Abstract
Background While many factors influence clinician supply and distribution, community-based training is an influential policy lever to increase health care access in underserved settings. The Teaching Health Center Graduate Medical Education (THCGME) program funds training in community-based settings. Recognizing the program's impact, Congress created the Teaching Health Center Planning and Development (THCPD) program to provide start-up funding to support community-based organizations in establishing new residency programs. To date, limited data are available on THCPD outcomes. Objective To describe THCPD program outcomes and training sites and compare characteristics of teaching health center (THC) counties to other eligible counties. Methods We analyzed differences in county-level characteristics among communities with THCs (THCGME [n=85] and/or THCPD [n=92] programs with training sites in 180 counties) to counties with community health centers that were not participating in THCGME/PD. We conducted univariate and multivariate regressions to identify county characteristics associated with having a THC program. Results THCPD is supporting the development of new residency programs, projected to create 900 resident positions, in 13 states and 73 counties that previously did not have a THC. Thirty-nine THCPD-supported programs have attained accreditation, totaling 501 accredited positions at full complement. Forty-seven of the 180 counties (26.1%) with THCGME/PD sites are rural. In contrast to other eligible counties, THCs serve counties with greater proportions of Medicaid beneficiaries (adjusted OR=1.06; 95% CI, 1.04-1.08) and mental health professional shortage areas (adjusted OR=5.00; 95% CI, 1.10-22.7). Conclusions THCPD is increasing the number of accredited residency programs in community-based settings with higher rates of Medicaid eligibility and a shortage of mental health care workforce.