Robert K. Maudlin: Teaching health center program good for doctors, patients

Recognizing the population of Washington state is growing and aging, access to health care is an increasing problem, especially at a time when our physician workforce is aging. The mean age for family physicians is 52 years, for internal medicine physicians 49, for pediatricians 50 and psychiatrists over 55 years old.

In Washington state, this is complicated by a maldistribution problem between Western Washington and Eastern Washington among general internists (26 per 100,000 population in Western Washington versus 19 in Eastern Washington), general pediatricians (14 versus 10) and psychiatrists (11 versus 5).

It is well known that residency program location is highly associated with the location where a physician eventually chooses to practice. While not an easy task, creating more residency programs in locations and for specialties that serve the populations where shortages are greatest could be an effective tool to reduce disparities in the distribution of Washington physicians. In fact, a recent study released by the Association of American Medical Colleges concluded that as the demand for physicians increases to meet the needs of a growing and aging population, the country will face a shortage of up to 104,900 physicians by 2030. The AAMC believes the main solution to this physician shortage is to train more physicians. They also recognize that while starting new medical schools and expanding class sizes is beneficial, it will be difficult to increase the overall number of practicing physicians without greater support of graduate medical education.

Spokane is following the national trend of starting new medical schools (Elson S. Floyd College of Medicine at WSU) and expanding enrollments (University of Washington/Gonzaga and Pacific Northwest University). Although the curriculum of these schools emphasizes experience and exposure to primary care and in rural communities, we still have a serious shortage in the next step of medical education, that being graduate medical education.

The Teaching Health Center Graduate Medical Education program provides funding to support the GME training for 732 resident physicians in much-needed primary care specialties, e.g., family medicine, internal medicine, pediatrics and psychiatry in 57 residency programs located in 27 states. Locally, the Spokane Teaching Health Center was born out of the THCGME program, which also built the new Spokane Teaching Health Clinic and has enabled the community to train nine additional family medicine and nine additional internal medicine resident physicians.

National data shows that when compared to traditional GME programs, residents who train in THCs are more likely to practice primary care (82 percent vs 23 percent) and remain in underserved (55 percent vs 26 percent) or rural (20 percent vs 5 percent) communities. Unfortunately, the THCGME program was scheduled to end September 30, 2017, effectively ending the funding support for most of the 732 future primary care physicians. The expansion of our local family medicine and internal medicine programs was in jeopardy as well.

Being aware of the impending THCGME program deadline, Congresswoman Cathy McMorris Rodgers, with input from medical educators locally and throughout the nation, began drafting a bill to reauthorize the THCGME program in early 2017. Importantly, this new bill would double the funding level to more accurately support the actual cost of training a resident physician, provide for more sustained funding and to increase the number of THC programs. In November 2017, a similar version of this bill passed the House, but stalled in the Senate. With several competing political priorities taking center stage, Congress passed interim funding to keep the THCGME program viable through March 31, 2018.

With leadership coming from the congresswoman and the efforts of others, funding for the THCGME program was included in the Continuing Resolution that passed on February 9, 2018, and was subsequently signed into law. This ensures that the program will receive $126.5 million per year for fiscal years 2018 and 2019 with a particular emphasis on existing programs like the Spokane Teaching Health Center and the new clinic.

We are thankful for the congresswoman’s collaborative work with health care leaders in our community and around the nation, and look forward to continuing to work together to improve health care and to train the next generation of doctors here in Eastern Washington. Spokane, Eastern Washington and the nation as a whole will be the beneficiaries.

Robert K. Maudlin, Pharm.D., is the Designated Institutional Official for the Spokane Teaching Health Center.