Healthcare Funding Instability Prevents Serving the Already Underserved

EDITOR’S NOTE: Research input for this report was provided by Kate Choi, a junior at Brown University and a current government affairs intern at Zelis.

Many of you may be familiar with the weeks leading up to Match Day when thousands of medical students learn where they will head after graduation for their first job as a physician. This can be an emotionally charged time not only for students but for residency programs, too, as many of them across the country are eagerly waiting to find out who they’ll be bringing on.   

Unfortunately, for numerous community health clinics partaking in the federal Teaching Health Center (THC), which is focused on training new physicians under a holistic, community-based approach, the lead-up to Match Day this year was instead filled with disappointment, as these clinics had to refrain from welcoming their share of graduating medical students to their respective residency programs.

The reason? The THC program relies on congressional appropriations for its funding – funding that is currently slated to run out at year’s end and has not yet been allocated by Congress to run past that date.

Programs like THC allow primary care resident physicians to gain extensive, community-based outpatient training, focused on serving patients at Federally Qualified Health Centers (FQHCs) and community health centers in what are considered rural, medically underserved areas of the country.

These programs meet a vital need but are falling victim to a stagnant body of lawmakers.

Our current Congress has continually struggled to pass legislation, especially that which funds various parts of the government. These difficulties were on full display during the second half of 2023 and into the early part of this year. And if things continue down the same path, the THC program is in real trouble.

Now, consider the stark differences in funding for this program versus hospital-focused residency programs. Hospitals received $18 billion in funding this year, while the THC program has a mere $215 million.

This spotlights a longstanding disparity between the healthcare needs of the U.S. population and the hospital-centric medical training that most physicians undergo. Many Americans either aren’t able to afford care in these types of settings or lack access to these types of hospitals, which leads them to seek care at community health clinics.

However, limited funding is preventing enough physicians from being trained in caring for underserved patients, making it challenging to find providers who can or will practice in these settings, as hospital-focused training doesn’t typically prepare new physicians well enough in identifying societal factors at play in patients’ lives, such as those that comprise the complex network of social determinants of health (SDoH).

A recent report published by the Association of American Medical Colleges (AAMC) projects that the U.S. will face a significant shortage of up to 86,000 physicians by 2036. The predictions are even worse for rural areas of the country.

Fortunately, graduates of the THC program have demonstrated a high likelihood to practice in medically underserved areas, emphasizing the provision of primary care services.

This subset of new doctors is critical to helping address our physician shortage problems by filling in key gaps across the country, but it is far from enough to solve them. And keep in mind that many past attempts to quell physician shortages and expand physician access in underserved areas have been unsuccessful or ineffective. Meanwhile, we’re also in an election year, when policymakers typically get even less done than usual.

In sum, the current ambiguity surrounding Congress funding certain federal programs is restricting opportunities for freshly graduated physicians to learn what providing primary care is like, using a community-centered approach. Nevertheless, the hope is that long-term financial support for the THC program – and those like it – will emerge soon, so that the underserved can be better served.

About the Author

Kate Choi is a rising junior at Brown University studying Public Health & Social Analysis/Research, who is working as a Government Affairs Intern at Zelis this summer.