicine (including phone and video appointments) for 90 percent of its outpatient and inpatient visits. 
  • At the same time, UAMS West, a family medicine THC in Little Rock, Ark., also went virtual in the span of one month — a transformation that would normally require two years of planning.  
  • THC residents at the Family Medicine Residency of Idaho screened and monitored homeless individuals for COVID-19 symptoms.
  • THC residents manned a drive-through COVID-19 testing site at Cahaba Medical Care in Centreville, Ala., 
  • THC residents also participated in county Emergency Preparedness Task Force operations at the Wright Center in Scranton, Pa.  
  • In Harlem, New York City, at the peak of the pandemic, THC residents, their faculty and staff physicians at the Teaching Health Centers did over 2,000 telehealth visits a day, as well as covering 36 COVID hospitalized patients in critical condition at Mount Sinai Hospital, where they do their inpatient rotations.   

Since 2015, despite broad bipartisan support for the THCGME program, Congress has only passed several short-term funding extensions for THC residencies. THCs and medical residents need long-term certainty and stability because sponsoring organizations (all nonprofits with low margins and significant local needs) are balancing uncertain federal funding and significant COVID-19 financial losses that threaten their stability. 

In addition, in the wake of the COVID-19 epidemic, Congress needs to recognize that community health centers that are also Teaching Health Centers are closing sites and furloughing staff to remain open. THCs have had to shift the way their programs operate over the past few months due to fewer patient visits, massive losses in revenue and depleted cash reserves and still don’t have a sustainable funding path in sight. This adds to the urgency of the multiyear extension of the THCGME program and also suggests that Congress should identify additional ways to support centers this month.

Dr. Neil Calman is chairman of the American Association of Teaching Health Centers and Cristine Serrano is the executive director of the American Association of Teaching Health Centers.

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