SEQUESTRATION CLOGS PREVENTIVE MEDICINE RESIDENCY PIPELINE

FEATURING: Linda Hill, MD, MPH, FACPM, Director of Preventive Medicine Residency, University of California San Diego, San Diego, California

 

STATE OF THE SPECIALTY

Both the Institute of Medicine and Council on Graduate Medical Education have reported on the need to train more preventive medicine physicians to strengthen the physician public health workforce. Preventive medicine residency training programs provide a blueprint on how to train our future physician workforce; physicians trained to zoom in on individual patient care needs and zoom out to the community and population level to identify and treat the social determinants of health. Preventive medicine physicians have a strong focus on quality care improvement and are at the forefront of efforts to integrate primary care and public health.

Despite the unprecedented national, state, and local need for properly trained physicians in population health, the number of preventive medicine residents is rapidly declining. Why? Preventive medicine residents are among the only medical residents whose graduate medical education (GME) costs are not fully supported by Medicare GME funding. Lack of federal support for preventive medicine residency training programs is hampering calls to train more preventive medicine physicians.

After reaching a high of nearly $10 million for preventive medicine residency training programs in 2010, today the Health Resources and Services Administration (HRSA) provides just $3.8 million to a handful of preventive medicine residency training programs across the country. The sharp decline in federal funding has been swift, and many residency training programs are struggling to survive.

RESIDENTS, PATIENTS SUFFER UNDER SEQUESTRATION

One such program, the preventive medicine residency training program at the University of California San Diego (UCSD) directed by Dr. Linda Hill is facing a crippling budget crunch as a result of the complete loss of its HRSA grant due to sequestration.

The UCSD preventive medicine residency training program has a long-standing mission to expose all of its residents to community and underserved clinical settings. Its HRSA grant not only allowed the program to train more residents but proved critical in securing matching funds from community-based training sites. HRSA funds were used to cover 50 percent of the training costs and the community-based training site would kick in the other 50 percent. According to Linda, with the loss of HRSA support:

I’ve been forced to dilute my teaching and research responsibilities and have quickly learned to become a fundraiser because without more funding our program will close. Spending more time raising funds and less time with my residents is not what’s best for our residents.

Linda’s unique challenge is that while community training sites value the skill-set of preventive medicine residents, they do not have the financial strength to shoulder 100 percent of the training costs while the resident is with them. “No one has money to pay the full amount for my residents’ training costs. I am now training fewer residents than ever before. The private sector is not in a position to fully fund graduate medical education. The federal government supports all other residency programs; preventive medicine is the only specialty without either Medicare GME of full HRSA support,” she said.

Yet, training residents in community settings that serve underserved populations is central to HRSA’s mission and preventive medicine. According to Linda:

It’s unfortunate that loss of our HRSA grant will dilute our core mission. The needs of our underserved communities are real but we now have to tailor our program to the needs of our funders.

Veronica Villareal, one of Linda’s residents, was born in a low-income community on the border of Texas and Mexico and chose to go to medical school and then pursue residency training in preventive medicine. Having seen first hand the health challenges of underserved populations, she wanted to utilize clinical and population-based medicine training to care for the vulnerable. She graduated in June and go on to provide care to patients at a community health center in a low income, largely Latino neighborhood, while also working at the UCSD student-run clinic teaching students how to identify and treat the needs of the underserved. It’s Veronica’s passion for the underserved and training in epidemiology, biostatistics, and how to develop and analyze community needs assessments that mark her as a preventive medicine physician and valuable asset to the UCSD medical community. “This country needs to train more residents like Veronica,” Linda said. “It would be a tremendous loss if the federal government turned its back on our specialty.”