AAFP Sees Workforce Win in Coming Rural Residencies

The news arrived shortly after the AAFP again called on Congress to center rural health care and graduate medical education in legislation to strengthen the primary care workforce. In a statement to the U.S. Senate Finance Committee for a May 16 hearing titled “Rural Health Care: Supporting Lives and Improving Communities,” the Academy urged passage of

• the Doctors of Community Act, which would permanently authorize the vitally important Teaching Health Center Graduate Medical Education program;
• the Rural Physician Workforce Production Act, which would boost rural residency training; and
• the Rural Obstetrics Readiness Act, which would establish training programs to help clinicians at facilities without dedicated obstetric units respond to obstetric emergencies.

The Academy added that rural health policy should acknowledge family physicians’ substantial role in addressing the disparities in maternal morbidity and mortality. More than one in 10 family physicians delivered babies in 2022, the letter said.

The AAFP echoed these calls to action in a June 24 response to questions included in a draft proposal outline by the same committee’s Bipartisan Medicare GME Working Group. That letter reminded lawmakers that most physicians train at large academic medical centers in urban areas and then typically go on to practice within 100 miles of their residencies.

“As a result, the current distribution of trainees leads to physician shortages that are particularly dire in medically underserved and rural areas,” the AAFP said. Citing HRSA data, the letter added that 7.3% of U.S. counties do not have a primary care physician.

About 20% of the U.S. population lives in rural communities, but only 12% of primary care physicians and 8% of subspecialists practice in these areas. Some 17% of AAFP members live and work in rural areas, the highest percentage of any medical specialty.

Among the June 24 letter’s recommendations was robust support for HRSA’s Rural Residency Planning and Development Program, which provides startup grants to create new rural residency programs.

“Creating residencies in rural areas can be particularly difficult and these grants are essential to help mitigate those challenges,” the AAFP wrote.

It’s been an active year for GME policy so far. In March, CMS accepted a third round of applications for federally funded GME under Section 126 of the Consolidated Appropriations Act of 2021. That legislation authorized 1,000 new Medicare-funded residency positions, with a maximum of 200 distributed to qualifying hospitals each year. About 100 new family medicine residency slots resulted from the first two rounds of Section 126 allotments.

The Consolidated Appropriations Act of 2021 also established rural emergency hospitals as a Medicare provider type; CMS in 2023 designated REHs as GME training facilities eligible to receive GME funds and serve as Rural Track Program rotator sites — both wins for the AAFP’s GME advocacy. Ahead of that designation, the Academy recognized the importance of ensuring that more family physicians could practice in rural communities, particularly given the country’s estimated shortage of more than 52,000 primary care physicians by 2025.