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Training Residents in Community Health Centers: Facilitators and Barriers

¹ Group Health Cooperative Family Medicine Residency, Department of Family Medicine, University of Washington, Seattle, Washington
² Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington

CORRESPONDING AUTHOR: Carl G. Morris, MD, MPH, Group Health Cooperative, Family Medicine Residency, Department of Family Medicine, 125 16th Ave East, CSB-160, Seattle, WA 98112-5260, morris.cg{at}ghc.org

PURPOSE Training family medicine residents in underserved settings, such as community health centers (CHCs), may provide a solution to the primary care workforce shortage. We sought to describe the facilitators and barriers to creating partnerships between CHCs and family medicine residencies (FMRs).

METHODS We conducted 19 key informant interviews and 3 focus groups to identify the key factors in the CHC-FMR relationship. Audiotapes and transcripts were analyzed to identify major themes. Key informant results were validated and expanded in the focus group discussions.

RESULTS Four major themes describe the CHC-FMR training partnership: mission, money, quality, and administrative/governance complexity. The CHC-FMR training affiliation is a complex relationship drawn together by a shared mission of service to the underserved, enhanced financial stability, workforce improvement, and greater educational and clinical quality. The relationship is hindered by competing primary missions, chronic underfunding, complex governing institutional regulations, and administrative challenges. In addition, the focus groups offered several policy solutions to address the barriers to CHC-FMR affiliation.

CONCLUSIONS A successful CHC-FMR training partnership relies upon the development of a shared mission of education and service, as well as innovation and flexibility by the organizations that govern them.

Key Words: Physicians, family/manpower • medically underserved area • medical residency • community health centers

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