E.M. Hawes is associate professor, Department of Family Medicine, University of North Carolina at Chapel Hill, and associate professor of clinical education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0001-7717-4066 .
M. Holmes is professor, Department of Health Policy and Management, UNC Gillings School of Global Public Health, and director, NC Rural Health Research Program, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Acad Med. 2022 Sep 1;97(9):1259-1263. doi: 10.1097/ACM.0000000000004797. Epub 2022 Jun 8.
Evidence shows that those living in rural communities experience consistently worse health outcomes than their urban and suburban counterparts. One proven strategy to address this disparity is to increase the physician supply in rural areas through graduate medical education (GME) training. However, rural hospitals have faced challenges developing training programs in these underserved areas, largely due to inadequate federal funding for rural GME. The Consolidated Appropriations Act of 2021 (CAA) contains multiple provisions that seek to address disparities in Medicare funding for rural GME, including funding for an increase in rural GME positions or "slots" (Section 126), expansion of rural training opportunities (Section 127), and relief for hospitals that have very low resident payments and/or caps (Section 131). In this Invited Commentary, the authors describe historical factors that have impeded the growth of training programs in rural areas, summarize the implications of each CAA provision for rural GME, and provide guidance for institutions seeking to avail themselves of the opportunities presented by the CAA. These policy changes create new opportunities for rural hospitals and partnering urban medical centers to bolster rural GME training, and consequently the physician workforce in underserved communities.
证据表明，农村社区的居民比城市和郊区居民的健康状况持续更差。通过研究生医学教育（GME）培训来增加农村地区的医生供应，是解决这种差距的一种经过验证的策略。然而，农村医院在这些服务不足的地区开发培训项目面临挑战，主要是因为农村 GME 的联邦资金不足。2021 年综合拨款法案（CAA）包含多项规定，旨在解决农村 GME 中医疗保险资金的差距问题，包括为农村 GME 职位或“插槽”增加资金（第 126 节），扩大农村培训机会（第 127 节），以及为支付给住院医师的费用非常低或有上限的医院提供救济（第 131 节）。在这篇特邀评论中，作者描述了阻碍农村地区培训项目发展的历史因素，总结了 CAA 每一项条款对农村 GME 的影响，并为寻求利用 CAA 提供的机会的机构提供了指导。这些政策变化为农村医院和合作的城市医疗中心提供了新的机会，以加强农村 GME 培训，并最终加强服务不足社区的医生队伍。
