Challenges and Opportunities in Building a Sustainable Rural Primary Care Workforce in Alignment With the Affordable Care Act

Abstract

The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.

Expanding Clinical Medical Training Opportunities at the University of Nairobi

“…The WWAMI model has been successful because of partnerships with physicians, local and state medical associations, other health care organizations, and state governments. 10 …”

“…Unpublished surveys of WWAMI physicians completed every five years indicate a sustained interest by volunteer faculty in participating in WWAMI because of the stimulation and enjoyment students bring to their practices despite the decreased clinical productivity these physicians report. 10 WWAMI has found that faculty development, or teaching the faculty to teach, is a key element of success for decentralized training sites. In the PRIME-K program, health care workers from decentralized training sites who are interested in adjunct faculty positions at the University of Nairobi participate in a three-day training program on clinical teaching and mentoring delivered by faculty members.…”

Assessing local capacity to expand rural breast cancer screening and patient navigation: An iterative mixed-method tool

“…In that context, then, programs like BSPAN might struggle to secure local provider participation in their network, as many providers consider Medicaid reimbursement inadequate to cover operational expenses of providing clinical procedures for underserved women. Future research should monitor how such healthcare developments may impact rural regions and affect delivery of care to indigent populations (Allen, Ballweg, Cosgrove, Engle, Robinson, et al, 2013; Kaufman, Reiter, Pink, & Holmes, 2016). …”

Effect of Regional Medical Campus Education on Student Pursuit of Primary Care Specialties

“…22 Finally , the UWSOM has a number of specialty programs designed to attract students to primary care and rural practice which many of the non-RMC graduates participate in: WWAMI Rural Integrated Training Experience (WRITE), which is a longitudinal integrated clerkship in a rural community for 6 months of third year; Targeted Rural Underserved Track (TRUST), through which students continually return to a regional site for clinical education throughout their training; the Rural/Underserved Opportunities Program, a one-month primary care experience in a rural community; and Track, which enables students to complete some or all of their clinical training in a particular regional location. 11,23,24 Incorporation of similar programs may improve primary care match frequencies among existing medical schools, although their effects on specialty choice have yet to be determined.…”