School of Medicine lands grants for crucial primary care training

Two programs at the University of Colorado School of Medicine have received $3.84 million in grants to train 12 additional residents to address a critical need for primary care doctors in Colorado and around the country.

The grants will fund the Family Medicine Residency Training Program and the Primary Care Track of the Internal Medicine Residency Training Program. Each will add six residents over the next three years starting in July 2011. The grants are from the federal Health Resources Service Administration (HRSA).

All the residents will practice in urban health clinics that mainly serve uninsured and under-insured populations.

Daniel Burke, M.D., director of the Family Medicine residency program, cites studies that show that "health systems with a strong foundation in primary care do better in terms of value, with better health outcomes for lower costs. Estimates are that a healthy workforce would be comprised of 50 percent primary care physicians. The current ratio is 32 percent."

The Family Medicine program now trains 24 residents at a time – six in its Denver Health Track, where the additional residents will be placed. Residents in that track spend their three-year residencies at the Lowry Family Health Center, where the vast majority of patients are either uninsured (29 percent) or receive Medicaid (53 percent). In the past five years, 93 percent of the training program's residents have gone on to practice primary care. Many are employed in community health centers or are serving rural communities.

"There are about 3,000 family medicine resident slots in the country. Most of those are being filled by international medical graduates," Burke said. "Creating new slots for family medicine graduates is only part of the solution. The greater solution will come when there is some equity in reimbursement for primary care services and when the workload for primary care physicians becomes more reasonable."

Internal Medicine has the School of Medicine's largest residency program. Among the 150 residents, 30 are in the Primary Care Track. The expansion to 12 from 10 positions per year means that two additional residents will be assigned each year to Denver Health's Westside Health Center. About 35 percent of patients there are uninsured, 30 percent are on Medicaid and 24 percent are on Medicare. Of Primary Care Track graduates, 85 percent chose primary care careers recently, one third in underserved settings.

As the nation's population grows and ages, the need for well-trained primary care clinicians is increasing. An estimated 15 percent of adults in the United States lack a usual source of care, which means they have no particular clinic, health center or other place to go for health-care advice.

According to the Internal Medicine Residency program director, Suzanne Brandenburg, M.D., interest in primary care careers by medical school graduates is declining, and the HRSA-funded projects are designed to address this trend. But she says innovations in educational programs are only a small part of the solution – true success depends on health care reform that emphasizes quality, access and value. The U.S. health care system is ranked first in spending but 37th in the world for health outcomes, and last among 7 developed nations with comprehensive primary care (Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom) for access and equity.

The CU School of Medicine ranks fourth in the nation in primary care medical education and is in the top quarter nationally for the number of graduates entering primary care specialties in the 2008-10 graduating classes, according to US News & World Report.